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  • Agenda and minutes
  • Agenda and minutes

    Venue: Council Chamber, Sessions House, County Hall, Maidstone

    Contact: Lizzy Adam  03000 412775

    Media

    Items
    Note No. Item

    27.

    Vice-Chairman in the Chair

    Additional documents:

    Minutes:

    (1)       In the absence of the Chairman, the Vice-Chairman, Mr Angell, assumed the chair for the meeting.

     

    (2)       The Committee requested the Scrutiny Research Officer pass on their best wishes for a speedy recovery to Mr Brookbank on behalf of Members and Officers.

    28.

    Declarations of Interests by Members in items on the Agenda for this meeting.

    Additional documents:

    Minutes:

    (1)       Mr Chard declared a Disclosable Pecuniary Interest as a Director of Engaging Kent.

    (2)       Cllr Lyons declared an Other Significant Interest as a Governor of East Kent Hospitals University NHS Foundation Trust.

    29.

    Minutes pdf icon PDF 116 KB

    Additional documents:

    Minutes:

    (1)       The Scrutiny Research Officer updated the Committee on the following actions that had been taken since 8 April 2016:

    (a)       Minute Number 9 – NHS Swale CCG: Review of Emergency Ambulance Conveyances. At HOSC on 29 January, a Member enquired if the closure of the A249 (Sheppey) had had an adverse impact on SECAmb. On 15 March SECAmb confirmed that there were no adverse incidents with the closure of the A249 to Sheppey and the Trust utilised the lower road bridge crossing in the event of a A249 closure. At HOSC on 8 April, a Member stated that the query about the closure of the A249 (Sheppey) was regarding the sinkhole and not the closure of the road bridge. Mr Davies, Interim Chief Executive, undertook to clarify if there had been an adverse impact on SECAmb due to the sinkhole. A response was awaited.

    (b)       Minute Number 23 – Better Care Fund. At HOSC on 8 April Mr Scott-Clark suggested a briefing to the Committee on public health datasets and how they helped to support health and social care commissioning. A Member briefing had been arranged for Tuesday 7 June at 13.00 in the Lecture Theatre.

    (c)        Minute Number 24 - King’s College Hospital NHS Foundation Trust: Outpatient Services at Sevenoaks Hospital. At HOSC on 8 April a Member requested a breakdown of postcodes for patients who used King’s College Hospital NHS Foundation Trust clinics at Sevenoaks Hospital. Patient activity was circulated to the Committee on 3 June 2016.

    (d)       The next meeting of the Kent and Medway NHS Joint Overview and Scrutiny Committee was scheduled for Thursday 30 June.

    (2)       RESOLVED that the Minutes of the meeting held on 8 April are correctly recorded and that they be signed by the Chairman.

    10:05

    30.

    Review of winter preparedness and BMA Industrial Action in Kent 2015/16 pdf icon PDF 98 KB

    Additional documents:

    Minutes:

    Matthew Drinkwater (Head of Emergency Preparedness Resilience and  Response, NHS England - South (South East)), Pennie Ford (Director of Assurance & Delivery, NHS England – South (South East)), David Robinson (Lead Commissioning Manager - Urgent Care, NHS West Kent CCG) and Corrine Stewart (Assistant Director of Commissioning, NHS Dartford, Gravesham and Swanley CCG) were in attendance for this item.

    (1)       The Chairman welcomed the guests to the Committee. Ms Ford began by providing an overview of the two papers. She explained that preparations for winter in Kent had worked well; although the health and social care system was challenged, none of the systems moved into whole system Black escalation. She noted that the systems worked well together and were able escalate and manage pressures locally which reflected the hard work undertaken behind the scenes. She reported that all systems including social care did escalation exercises in advance of winter to test their plans and further exercises were planned for the summer and autumn in preparation for next winter. She stated that NHS England had run Winter Resilience Rooms to monitor and support systems and manage data reporting. She noted that the spike in winter pressures was in February and March which was later than the spike before Christmas during the previous winter; work was being undertaken to prepare for next year’s spike. She explained that she was very grateful to all Trusts’ for their effective emergency planning and response during the periods of industrial action; the system had worked well. She noted that NHS England was waiting on the outcome of the BMA national ballot on the new agreement for the Junior Doctor contract.

    (2)       Mr Drinkwater explained that there had been a national Winter Resilience Room in London, a regional Winter Resilience Room in Reading and a local Winter Resilience Room in Tonbridge. He explained that the local Winter Resilience Room in Tonbridge monitored pressure being experienced across the South East and allowed NHS England to support systems as required particularly in Surrey and Sussex during spikes. Mr Robinson reported that NHS West Kent CCG no longer planned just for winter; they were constantly reviewing services with partners. The CCG and providers had come together to reflect on the previous year and completed exercise scenarios. The CCG had also updated surge plans, membership and risk register of the local Systems Resilience Group. Daily conference calls with providers had taken place and designated leads were assigned which had improved relationships and communication. Ms Stewart explained that in North Kent workshops had been carried out with all providers to ensure the necessary escalation plans were in place prior to winter. Daily telephone calls with providers took place during the winter to enable the CCGs to understand and deal with local pressures. Workshops to refine the plan for the upcoming winter were planned. She noted that there were significant challenges throughout the year and the system was continually under pressure.

    (3)       Members of the Committee then proceeded to ask a series of  ...  view the full minutes text for item 30.

    10:45

    31.

    Darent Valley Hospital: MRSA pdf icon PDF 48 KB

    Additional documents:

    Minutes:

    Susan Acott (Chief Executive, Dartford and Gravesham NHS Trust), Annette Schreiner (Medical Director, Dartford and Gravesham NHS Trust), Patricia Davies (Accountable Officer, NHS Dartford, Gravesham & Swanley CCG and NHS Swale CCG), Richard Miller-Holliday (Interim Deputy Chief Nurse, NHS Dartford, Gravesham & Swanley CCG) and Nicola Jones (Head of Quality & Safety, NHS Dartford, Gravesham & Swanley CCG and NHS Swale CCG) were in attendance for this item.

     

    (1)       The Chairman welcomed the guests to the Committee. Ms Acott began by explaining that hospitals were high risk for  infections as patients included those who were admitted due to an infection, those who were immunosuppressed or very unwell  and those receiving treatment with side effects which made them prone to infections; in addition to infections which were antibiotic resistant. She highlighted the importance of infection prevention and control at the Trust; data relating to a number of infections including MRSA, E.coli, C. difficile and MSSA was publically published and monitored by the Trust’s board as a measure of infection prevention and control.

     

    (2)       Ms Schreiner explained that the Trust reported monthly to Public Health England on acquisitions of MRSA, E.coli, C. difficile and MSSA. She noted that 3% of the population carried MRSA on their skin and infection occurs if there is a break in colonised skin. She reported that E.coli was often linked to catheter acquired infections and C. difficile affected people recently treated with antibiotics. She stated that up until February 2015 there had been no MRSA acquisitions at the Trust for 12 months. In April 2015 the Trust moved from universal to targeted screening following advice published by Public Health England in 2014. In summer 2015 the infection prevention and control team had been affected by long term sickness and the teaching programme fell behind. She noted that there were 14 MRSA acquisitions at the Trust in 2015/16; five between the introduction of targeted screening in April 2015 and 19 December 2015 and nine between 20 December 2016 and 25 February 2016 which was outside of acceptable and expected levels. She reported that universal screening was reintroduced on 25 January 2016 and there had been no further acquisitions since 26 February 2016; a large number of MRSA colonised patients were identified following the reinstatement of universal screening which was reducing. She reported that there had been no cases of C. difficile and MSSA since March 2016 and there had been a very low number of cases of E.coli.

    (3)       Ms Schreiner stated that in March 2016 all of the infection prevention and control team had left the organisation due to retirement, long term sickness and personal reasons; NHS Dartford, Gravesham and Swanley CCG seconded an infection prevention specialist nurse to the Trust to stabilise the interim team whilst permanent staff were appointed. A taskforce met every two weeks to implement the action plan following the TDA inspection visit in March 2016. As part of the action plan, daily MRSA huddles took place every morning to coordinate work streams.  ...  view the full minutes text for item 31.

    11:15

    32.

    North and West Kent Neurorehabilitation Service pdf icon PDF 77 KB

    Additional documents:

    Minutes:

    Ian Ayres (Accountable Officer, NHS West Kent CCG) and Dave Holman (Head of Mental Health and Children's Commissioning, NHS West Kent CCG) were in attendance for this item.

    (1)       The Chairman welcomed the guests to the Committee. Mr Holman began by giving an overview of actions taken following the closure of the Knole Centre in Sevenoaks, provided by the Kent and Medway NHS and Social Care Partnership Trust, in December 2015. He explained that the CCGs had worked to develop a new community based model and pathway using external providers. He noted that there had been eight placements since 24 December which was in line with the predicted annual activity and financial envelope; the CCGs were not looking to reprocure the service. He reported that the CCGs were looking to engage with Healthwatch Kent to receive patient feedback. He stated that practitioners were pleased with progress and found the placements were meeting patients’ needs; in some cases patients’ length of stay had reduced. 

    (2)       A Member enquired about the South East Commissioning Support Unit (SECSU). Mr Holman explained that NHS West Kent CCG commissioned SECSU to deliver their assessment and placement process; the SECSU made recommendations to the CCG about placements which where ratified by panels made up of staff from both organisations. Mr Ayres noted that Commissioning Support Units (CSUs) were governed by NHS England; there had been speculation since the Health & Social Care Act 2012 that CSUs would become autonomous and self-sustaining entities but this had not yet happened. 

    (3)       RESOLVED that the report provided by NHS West Kent CCG be noted.

     

    11:45

    33.

    Kent and Medway Sustainability and Transformation Plan pdf icon PDF 96 KB

    Additional documents:

    Minutes:

    Ian Ayres (Accountable Officer, NHS West Kent CCG) and Michael Ridgwell (Programme Director, Kent & Medway Sustainability and Transformation Plan) were in attendance for this item.

    (1)       The Chairman welcomed the guests to the Committee. Mr Ayres began by giving apologies for Glenn Douglas, Chief Executive of Maidstone and Tunbridge Wells NHS Trust, who was the nominated lead for the Kent and Medway Sustainability and Transformation Plan (STP). He stated that Mr Ridgwell was working with Glen to support him in his STP role.

    (2)       Mr Ridgwell began by highlighting that there were significant challenges for health and social care both locally, in Kent & Medway, and nationally due to population demographics, quality, performance and finance. He stated that those challenges were being addressed by a strategic solution, the Five Year Forward View (FYFV), and 44 Sustainability and Transformation Plans were being developed to create system leadership to enable the implementation of the FYFV. He noted that the four main areas of work in Kent and Medway were: self-care and prevention; strengthened primary care and integrated out of hospital care; acute hospital strategy including mental health; and cost reduction measures.

    (3)       In response to a specific question about the financial position of the NHS in Kent and Medway. Mr Ridgwell explained that currently demand outstripped supply and would get worse due to an increasing elderly population; the forecasted financial outturn for the end of 2015/16 was £-105.9 million in Kent and Medway. He noted that quality of care and finance were linked and workforce was often the common factor. Mr Ayres stated that the deficit would remain in Kent and Medway until a plan of action through the STP process would be implemented to resolve the financial position. He reported that the NHS had not done collaborative planning like this for over twenty years and there was the opportunity to create integrated out of hospital care using primary care, mental health and social care. He stated that there would need to be an IT infrastructure to support integrated care and develop a single clinical record.

    (4)       Members enquired about social prescribing and the commissioning of voluntary services. Mr Ridgwell explained that medicalised models of care were not always best for patients’ health and wellbeing; social prescribing provided alternative models of care such as exercise and feeling part of a community. Mr Ayres stated that due to the ongoing financial positon, the NHS would need to move away from giving grants to the voluntary sector to commissioning them to deliver care. He noted that a fully professionalised service was not sustainable in supporting complex community needs.

    (5)       RESOLVED that the report on the Kent and Medway Sustainability and Transformation Plan be noted and an update be presented to the Committee in September.

    12:30

    34.

    East Kent Strategy Board pdf icon PDF 88 KB

    Additional documents:

    Minutes:

    Hazel Carpenter (Accountable Officer, NHS South Kent Coast CCG and NHS Thanet CCG) was in attendance for this item.

    (1)       The Chairman welcomed Ms Carpenter to the Committee. Ms Carpenter began by outlining the work in progress as part of the East Kent strategy development. She explained that the Case for Change was being finalised and would be presented to the East Kent Strategy Board in early June prior to publication and stakeholder engagement.  An assurance exercise with NHS England had recently been undertaken regarding options appraisal and planned consultation in late October and November. She reported that information for the options appraisal was being drawn from a wide range of sources including clinical task and finish groups which had been established to look at best practice and set out clinical ambition for mental health, urgent care, frailty and paediatrics; the Clinical Senate report into co-dependencies; the Whitstable Medical Centre MCP Vanguard and the Accountable Care Organisations in Thanet and the South Kent Coast.

    (2)       Members enquired about the patient pathway and engagement with the South Kent Coast Health and Wellbeing Boards. Ms Carpenter explained that the patient pathway would be developed as part of the options appraisal; technical documents had been developed to inform the Case for Change. Ms Carpenter stated that the CCG was represented on the South Kent Coast Health and Wellbeing Board and the views of the local Health and Wellbeing Boards were being feed back to the East Kent Strategy Board. She noted that both the NHS South Kent Coast CCG and NHS Thanet CCG were looking to integrate commissioning for health and social care.

    (3)       RESOLVED that the report be noted and the East Kent Strategy Board be requested to present an update to the Committee at its September meeting.

     

    35.

    East Kent Integrated Urgent Care Service Procurement (Written Briefing) pdf icon PDF 88 KB

    Additional documents:

    Minutes:

    (1)       The Committee received a report from the East Kent CCGs which provided an update about the outcome of the East Kent integrated urgent care service procurement combining NHS 111, GP Out-of-Hours and new care navigation service.

    (2)       RESOLVED that the report on the East Kent Integrated Urgent Care Service Procurement be noted and the East Kent CCGs be requested to provide an update on the implementation of the new contract.

    36.

    Date of next programmed meeting – Friday 15 July 2016 at 10.00

    Proposed items:

    §  CQC Inspection Report: East Kent Hospitals University NHS Foundation Trust

    §  SECAmb: Update

    Additional documents:

    Minutes:

    (1)       The Scrutiny Research Officer advised the Committee that the two Agenda items scheduled for the next meeting were not time critical and could be postponed until a later date.

    (2)       RESOLVED that the Health Overview and Scrutiny Committee scheduled for Friday 15 July be cancelled.

    (3)       The meeting was adjourned at 12.30 and reconvened at 12.45.

    13:00

    37.

    Kent & Canterbury Hospital: Emergency Care Centre pdf icon PDF 75 KB

    Additional documents:

    Minutes:

    Matthew Kershaw (Chief Executive, East Kent Hospitals University NHS Foundation Trust) and Liz Shutler (Director of Strategic Development and Capital Planning, East Kent Hospitals University NHS Foundation Trust) were in attendance for this item.

    (1)       The Chairman welcomed the guests to the Committee. Ms Shutler began by providing an update about the model of care at Kent & Canterbury Hospital’s Emergency Care Centre. The Trust had worked with SECAmb to reinforce the criteria for patients conveyed to hospital who were severely inebriated, had a primary mental health condition and had abdominal pain that may require a general surgical assessment. The revised conveyance criteria was implemented on 9 May 2016 and was expected to affect 9 patients a week; patient flow was monitored on a daily basis.

    (2)       She reported that the Trust had been working to design a primary care led Urgent Care Centre  where all patients who self-presented were triaged by a GP or nurse to the MIU, Urgent Care Centre or Acute Medical Unit; the Urgent Care Centre was due to be introduced on 6 July 2016. She stated that there had been a successful recruitment of GPs to cover during the day but acknowledged that the Trust was looking to use locums to cover the overnight period. She noted that the Trust had communicated changes to stakeholders; there had been less communication with the public  as the service provided by the Kent & Canterbury Hospital would remain unchanged for the majority of the public. The Trust and NHS Canterbury & Coastal CCG worked with Healthwatch Kent and the University of Kent on the communication plan.

    (3)       Mr Kershaw noted that he had met with Health Education Kent, Surrey & Sussex and the GMC. He stated that his understanding was that if the new model of care and GP led Urgent Care Centre was implemented; Health Education Kent, Surrey & Sussex and the GMC would continue to support the provision of medical trainees at the Kent & Canterbury Hospital site.

    (4)       Members enquired about the sustainability of services and patient choice. Mr Kershaw explained that the changes to the Emergency Care Centre was linked to East Kent Strategy Board and wider Kent and Medway Sustainability and Transformation Plan as part of the Trust’s developing clinical strategy. He stated that the Trust needed to take urgent action to ensure it continued to provide safe, sustainable and effective services. He highlighted the Trust’s increasing challenge in maintaining the consultant rota with 20 consultant vacancies including 10 emergency consultants. He noted that the Trust may need to make changes outside of the STP process and requested to provide an update to the Committee in July. He stated that patient choice remained but running the same services at multiple sites  such as vascular services was not sustainable and did not provide the best service for patients.

    (5)       RESOLVED that:

    (a)        the East Kent Hospitals NHS University Foundation Trust report be noted;

    (b)       East Kent Hospitals NHS University Foundation Trust be requested to organise an informal briefing about their  ...  view the full minutes text for item 37.