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  • Agenda and minutes
  • Agenda and minutes

    Venue: Council Chamber, Sessions House, County Hall, Maidstone. View directions

    Contact: Lizzy Adam  03000 412775

    Media

    Items
    Note No. Item

    38.

    Election of Chairman

    Additional documents:

    Minutes:

    (1)       Mr Chard proposed and Mr Bowles seconded that Mr Angell be elected Chairman of the Committee.

    (2)       RESOLVED that Mr Angell be elected as Chairman.

    (3)       The Chairman stated that it was with regret that he had to inform Members of the death of Mr Robert Brookbank, Chairman of the Health Overview and Scrutiny Committee.

    (4)       RESOLVED that the Committee records the sense of loss it feels on the sad passing of Mr Brookbank and extends to his family and friends our heartfelt sympathy to them in their sad bereavement.

    39.

    Election of Vice-Chairman

    Additional documents:

    Minutes:

    (1)       The Chairman proposed and Mr Bowles seconded that Mr Chard be elected Vice-Chairman of the Committee.

     

    (2)       RESOLVED that Mr Chard be elected as Vice-Chairman.

    40.

    Membership

    Additional documents:

    Minutes:

    (1)       Members of the Health Overview and Scrutiny Committee noted the following changes to the membership of the Committee:

    (a)       Ms Marsh filled the vacancy following the recent death of Robert Brookbank.

    (b)       Cllr Woodward (Tunbridge Wells Borough Council) replaced Cllr Ring (Maidstone Borough Council) as a borough representative on the Committee in 2016/17.

    (c)        Cllr Heslop (Tonbridge & Malling Borough Council) replaced Cllr Peters (Dartford Borough Council) as a borough representative on the Committee in 2016/17.

    41.

    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.

    42.

    Minutes pdf icon PDF 143 KB

    Additional documents:

    Minutes:

    (1)       The Scrutiny Research Officer updated the Committee on the following actions that had been taken since 3 June 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 utilise the lower road bridge crossing in the event of the 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. On 3 June SECAmb confirmed that there had been no adverse impact.

    (b)       Minute Number 30 - Review of winter preparedness and BMA Industrial Action in Kent 2015/16. At HOSC on 3 June, a Member requested NHS England to provide a written briefing about the SAFER bundle which was circulated to Members on 9 June.

    (c)        Minute Number 31 - Darent Valley Hospital: MRSA. On 3 June the Committee agreed that the Vice-Chairman-in-the-Chair would write a letter to the Secretary of State for Health and Chief Executive of Public Health England requesting a review of the Public Health England guidance on targeted admission screening for MRSA.

    Subsequently the Vice-Chairman-in-the-Chair was made aware of Public Health England data which showed that since the introduction of targeted screening in 2014 MRSA infection rates had remained steady nationally. As a result of this infomation, Mr Angell, in consultation with the group representatives, sent a letter to the Trust to say that he would not be writing to the Secretary of State for Health asking for a review of the guidance – it was felt that it was local issue regarding infection control management at the Trust (rather than the guidance).

    (2)       RESOLVED that the Minutes of the meeting held on 3 June are correctly recorded and that they be signed by the Chairman.

    10:00

    43.

    Patient Transport Service pdf icon PDF 75 KB

    Additional documents:

    Minutes:

    Ian Ayres (Accountable Officer, NHS West Kent CCG) was in attendance for this item.

    (1)       The Chairman welcomed Mr Ayres to the Committee. Mr Ayres began by explaining that the new contract with G4S went live on 1 July. He reported that overall mobilisation of the contract had gone well and G4S was moving to the ‘business as usual’ phase. He noted that there had been some teething problems for dialysis patients in West Kent, receiving their treatment from Guy's and St Thomas' NHS Foundation Trust, which was being monitored daily. There had been very few patient complaints and media enquiries in recent weeks and Trusts had reported that G4S were responsive and resolved issues. He stated that sub-contractors who had been brought in to reduce deficits of the previous provider were being stood down and the transporting of Kent and Medway patients to and from London hospitals would begin on 1 November. He explained that the CCG would be carrying out a true-up process with the provider, taking place three and six months into the contract, to look at the actual activity against the data set out in the contract; this process had been implemented following the lessons learnt from the previous contract.

    (2)       A number of questions were asked about the capture and reporting of performance data. Mr Ayres explained that there were three contracts: one for renal patients, one for Dartford and Gravesham NHS Trust patients and one for the rest of Kent and Medway. He noted that once data became available the CCG would be able to breakdown performance data by acute hospital and be able to identify hotspots. He noted that G4S were undertaking 6000 journeys a week including 50-80 journeys a day for patients requiring dialysis in West Kent. He reported that one or two of the renal journeys a day were disrupted which was too high but stated that this was a significant improvement from the previous provider. Mr Ayres undertook to check whether data was being captured about the number of journeys completed but were found no longer to be required due to cancellations of appointments and clinics on arrival at the place of care.

    (3)      RESOLVED that the report be noted and NHS West Kent CCG & G4S be requested to attend the Committee in March and provide an update including qualitative and quantitative performance data with details about the patient experience and areas of underperformance.

    10:30

    44.

    Maidstone & Tunbridge Wells NHS Trust: Financial Special Measures pdf icon PDF 88 KB

    Additional documents:

    Minutes:

    Steve Orpin (Finance Director, Maidstone & Tunbridge Wells NHS Trust) and Ian Ayres (Accountable Officer, NHS West Kent CCG) were in attendance for this item.

    (1)       The Chairman welcomed the guests to the Committee. Mr Orpin began by explaining that Maidstone & Tunbridge Wells NHS Trust was one of five acute providers to be part of the first cohort of financial special measures. The new system of financial special measures was introduced by NHS Improvement in July 2016; providers were considered for financial special measures using a small number of criteria including those who had not agreed a control total and those who had agreed a control total but had a negative variance against the plan. He stated that the Trust was moving at pace to rapidly respond and move forward towards an agreed control total. NHS Improvement had identified support including the appointment of Simon Worthington who was Deputy Chief Executive of Bolton NHS Foundation Trust – a Trust which was in surplus and had been rated ‘good’ by the Care Quality Commission. He noted that the Trust was developing a high level recovery plan and would be meeting regularly with NHS Improvement who would review whether the Trust would remain or exit financial special measures.

    (2)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. Members enquired about the pay bill. Mr Orpin explained that NHS Improvement had carried out a review and the Trust’s pay bill, in relation to its activity, was growing faster than comparable organisations. He noted that the pay bill (5 – 10%) was growing faster than income activity (4 – 5%). The pay bill accounted for 65% of expenditure and its increase was made up of three key components.

    (3)       Mr Orpin stated that the first was increasing activity and demand in urgent and emergency care; there had been a 6% increase in A&E attendance in the first four months in comparison to the previous year and in August there had been an unprecedented spike of serious illness in additional to the expected increase in seasonal accidents. The second was that the human resources market was influenced by the Trust’s proximity to London with staff commuting or moving to London to progress their careers in teaching hospitals. The third was workforce planning particularly for medical surgical specialities. There were shortages of nursing and medical staff in acute frontline services due to constant growth, increased pressure and organisations with quality issues locally which resulted in greater competition for staff. The Trust was working to reduce its agency and temporary staffing through recruitment and the bank process; there had been a 20% decrease in agency and temporary staffing in the previous year with no deterioration to the quality of service. He noted that the Trust was working in collaboration with the CCG to develop new services and expand provision in acute and community settings to serve patients in West Kent which were effective and efficient and provided  ...  view the full minutes text for item 44.

    11:00

    45.

    Kent and Medway Sustainability and Transformation Plan pdf icon PDF 82 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. Members of the Committee then proceeded to ask a series of questions and make a number of comments. A Member enquired about emergency & elective care provision and patient choice. Mr Ridgwell explained that although emergency and elective services provided different services, they were intransigently linked. He noted that whilst emergency and elective services could be provided on the same or different sites, it was important that medical, rather than surgical services were co-located with emergency care. He reported that the current acute emergency medical pathway was unviable due to workforce pressures. He stated that whilst patients had the right to choose their healthcare including the use of private providers; in emergency provision it was more important to have a sustainable workforce.

    (2)       A number of comments were made about centralisation of services. Mr Ayres stated that a number of specialist services in Kent had already been successfully centralised including cancer and major trauma. He noted that in West Kent, the CCG was working with district and borough councils to improve primary care estates to enable community services to jointly use the same sites. He stated that it was not sustainable for the seven acute sites in Kent & Medway to continue to provide all services. Through the STP process some services would need to be centralised and some would need to be provided locally.  He reported that engagement work for the Kent and Medway STP would begin in the autumn, prior to public consultation to be held after the County Council elections in May 2017. Mr Ridgwell noted that the East Kent system was further advanced and had its own timetable.

    (3)       In relation to the cost effectiveness of centralisation, Mr Ayres gave an example regarding the centralisation of elective care by the Epsom and St Helier University Hospitals NHS Trust. The Trust previously provided elective care specifically hip and knee replacements across five sites. Following centralisation quality had improved; there was no hospital acquired infection; length of stay had reduced; professionals were working with each other to improve services; and patient satisfaction had increased. Due to its cost effectiveness, the centralisation had also enabled Accident & Emergency centres to be maintained on the other sites. He noted that specialist centres were attractive to workforce and stressed the need to engage with local people.

    (4)       Members enquired about collaboration, out of hospital care, A&E attendance and population growth & decline. Mr Ayres explained that through the STP the local system was required to balance the budget collectively which may result in commissioners and providers having a surplus or deficit. Mr Ayres stated that out of hospital care and general practice had diminished over the last 20 years which had put pressure on acute providers; both community and primary care services  needed to be improved going forward. He noted  ...  view the full minutes text for item 45.

    12:00

    46.

    East Kent Strategy Board pdf icon PDF 89 KB

    Additional documents:

    Minutes:

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

    (1)       The Chairman welcomed Ms Carpenter to the Committee. Ms Carpenter began by explaining that since the last presentation to the Committee in June, the East Kent Strategy Board had been working closely with the Kent & Medway Sustainability and Transformation Plan to determine how best to engage with the wider plan. She noted that the Case for Change had been published on 26 July and the public engagement programme had begun including public focus groups to discuss the new models of care. She reported that the East Kent Clinical Forum had agreed the outputs of the four clinical workshops as the basis for developing future models of care and work was under way to ensure the full utilisation of NHS and local authority estates in East Kent.

    (2)       Ms Carpenter noted that the evaluation criteria for the long list of options were being developed and public consultation was planned to start at the end of January 2017 and conclude prior to the start of purdah for the local council elections. She highlighted that the options would be tested by the Clinical Senate on 26 October, confirmed by the Clinical Senate on 6 November and presented to the National Investment Committee at the beginning of January. She reported that the Board was exploring the development of out of hospital integrated health and care services being provided across 16 localities in East Kent.

    (3)       In response to a specific question about local services in Deal, Ms Carpenter explained that she was unable to give specific details but highlighted that GPs in Deal wanted the maximum number of services to be delivered locally. She stated that the model was most advanced in Thanet with the development of Primary Care Homes; a pilot in Margate was planned for the autumn. Primary Care Homes would be a community focused model with a dedicated integrated team to manage patients with comorbidities and work with primary and secondary care practitioners; if a patient was unable to be managed in the community they would be moved to a hot ambulatory care unit.

    (4)       A number of comments were made about finance and public consultation. Ms Carpenter explained that the Board would not be able to go out to public consultation until the finance and costings had been completed. She noted that the financial analysis was being undertaken by a collaboration of finance leaders from East Kent Hospitals University NHS Foundation Trust, Kent County Council, Kent Community NHS Foundation Trust and Kent and Medway NHS and Social Care Partnership. The Chairman requested that a draft copy of the public consultation be shared with the Committee before publication. Ms Carpenter undertook to provide the engagement programme and draft consultation document to the Committee.

    (5)       RESOLVED that the report on the East Kent Strategy Board be noted and an update be presented to the Committee in November with a detailed plan including  ...  view the full minutes text for item 46.

    47.

    Chemotherapy Services in East Kent & East Kent Cervical Screening Programme (Written Briefing) pdf icon PDF 82 KB

    Additional documents:

    Minutes:

    (1)       The Committee received a report from East Kent Hospitals University NHS Foundation Trust which provided an update about the Celia Blakey Centre at the William Harvey Hospital, Ashford and actions taken following the Public Health England Screening Quality Assurance Review of the East Kent Cervical Screening Programme and there was no discussion.

    (2)       RESOLVED that the report on the Chemotherapy Services in East Kent & East Kent Cervical Screening Programme be noted and the Trust be invited to submit an update to the Committee in January 2017.

    48.

    CCGs Annual Rating (Written Briefing) pdf icon PDF 69 KB

    Additional documents:

    Minutes:

    (1)       The Committee received a report from the Kent CCGs which provided details of NHS England's assessment of their performance against the 2015/16 CCG assurance framework and a summary of their improvement plans.

    (2)       RESOLVED that the report be noted and the Kent CCGs be requested to provide an update to the Committee annually.

    49.

    All Age Eating Disorder Service in Kent and Medway (Written Briefing) pdf icon PDF 71 KB

    Additional documents:

    Minutes:

    (1)       The Committee received a report from NHS West Kent CCG regarding the procurement of an all age eating disorder service for Kent and Medway.

    (2)       A Member enquired about the difference between waiting time standards between children & young people and adults. The Scrutiny Research Officer undertook to liaise with NHS West Kent CCG to provide a response.

    (3)       RESOLVED that:

    (a)       the Committee does not deem the proposalsto be a substantial variation of service;

    (b)       NHS West Kent CCG be invited to submit a report to the Committee at the conclusion of the procurement of an all age eating disorder service for Kent and Medway.

    50.

    Dermatology Services in West Kent (Written Briefing) pdf icon PDF 78 KB

    Additional documents:

    Minutes:

    (1)       The Committee received a report from NHS West Kent CCG which provided an update about the procurement of dermatology services in West Kent and a written briefing from King's College Hospital NHS Foundation Trust regarding the relocation of dermatology outpatient services from Orpington Hospital to Beckenham Beacon.

    (2)       RESOLVED that:

    (a)       the report on the procurement of dermatology services in West Kent be noted and NHS West Kent CCG be requested to provide an update following the mobilisation of the new provider.

    (b)       the written briefing provided by King’s College Hospital NHS Foundation Trust regarding the relocation of dermatology outpatient services from Orpington Hospital to Beckenham Beacon be noted.

    (3)       The meeting was adjourned at 12:30 and reconvened at 13:50.

    14:00

    51.

    SECAmb: Update pdf icon PDF 90 KB

    Additional documents:

    Minutes:

    Geraint Davies (Acting Chief Executive, South East Coast Ambulance NHS Foundation Trust), Patricia Davies (Accountable Officer, NHS Swale CCG) and Helen Medlock (Associate Director of 999 and NHS 111 Commissioning for Kent and Medway CCGs) were in attendance for this item.

    (1)       The Chairman welcomed the guests to the Committee. Ms Davies began by explaining that NHS Swale CCG was the lead commissioner for 999 and 111 in Kent and Medway. She noted that the Trust had been through a period of turmoil relating to quality, safety and performance. She stated that the Trust was developing a Unified Recovery Plan which would include clear and realistic targets. She noted that the changes being implemented by the Trust were moving in the right direction.

    (2)       Mr Davies explained that following a CQC inspection in May 2016, the Trust received a warning notice from the CQC with regards to governance, leadership and operations at the Trust. A two year recovery plan was being developed to cover eight specific areas where improvement was required such as an improved culture, the roll out of electronic patient records and the move to the new headquarters. He stated that he would be the acting Chief Executive until a new substantive appointment was made; his focus during this interim period would be to take forward the concerns in the warning notice to ensure safe services. Mr Davies committed to bringing back the CQC inspection report once published.

    (3)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A number of comments were made about staffing. Mr Davies explained that following an enhanced recruitment process the NHS 111 service was now fully staffed. The Trust had undertaken work to find out why staff were leaving and buddied new members of staff with experienced call takers as part of the training programme. A similar piece of work was being carried out in 999 as it was facing similar problems; the management of 111 and 999 were now sharing best practice.  He stated that the Trust needed to recruit 200 paramedics and was competing against nine other Trusts; the Trust needed to be seen as an attractive organisation to recruit and retain paramedics including a clear career structure and opportunities to become a paramedic practitioner and rotate into primary  and higher acuity care. He reported that there was currently a 14% turnover of paramedics.

    (4)       Members enquired about the structure of the Trust, the role of the CQC and dispatching multiple ambulance vehicles. Mr Davies explained that the Trust was restructuring its operation system to better engage and support staff; an operations manager would now be responsible for 15 members of staff and would be on the same rota as those staff. There would also be a clinical lead as part of the team. He noted that if the ambulance service was county based, the same operations system would have to be implemented.  Mr Davies stated that the CQC played a  ...  view the full minutes text for item 51.

    14:30

    52.

    Healthwatch Kent: Annual Report and Strategic Priorities pdf icon PDF 73 KB

    Additional documents:

    Minutes:

    Steve Inett (Chief Executive, Healthwatch Kent) was in attendance for this item.

    Mr Chard referred to his Disclosable Pecuniary Interest as a Director of Engaging Kent and the requirement for him to withdraw from the meeting for this item. At the invitation of the Chairman, Mr Chard remained in the meeting.)

    (1)       The Chairman welcomed Mr Inett to the Committee. Mr Inett introduced Healthwatch Kent’s Annual Report and Strategic Priorities and proceeded to give a presentation (attached as a supplement to the Agenda pack) which covered the following key points:

    §  Background infomation about Healthwatch Kent

    §  Review of activity in 2015/16

    §  Feedback from the public in 2015/16

    §  Achievements in 2015/16

    §  Priorities for 2016/17 including Sustainability & Transformation Plan & Discharges

    (2)       A Member enquired about the expenditure relating to Engaging Kent, grants, projects and research. Mr Inett explained that the £28,000 payment to Engaging Kent went to the Directors for their time in ensuring it met its legal and contractual requirements and providing support to projects; in addition, as part of its contract with KCC at the time, Healthwatch Kent had to submit a business case to KCC when working with an external provider with a proportion of money going to Engaging Kent to fund the cost of the business case. Mr Inett stated that grants included funding to set up the Physical Disability Forum and reimbursement to Porchlight for assisting their clients to fill out a survey.

    (3)       A Member reminded the Committee of the legal obligations relating to Declarations of Disclosable Pecuniary Interest.

    (4)       RESOLVED that the report be noted and Healthwatch Kent be requested to provide an update to the Committee annually.

    53.

    Date of next programmed meeting – Friday 7 October 2016 at 10:00

    Proposed items:

     

    §  NHS England: Winter Preparedness 2016/17

    §  Medway NHS Foundation Trust

    §  Emotional Wellbeing Strategy for Children, Young People and Young Adults

    §  Future of Sevenoaks Hospital 

    §  Kent and Medway NHS and Social Care Partnership Trust

    Additional documents:

    Minutes:

    (1)       A Member enquired about the scope of the Sevenoaks Hospital item scheduled for 7 October. The Scrutiny Research Officer undertook to liaise with NHS West Kent CCG to provide a response.

    (2)       A Member requested information to be provided about the financial implications for any service change brought to the Committee for consideration.