Agenda and minutes

(1)       The Scrutiny Research Officer updated the Committee on the following actions that had been taken since 7 October:

(a)       Minute Number 46 - East Kent Strategy Board. On 2 September, the Committee considered an update about the work of the East Kent Strategy Board and requested that an update be presented to the Committee in November. On 24 November 2016 the Committee was notified that the East Kent strategy work had become the STP content for east Kent and that the Board would now operate as an East Kent Delivery Board to refine recommendations for how services could best be organised in east Kent in the future.

(b)       Minute Number 52 - Healthwatch Kent: Annual Report and Strategic Priorities. As part of the update regarding follow-up actions taken since the previous meeting on 7 October, Members were asked to submit any questions for Healthwatch which had not been covered during the Healthwatch item on 2 September. The responses to those questions were circulated to the Committee on 22 November.

(c)        Minute Number 57 - Medway NHS Foundation Trust: Update. On 7 October the Committee requested that Medway NHS Foundation Trust be requested to provide the Committee with a series of graphs to demonstrate progress since the original CQC inspection in 2014. A series of slides showing the Trust’s improvements was circulated to the Committee on 22 November. Medway NHS Foundation Trust had also invited the Committee to come for a tour of the hospital to see first-hand some of the recent improvements including work to improve emergency department.

(2)       RESOLVED that the Minutes of the meeting held on 7 October are correctly recorded and that they be signed by the Chairman.

(1)       Following the Council’s approval of the revised proportionality statement on 20 October 2016, it was agreed that the Conservative group would gain a seat on the Health Overview and Scrutiny Committee at the expense of the Labour group.

(2)       Members of the Health Overview and Scrutiny Committee are asked to note that:

(a)       Mr Brazier (Conservative) has replaced Mrs Brivio (Labour) as a member of the Committee.

(1)       Following the Council’s approval of the revised proportionality statement on 20 October 2016, it was agreed that the Conservative group would gain a seat on the Health Overview and Scrutiny Committee at the expense of the Labour group.

(2)       Members of the Health Overview and Scrutiny Committee note that:

(a)       Mr Brazier (Conservative) had replaced Mrs Brivio (Labour) as a member of the Committee.

(1)       The Committee is asked to note the following dates for meetings in 2017:

            Friday 27 January

Friday 3 March

Friday 2 June

Friday 14 July

Friday 1 September

Friday 6 October

Friday 24 November

(1)       The Committee is asked to note the following dates for meetings in 2017:

Friday 27 January

Friday 3 March

Friday 2 June

Friday 14 July

Friday 1 September

Friday 6 October

Friday 24 November

Pennie Ford (Director of Assurance and Delivery, NHS England South (South East)), Hazel Gleed (Head of Emergency Preparedness, Resilience and Response, NHS England South (South East)), Matthew Capper (Director of Performance and Delivery, NHS Ashford and Canterbury & Coastal CCGs), Corrine Stewart (Assistant Director of Commissioning, NHS Dartford, Gravesham and Swanley CCG), Jacqui West (Health Interface Manager, Kent County Council) and Adam Wickings (Joint Chief Operating Officer, NHS West Kent CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Ms Ford began by explaining that the previously established Systems Resilience Groups had been replaced with Local Accident and Emergency Delivery Boards (LAEDB) which had a more focused remit on the delivery of urgent and emergency care. She stated that the winter pressures facing Accident and Emergency departments were really challenging and there had not been a reduction in pressure throughout the course of the year. She noted that there was a national A&E Improvement Plan which had made recommendations to be implemented locally including improving flow and discharge processes. She reported that improved discharge was particularly important for older people who began to lose function if they stayed in hospital longer than required. Mr Scott-Clark commented that, in addition to muscle wastage, the longer patients stayed in hospital, it was more likely that they would get a hospital acquired infection.  

(2)       Ms Ford explained that in preparation for winter, each system had been refreshing their escalation plans and changing terminology following a national review of definitions. She reported that all systems had tested their plans including their response to snow and flooding; an increase in pressure was expected over the bank holiday period and into early January. She highlighted the national flu immunisation programme and the importance of Councils in encouraging people to take up the flu vaccination. The peak of the current winter’s flu season was not known; it had been late last winter and at Christmas during the previous winter.  Ms Ford invited each health economy to give an overview of their preparations for winter.

(3)       Mr Capper stated that in East Kent, a whole system meeting was held at the beginning of October to review and refresh response plans, escalation triggers and terminology to ensure they dovetailed together. He noted that the cold weather and flu plan was due to refreshed within the next two weeks. In the run-up to the Christmas holidays, a super discharge week was planned where all agencies would be working together in an enhanced way to create additional capacity in the system; a follow up activity was planned for January. He reported that the implementation of GP triage model at the Kent & Canterbury Hospital, Canterbury last year had reduced the number of admissions; the CCGs with the providers were looking to replicate model as quickly and safely as possible at the William Harvey Hospital, Ashford and the Queen Elizabeth The Queen Mother Hospital, Margate.  He explained that the daily escalation levels were circulated including the  ...  view the full minutes text for item 62.

Gail Arnold (Chief Operating Officer, NHS West Kent CCG) was in attendance for this item.

(1)       The Chairman welcomed Ms Arnold to the Committee. Ms Arnold began by explaining that the paper provided an initial overview of West Kent CCG’s plans to design and implement local care, in line with the CCG’s strategic vision, Mapping the Future, and the Sustainability and Transformation Plan. She stated that the CCG had begun to work with key partners and stakeholders on the proposals. She reported that the delivery of care would be undertaken in two phases. The first phase was the development of a service specification for core cluster level team which would support GP federations to provide services. She reported the likely establishment of eight clusters: Sevenoaks, Tunbridge Wells, Tonbridge, Weald and four clusters covering the Maidstone district which would act as building blocks in developing the local care and training. She noted the importance of having a critical mass of services for an effective hub of care.  She reported that the specification would comprise of four work streams including the provision of mental health and social care. She explained that the service would begin to take effect in 2017/18 in an informal way; in 2018/19 it was expected that the CCG would move towards the multi-speciality community provider model (MCP). The new model of care was expected to be fully established and embedded by March 2019; the CCG was in discussions with providers about how the new model would be delivered and governed.

(2)       Ms Arnold highlighted that the emergence of two GP federations in preparation for local care; the two federations had jointly set up a provider arm and were joint shareholders. It was anticipated that services would be provided by hubs of care with services collocated on the same site. The location of hubs was still to be determined, as part of discussions with local providers, but would need to serve a population of 100,000 to be cost effective and sustainable. It was expected that hubs would provide access to diagnostics and extended opening hours with the potential to include a GP surgery to enhance medical cover on site. Ms Arnold stated that the she was engaging with 61 GP practices over the next 8 – 10 weeks; she noted that national pressures on general practice had begun to impact on the delivery of services in West Kent with a high percentage of surgeries being unable to fill GP vacancies. She acknowledged that GP surgeries were all independent businesses and all had their own plans and aspirations for the next five – 10 years.

(3)       Ms Arnold noted that there had been advance discussions in Edenbridge and Sevenoaks. In Edenbridge, the CCG was looking to combine the current GP surgery, whose building has reached the end of its life, with services at Edenbridge Hospital. The strategic outline case was in the final stages of development and needed to be signed off by NHS England before formal consultation with  ...  view the full minutes text for item 63.

Gail Arnold (Chief Operating Officer, NHS West Kent CCG) and Priscilla Kankam (Lead Pharmacist, NHS West Kent CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Ms Kankam began by explaining that NHS West Kent CCG was looking to stop the routine prescribing of gluten free items as part of its review into cost effective prescribing. She noted that the CCG spent £130,000 on gluten free products for 300 patients a year in West Kent with coeliac disease.  Patients with other conditions which required specialist diets such as diabetes and renal failure were not prescribed food items. She reported that when gluten free items on prescription were introduced, the availability of these items was low; now there were readily available in supermarkets and a loaf of gluten free bread cost £1.60 in Asda, Tesco & Waitrose. The cost to the NHS for a loaf of gluten free bread would be £4 - £10 which included the cost of the product, dispensing fee and delivery charge. She noted that there was a small group of patients who could only have a low protein food and those patients would be allowed to be prescribed low protein products as part of the proposals. She stated that the CCG had consulted its GPs and Governing Body and a public consultation would begin on 29 November to inform the public about the issue.

(2)       Members enquired about the availability of gluten free prescriptions nationally and if there was an advisory committee which provided guidance about the prescription of gluten free items. Ms Arnold stated that it was technically down to each individual GP to prescribe. Ms Kankam advised that there were lots of other gluten free products available which did not require a prescription such as potato and rice. Ms Arnold reported that there was an advisory committee which looked at the clinical conditions for gluten intolerance but did not have a role in providing guidance or criteria about prescriptions. Mr Inett commented that this change would most impact those who received free prescriptions, due to being on benefits or a low income; a loaf of gluten free bread which cost £1.40, in comparison to a normal loaf which cost 40p, would be unaffordable.

(3)       There was a discussion by Members about whether this constituted a substantial variation of service. The Scrutiny Research Officer advised the Committee that there was not a definition or criteria for substantial variation of service set out in the regulations and if the Committee did determine the proposal to be substantial, a period of formal consultation between the Committee and the CCG would start. If the CCG went ahead with the proposals but the Committee did not think that the proposals were in the best interests of the local people, the Committee could make a referral to the Secretary of State for Health. The Scrutiny Research Officer noted that there were separate duties on the NHS to consult with the Committee and the public  ...  view the full minutes text for item 64.

Hazel Carpenter (Accountable Officer, NHS South Kent Coast CCG and NHS Thanet 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 Ridgwell began by acknowledging that the draft Kent and Medway Sustainability & Transformation Plan (STP) was published on 23 November which had not given Members long to consider the documents and it was proposed that the item return to the Committee for full consideration in January.

(2)       A Member requested that Mr Ridgwell provide an overview of the key service changes set out in the document. Mr Ridgwell explained that the STP was a work in progress and there were no definitive proposals; the STP required a cross organisation approach to resolve the quality, inequality and financial challenges facing the NHS. The emerging four themes from the STP was care transformation by improving prevention, local care, hospital transformation and mental health; productivity through efficiencies in shared services, procurement and prescription; creating enablers for transformation by investing in workforce, digital infrastructure and estates; and system leadership. He reported that the extended Case for Change was due to be published in the New Year along with public and stakeholder engagement.

(3)       Ms Carpenter explained that the work carried out previously by the East Kent Strategy Board was part of the STP. There would be a process to set out which areas of work would be achieved on a Kent & Medway wide level and which would be specific to geographic area. She noted that workforce was an area which needed to be considered on a Kent & Medway wide level; as part of the STP it was hoped that that in partnership with the local universities that a medical school could be developed.  She stated that in East Kent high level modelling for local care was being developed and she anticipated that there would be a specific consultation in 2017 for East Kent with updates brought back to the Committee.

(4)       The Committee then proceeded to ask a number of questions and make a number of comments. A Member enquired about the differences between the published draft STP submission and a summary presentation which had been circulated to the Committee. The Scrutiny Research Officer clarified that the summary presentation had been presented to the South East Regional HOSC Network on 18 November. Mr Ridgwell explained that the STP was a live document and the published draft STP submission was the document submitted to NHS England on 21 October; the summary document was a shortened version of the published draft STP submission which had been condensed for the purpose of the presentation resulting in minor differences between the two papers.  Ms Carpenter reported that the STP Programme Board had made the decision to publish the draft STP submission as there was nothing in the document which could prevent it from being published.

(5)       In relation to a specific question about the reduction of 300 beds in  ...  view the full minutes text for item 65.

Ivan McConnell (Executive Director of Commercial Development and Transformation, KMPT) and Hazel Carpenter (Accountable Officer, NHS South Kent Coast CCG and NHS Thanet CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Ms Carpenter began by explaining that the proposed closure of Davidson Ward was a positive change which she felt had not been conveyed in the submitted paper. She stated that the Davidson ward was one of two wards located in the St Martin’s building which was an old asylum building and the suitability of the building in providing appropriate care had been questioned by the CQC; it was not best practice for patients to be treated in its current setting. The ward was a ten bedded rehabilitation ward but only had five occupants and did not provide acute care. She noted that KMPT had increased the number of community rehabilitation beds through the provision of nine beds in supported housing. She reported that there was an opportunity to invest the £10 million in community rehabilitation services, which was currently spent in out of area placements for patients in East Kent, by repatriating them to the county; eight patients from Thanet have already been identified to return locally.

(2)       Mr McConnell explained that Davidson Ward was not fit for purpose and had been heavily criticised by the CQC. It was not a suitable facility for patients to undertake rehabilitation as it did not have access facilities and the Trust was unable to recruit staff to the ward. He highlighted that the guidelines stated that community rehabilitation should take place in the local community with intensive support.  He noted that there were two types of rehabilitation: services provided in the community and intensive services for post-acute discharge which were provided in three units in East Kent which were highly acclaimed.

(3)       A Member enquired about engagement with partners about supported housing and out of area placements. Mr McConnell stated that nine beds in supported housing had been created which would help to mitigate the closure of the 10 bedded Davidson Ward. He noted the importance of working with partners including borough and district councils with regards to social housing and undertook to work more collaboratively with them. Mr McConnell explained that seven patients from Thanet who received intensive rehabilitation out-of-area cost £951,208 a year in locations as far away as Manchester and Newcastle; if all out-of-area patients in East Kent were repatriated and they could be treated nearer to home and £10 million would be saved which would be used to invest in local rehabilitation services.

(4)       A number of comments were made about staffing. Mr McConnell explained that rehabilitation services did not always need to be undertaken by social workers and mental health professionals; a whole range of alternative staffing could be used such as peer support workers to provide support in the community. He reported the need to look at alternative models of staffing and highlighted the work of some housing  ...  view the full minutes text for item 66.

Ivan McConnell (Executive Director of Commercial Development and Transformation, KMPT) was in attendance for this item.

(1)       Mr McConnell began by explaining that the paper was an update and appraisal to the paper presented in October and it was proposed that the Trust would return to the Committee in January with more detailed feedback. He noted that the new Chief Executive, Helen Greatorex, had set the Trust a target of reducing out-of-area beds to fifteen by October and zero by December; he reported that, as of 25 November, there were only five people in psychiatric intensive care out-of-area beds. He stated that there were no young or older people in out of area beds and this was a position that the Trust needed to sustain. He noted that the Trust currently had a bed occupancy rate of 97% which higher than the recommended rate of 85% set by the CQC and Royal College. He noted that bed occupancy was an issue that the Trust needed to work with its commissioners; the repatriation of patients from out-of-area beds had created significant quality improvements and financial savings.

(2)       Mr McConnell reported that that the Trust had been working with the Police & Crime Commissioner on Section 136 detention and there were now two funded street triage pilots in Medway and Thanet. He noted that the Trust was involved with an internationally acclaimed research project to support early intervention in psychosis and had received £2 million of funding to support this; the Trust was the only Trust in the country to be involved in this project. He explained that the Trust’s Board had received feedback that the therapeutic staffing model was helping patients to get out of hospital and support recover quickly.  He noted that he was leading a review of community mental health teams to reduce their high caseload to 35 cases; the Trust needed to work with partners to prevent the Trust being responsible for all aspects of mental health as it was only a designated secondary care provider.

(3)       Mr McConnell noted that improvement of perinatal mental health was a priority; there was currently only one consultant and three specialist nurses covering the county. The Trust had recently been successfully in being awarded £2 million of NHS England funding to support perinatal mental health including post-partum and post-natal depression. He reported that perinatal services were an attractive area of work for staff and the Trust was able to recruit staff to these posts.

(4)       Members made comments about services for young people and Section 136 detention. Mr McConnell stated that whilst services for children and young people were provided for Sussex Partnership NHS Foundation Trust, the Trust provide intervention psychosis services for young people aged 14 and over and it was important that those young people were captured early to avoid deterioration later. 

(5)       In response to a specific question about Section 136 detention, he noted that Section 136 detentions were challenging for both the Police and Trust. He reported  ...  view the full minutes text for item 67.

(1)       The Committee considered an update about the implementation of the new East Kent integrated urgent care service contract provided by Nestor Primecare Limited.

(2)       A Member raised concerns about the mobilisation of the 111 service and requested that the CCGs be invited to present an update in March. Mr Inett stated that service users had reported significant problems accessing out of hours GP appointments.

(3)       RESOLVED that the report be noted and the East Kent CCGs be requested to provide an update, including performance data about the GP out-of-hours service and the mobilisation of 111 service, to the Committee in March.