Agenda and minutes

Health Overview and Scrutiny Committee - Friday, 14th July, 2017 10.00 am

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

Contact: Lizzy Adam  03000 412775


Note No. Item



Members of the Health Overview and Scrutiny Committee are asked to note the membership listed above.

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(1)       Members of the Health Overview and Scrutiny Committee noted the membership.


Election of Vice-Chairman

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(1)       The Chair proposed and Mr Pugh seconded that Mr Angell be elected Vice-Chair of the Committee.

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


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

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


(2)       Mr Bartlett stated that he used to be a Governor at East Kent Hospitals University NHS Foundation Trust; he confirmed that he had recently resigned from this role.


(3)       Mrs Game declared an interest as the Chair of the QEQM Hospital Cabinet Advisory Group at Thanet District Council.


(4)       Mr Pugh declared an interest as a non-voting member of NHS Swale CCG’s Primary Care Committee.


(5)       Mr Whiting declared an interest that his wife was an employee of the Kent Community Health NHS Foundation Trust.


Minutes pdf icon PDF 90 KB

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(1)       RESOLVED that the Minutes of the meeting held on 3 March and 25 May 2017 are correctly recorded and that they be signed by the Chairman.



EKHUFT Operational Issues pdf icon PDF 67 KB

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Liz Shutler (Director of Strategic Development and Capital Planning, East Kent Hospitals University NHS Foundation Trust), Natalie Yost (Director of Communications, East Kent Hospitals University NHS Foundation Trust), Lesley White (Divisional Director, East Kent Hospitals University NHS Foundation Trust) and Simon Perks (Accountable Officer, NHS Ashford CCG and NHS Canterbury & Coastal CCG) were in attendance for this item.

(1)       The Chair welcomed the guests to the Committee. She began by reminding Members that the Committee did not consider individual complaints relating to health services and acknowledged receipts of letters from Concern for Health in East Kent (CHEK), Faversham Health Matters, Helen Whately MP and Rosie Duffield MP.

(2)       The Chair invited Ida Linfield, Elected Member for Canterbury City South, to address the Committee. Ms Linfield stated that the Kent & Canterbury Hospital was located in her division and she had been contacted by staff, residents and politicians with their concerns regarding the emergency transfer of services. She raised concerns about recruitment of consultants, disciplinary action against staff who made public statements and the introduction of an additional 20 ambulances. She requested that the Committee establish a Task and Finish group to look at the operational issues in more detail.

(3)       The Chair reminded the Committee that the focus of the item was the operational issues being faced by the Trust and its response to it. The longer term strategy would be contained with the STP item and the Chair asked that Members consider this when asking their questions. 

(4)       Ms Shutler began by highlighting the key issues with regards to the Trust’s operational issues. She stated that the decision to remove 38 junior doctors from the Kent & Canterbury Hospital site was taken by Health Education England (HEE) and the General Medical Council (GMC) in March 2017. In June 2017 the Trust decided to temporarily move emergency medicine services from the Kent & Canterbury Hospital site as it was not able to safely provide those services without the junior doctors.  The emergency transfer of services was scrutinised and overseen by the Trust’s commissioners and regulators. In order for services to return to the Kent & Canterbury Hospital site, the Trust must be assured the services can be provided safely which would require the return of the junior doctors. A decision to return the junior doctors by HEE and GMC could only be taken once they were satisfied that the Trust could adequately train and supervise of the junior doctors. She noted that the Trust was continuing to recruit consultants across the Trust to fill vacancies and provide the required support to junior doctors. She reported that the Trust was encouraging staff to talk to the senior management team directly about their concerns and denied that staff had be warned about disciplinary action if they made public statements. She concluded by explaining that an investigation into a transfer of a patient, following the implementation of the emergency transfer of services, did not delay their treatment. 

(5)       Mr Perks provided clarification regarding the transportation of patients;  ...  view the full minutes text for item 6.



Kent and Medway Sustainability and Transformation Plan pdf icon PDF 92 KB

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Michael Ridgwell (STP Programme Director), Liz Shutler (Director of Strategic Development and Capital Planning, East Kent Hospitals University NHS Foundation Trust) and Simon Perks (Accountable Officer, NHS Ashford CCG and NHS Canterbury & Coastal CCG were in attendance for this item.

(1)       The Chair welcomed the guests to the Committee. Mr Ridgwell began by explaining that service models and hurdle criteria had been developed; the long list of options would be identified using the service models. The long list options will be evaluated using the hurdle criteria to get the preferred options which would be submitted to NHS England for review and assurance before going out to public consultation.   

(2)       Mr Perks stated that feedback from the public had been reflected in the development of the service model for local care which included more joined up services and better access to primary care. He noted that there were 300 patients in East Kent hospital beds who did not require acute care and would be more appropriately cared for by the proposed local care model. He reported that this was particularly important for the frail and elderly as hospital stays could lead to loss of muscle tone and make it more difficult for them to return home.

(3)       Ms Shutler reported that the proposed model for hospital care included the creation of centres of excellence with access to specialist teams; evidence showed that access to specialist services, rather than the time taken to access the services, led to improved outcomes for patients. She noted that stroke services were currently provided in seven sites across Kent and Medway and did not have as good outcomes as centralised stroke centres. Similarly the centralisation of orthopaedic services reduced infection rates and patient stay and improved efficency and patient outcomes. Emerging thinking as part of the STP in East Kent included a proposal to have an emergency care hospital with an A&E and specialist services; an emergency care hospital with an A&E and a planned care hospital.  She stated that all the options were being considered and a second round of engagement events was scheduled.

(4)       Members then proceeded to ask a number of questions and make a number of comments. A Member enquired about the impact of growth, capital investment, the lessons learnt from the potential closure of Faversham minor injuries unit in 2013 and the management of chronic conditions. Mr Ridgwell explained that growth was challenging but had been factored into the planning and the NHS was working with KCC to ensure the models were kept up-to-date. Mr Perks stated that primary care in Ashford, as one of the major growth areas, had some of the best facilities in the county including an extension to the New Hayesbank Centre. Mr Ridgwell stated that there was an ongoing dialogue with NHS England regarding capital investment required to make changes.  Mr Perks noted that the key lesson learnt from Faversham minor injuries unit was the importance of working with the local community and GPs  ...  view the full minutes text for item 7.



North Kent CCGs: Urgent & Emergency Care Programme pdf icon PDF 83 KB

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Patricia Davies (Accountable Officer, NHS Dartford, Gravesham and Swanley CCG & NHS Swale CCG) and Gerrie Adler (Portfolio Programme Director (Consultant), NHS Dartford, Gravesham and Swanley CCG & NHS Swale CCG) were in attendance for this item.

(1)       The Chair welcomed the guests to the Committee. Ms Adler began by explaining that the papers covered two different clinical models for NHS Dartford, Gravesham and Swanley CCG & NHS Swale CCG. The models included nationally mandated changes to include the provision of a  111 service  supported by an Integrated Clinical Advice Service (ICAS)  and the requirements of the Five Year Forward View to extend primary care access. She highlighted the range of engagement events which had taken place including Patient and Clinician Reference Groups in 2015, GP engagement event in November 2016; urgent and emergency care whole systems event in November 2016 which brought together over 80 patient representatives, voluntary sector organisations, hospital clinicians, GPs and commissioners. Three further listening events were held in February 2017 in Shorne for NHS Dartford, Gravesham & Swanley CCG residents and Sittingbourne & Sheppey for NHS Swale CCG residents. She stated that feedback from the events had helped to shape the case for change and emergent model of care.

(2)       Ms Davies explained that feedback from Swale residents was that they liked the existing services but would like them to be more responsive and coordinated and this was reflected in the CCG’s proposals. She stated that Dartford, Gravesham & Swanley was a growth area with an expected 26% gorwth over the next 7 years. She reported that the CCG was looking to form an urgent care centre at the Gravesham Community Hospital site which would include the existing minor injuries unit and relocation of the walk-in centre from the Fleet Healthcare Campus located 1.3 miles away. She noted that the Gravesham Community Hospital was located near to the train station and had good bus services.  She stated that the four GP practices at the Fleet Healthcare Campus were looking to merge, consolidate nursing and back office staff and extend primary care access.

(3)       Mr Pugh encouraged the CCGs to work with the planners in growth areas to develop and implement services prior to residents moving in. Cllr Pugh, in accordance with his Interest as a as a non-voting member of NHS Swale CCG’s Primary Care Committee, then withdrew from the meeting for this item and took no part in the discussion or decision. 

(4)       In response to a specific question regarding the recommissioning of the 111 service, Ms Adler explained that the reprocurement would include an enhanced ICAS which would  assess and advise on the most of appropriate course of action including self-care and onward referral to a clinician; call handlers would be able to refer up to 60% of calls to clinicians from the current 25%. Ms Davies noted that the current service was provided by the South East Coast Ambulance NHS Foundation Trust (SECAmb) and there were some issues with call handling and onward referral and  ...  view the full minutes text for item 8.



West Kent CCG: Edenbridge Primary and Community Care pdf icon PDF 91 KB

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Adam Wickings (Joint Chief Operating Officer, NHS West Kent CCG) was in attendance for this item.

(1)       The Chairman welcomed Mr Wickings to the Committee. Mr Wickings began by explaining that the Committee had previously determined that the proposals were not a substantial change but had asked for an update to be brought to the Committee following public consultation. Three public engagement events were held as part of the public consultation and there was strong support for bringing the GP practice and community hospital together on a new site. He stated that the GP practice and Kent Community NHS Foundation Trust were reviewing the consultation feedback and the CCG’s Governing Body would be taking a decision on 25 July. He reported that the CCG was committed to maintaining the same level of funding in the Edenbridge area and was looking to appoint a Project Manager who would produce a business case, on the basis of the final CCG decision, to explore funding opportunities. He noted that the community hospital site was owned by NHS Property and the CCG had requested that the site be released to the CCG as an asset.

(2)       In a response to a specific question about partnership working, Mr Wickings explained that the CCG had created a West Kent Partnership Board which was enhancing partnership working between providers and commissioners. He noted that if a new build was developed, it would be designed with maximum flexibility so that rooms could be used by both primary and community care services. He stated the CCG was committed to keeping an minor injuries unit which would become GP led and be supported by day beds, outpatient services and a range of diagnostic services.

(3)       Members enquired about the withdrawal of inpatient beds in Edenbridge. Mr Wickings explained that the preferred option was to build on a new site without inpatient beds; at present the community hospital had 14 inpatient beds, with two or three beds being used by Edenbridge residents if available, which was not sustainable. The preferred option would include day care beds; the CCG was considering a range of options to support day care beds including improvements to enablement services; increasing the number of community beds in larger facilities and working with the independent sector to provide additional capacity in nursing homes.

(4)       RESOLVED that:

(a)       the Committee does not deem the proposed changes to primary and community care in Edenbridge by NHS West Kent CCG to be a substantial variation of service.

(b)       West Kent CCG be invited to submit a written report to the September meeting of the Committee to notify them of the decision taken by the CCG Governing Body on 25 July.


Mental Health Rehabilitation Services in East Kent (Written Briefing) pdf icon PDF 75 KB

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(1)       The Committee considered an update report by Kent & Medway NHS and Social Care Partnership Trust (KMPT) and East Kent CCGs about the transformation of mental health rehabilitation services in East Kent including the closure the Davidson ward at St Martins Hospital, Canterbury.

(2)       RESOLVED that:

(a)       the report on mental health rehabilitation services in East Kent be noted;

(b)       the Chair write to the Trust to request information on outcomes of patients moved from the Davison Ward to other  inpatient rehabilitation units in East Kent and the anticipated outcomes for patients who will be supported by the developing rehabilitation community team.