Agenda and minutes

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

(2)       Ms Constantine declared an interest, in relation to her work with the Managers in Partnership which ends in August.  She confirmed that she was not undertaking work in Kent. 

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

(4)       Mr Thomas declared an interest, in relation to any discussion regarding a new hospital in Canterbury, as a member of Canterbury City Council’s Planning Committee. Mr Thomas declared a further interest in relation to the EKHUFT’s mobile chemotherapy unit which had been funded by Hope for Tomorrow, a Freemasons’ charity, which he had contributed too.

(1)       RESOLVED that the Minutes of the meeting held on 27 April 2018 are correctly recorded and that they be signed by the Chair.

(1)       RESOLVED that the Minutes of the meeting held on 8 June 2018 are correctly recorded and that they be signed by the Chair.

Louise Dineley (East Kent Programme Director, Kent & Medway STP), Liz Shutler (Deputy Chief Executive & Director of Strategic Development and Capital Planning, East Kent Hospitals University NHS Foundation Trust), Michael Ridgwell (Programme Director, Kent and Medway STP), Matt Jones (Consultant Anaesthetist, East Kent Hospitals), Upaasna Garharran (Consultant Geriatrician and Acting Medical Director for Urgent Care, East Kent Hospitals) were in attendance for this item.

(1)   The Chair welcomed the guests to the Committee.  Mr Ridgwell briefly introduced the paper and summarised progress to date. He reported that  NHS England had updated the assurance process that applied to reconfiguration programmes involving changes to bed numbers and schemes requiring capital investment; capital sources needed to be identified before public consultation to ensure that they were implementable.

(2)   He stated that the first draft of the pre-consultation business case is due to be presented to NHS England in October and November which will, once signed off, proceed to consultation.  Senior colleagues from NHS England have visited to see the challenges being faced in East Kent. 

(3)   Mr Ridgwell informed the Committee, that a further report will be presented on patient in-flows to East Kent.  He noted that whilst services in East Kent largely supported the East Kent population; for some residents in  East Sussex, their main hospital services were provided in East Kent  in addition to  more specialist services, such as coronary care, which were provided to the wider population. He noted that a Joint HOSC with neighbouring authorities may be required.  The Chair welcomed a discussion on this as soon as possible.

(4)   A Member enquired about the establishment and membership of a Joint HOSC, engagement with community and voluntary groups and a major trauma centre. The Chair confirmed that the creation of a new committee was a decision for the local authorities involved and the power to make a referral to the Secretary of State would remain with the Kent HOSC.

(5)   Mr Ridgwell welcomed the opportunity to discuss engagement with community and voluntary sectors outside of the meeting. He noted the importance of the sector particularly in supporting local care. Dr Jones explained that the major Trauma Centre for Kent was King’s College Hospital and there were no plans for a Major Trauma Centre in East Kent as  it would not meet the national designation criteria set by NHS England. 

(6)   A Member asked about the financial position, public consultation and implication on KCC’s budget.   Mr Ridgwell noted that a  planning submission has been made to NHS England which  outlined the costs of the East Kent reconfiguration; all forms of capital opportunities were being explored. He stated that the NHS England assurance process would determine the start of public consultation.  He anticipated that the delivery of local care, through the integration of and investment in health and social care, would have a cost implication to KCC.

(7)   In response to specific question about PFI, Mr Ridgwell stated that whilst there was preference for public capital, main objective was for better care  ...  view the full minutes text for item 66.

Louise Dineley (East Kent Programme Director, Kent & Medway STP), Liz Shutler (Deputy Chief Executive & Director of Strategic Development and Capital Planning, East Kent Hospitals University NHS Foundation Trust), Michael Ridgwell (Programme Director, Kent and Medway STP), Matt Jones (Consultant Anaesthetist, East Kent Hospitals), Upaasna Garharran (Consultant Geriatrician and Acting Medical Director for Urgent Care, East Kent Hospitals) were in attendance for this item.

(1)   The Committee welcomed the viewing of the newly released NHS national nursing recruitment campaign filmed locally and showcasing local staff.

(2)   Ms Shutler presented the paper and informed the committee that preparations were underway for winter planning to ensure that the difficult winter would not be experienced again.  Investment was being made in models of care, ambulatory care, investment in beds, extending and increasing resuscitations in A & E and work to improve waiting times.

(3)   Members enquired about funding for the Dementia Village.

(4)   Ms Shutler reported that the funding had already been approved and that there was no risk to that.  It was an exciting project and would aid discharge through a different way of working.  It was based on a European model and they visited an example in Holland.  The proposed scheme was smaller in scale than some sites elsewhere in the country, but the aim was for it to be a long-term home, as well as offering respite services.  The facilities will use existing buildings at the back of Buckland Hospital, Dover.

(5)   Members welcomed the news that a local nursery could potentially be on site as evidence had shown that there was a healing and calming effect on the mixing of ages was beneficial and that this should be encouraged across Kent.

(6)   A Member enquired about the impact of personnel changes, the CQC news on reviewing scans in radiology and the potential for exploring the Dutch ambulance model for stroke provision, currently available in Essex.  In relation to the personnel changes question Ms Garharran confirmed that the Clinical Decision Unit Lead Consultant was not moving and that the evening out of numbers across William Harvey and the Queen Elizabeth the Queen Mother Hospital was completed successfully without moving substantive staff.  Concerning the CQC news article Ms Shutler informed the committee that two issues were being confused, the issue in question is in relation to a picture archiving and communication systems and the radiology information system and that there was an issue across Kent and Medway with the information system. The backlog has been caught up on very quickly and any backlog was within normal parameters.  Ms Shutler reassured the committee that there had been no patient harm arising from any delayed reporting of scans.  Mr Ridgwell said that the pilot in Essex was part of the national stroke programme and was being reviewed by the Kent and Medway Clinical Reference Group for stroke.

(7)   A Member asked about Ophthalmology providers in Dover and the progress on Tier 2 services in Canterbury and Dover.  Mr Ridgwell committed to provide an update to  ...  view the full minutes text for item 67.

Louise Dineley (East Kent Programme Director, Kent & Medway STP), Liz Shutler (Deputy Chief Executive & Director of Strategic Development and Capital Planning, East Kent Hospitals University NHS Foundation Trust), Michael Ridgwell (Programme Director, Kent and Medway STP), Matt Jones (Consultant Anaesthetist, East Kent Hospitals), Upaasna Garharran (Consultant Geriatrician and Acting Medical Director for Urgent Care, East Kent Hospitals) were in attendance for this item.

(1)   Ms Shutler introduced the item and stated that this proposal formed a critical part of winter planning in terms of getting the right number of emergency medical beds on sites and to be able to continue to operate and offer elective orthopaedic services.  The Getting It Right First Time (GIRFT) programme was an important programme of driving quality across the country and as a way of challenging clinicians to focus on the clinical quality of care offered by benchmarking surgical specialities.  Professor Briggs was the national lead and was keen to build up an evidence base and challenged the Trust to take part in a pilot in light of its experiences over the last winter.  An early pilot in Gloucester has shown improvements in trauma.

(2)   Members welcomed the report and enquired about staffing.  Mr Jones said that      this was about relocating existing services with a small amount of recruitment potentially required; Ms Garharran explained that the pilot had been driven by staff.  Ms Shutler informed the committee that overall it would bring better wellbeing to staff; consultation would take place with staff, with other opportunities available if the relocation was not suitable and their usual employment rights would be covered.

(3)   A Member enquired about the planning and financial process.  Ms Shutler stated that the pilot was subject to the normal planning process and the Trust had had pre-emptive discussions with Canterbury City Council.  Emergency capital funding had been applied for, with a business case submitted.  A bid for Wave 4 Sustainability and Transformation Partnership (STP) funding had also been submitted. The outcome of this was awaited but consideration for bridging in the interim was also being looked at but that could potentially impact existing capital allocation and slow down other programmes.

(4)   The Chair enquired about timelines for funding bids to which Mr Ridgwell replied that the STP Capital bidding process was not due to take place until the end of the year, but they were exploring expediting this process.

(5)   RESOLVED that:

(a)   the committee note the report on the Getting It Right First Time (GIRFT) Orthopaedics Pilot.

(b)   East Kent Hospitals University NHS Foundation Trust provide an update about the pilot as part of their general update in January 2019.

Ailsa Ogilvie (Chief Operating Officer, Thanet CCG), Professor Mike Oliver (Representative of the Kent Physical Disability Forum) and Adrian Halse (Thanet CCG) were in attendance for this item.

(1)       The Chair introduced the item by explaining that Healthwatch had made a request for the item to be looked at and welcomed Steve Inett and Professor Mike Oliver to the Committee.

(2)       Mr Inett explained that Healthwatch supported the Kent Physical Disability Forum, who had been proactive in raising concerns with Millbrook Healthcare, the current provider, and the CCG. The forum had collected feedback from its members on the issues being raised; a summary of those concerns was presented in the report.

(3)       Professor Oliver informed the Committee that he had used wheelchair services for 56 years and had a personal and professional connection with the service. He expressed significant concerns about the current service and outlined engagement between service users, the CCG and Millbrook.  He stated that he did not accept the proposal for the CCG to continue working with Millbrook to resolve the problems.  He noted that the forum had invited the CCG to come back in early August; the forum was also considering writing an open letter to CCG Clinical Chairs to express their view that the contract should not be continued.

(4)       The Chair invited the CCG to respond. Ms Ogilvie apologised to service users and welcomed the support of Healthwatch and the continued opportunity to work with the forum. She reported that the CCG and Millbrook had agreed additional funding to clear the backlog; discussions regarding additional investment from the eight Kent & Medway CCGs were being held. She noted that the audit had been undertaken to understand the extent of the backlog. Millbrook had been asked to develop an improvement plan to deal with the backlog at pace; the availability of additional staffing had been identified as a potential risk. Millbrook had also been asked to present improved data, to distinguish between the inherited and new backlog, to the CCG. She stated that further assurance was being sought from Millbrook about complaints, risk assessments and prioritising patients with the highest needs; a quality visit had found that patients were not being harmed as a result of their wait. Ms Ogilive highlighted that she was taking personal responsibility to get the contract back on track.

(5)       Members expressed concerns about service user experience; the procurement of the contract and performance monitoring. The Chair enquired if terminating the contract had been considered. Ms Ogilvie stated that it had not been considered. She explained that the backlog was not known at the time of awarding the contract and since the contract began, there had been significant requests for powered chairs that had exceeded procurement expectations. She confirmed that a further clinical audit, to understand the categorisation of referrals, would take place in August. In response to a specific question about wheelchair fitting, Ms Ogilvie stated that a full clinical assessment by a clinician took place to determine what equipment  ...  view the full minutes text for item 69.

Vincent Badu (Director of Transformation, Kent and Medway NHS and Social Care Partnership Trust) was in attendance for this item.

(1)          Mr Badu began by stating that the report focussed specifically on the work that the Trust is undertaking to improve the quality of the community mental health teams for younger adults and general activities taking place across the Trust.  Mr Badu wished to acknowledge the Trust’s commitment to providing better services for the community in mental health services.  Services overall were currently rated as ‘good’, but the community mental health teams ‘required improvement.’  To resolve this, caseloads were being reduced.  Services were revisited in January 2018 and teams were inspected over a period of two days.  Concerns related to variability of quality of planning for care and articulation of risks as people presented and how they planned to meet those risks.  As a result, the CQC decided to issue a warning notice because of concerns.  The Trust accepted the findings and were working robustly to make improvements on quality of care and to ensure that patients were safe and receiving care within agreed timeframes, ensuring those waiting have an active review of their needs so that if changes took place the care can be responsive to prevent deterioration.

(2)          One of the key indicators was to receive an assessment of need within 28 days of referral to the secondary mental health service. He reported that at the end of June significant improvements had been made by the three teams visited by the CQC with the highest performing team reaching 93% against a target of 95%.  The lowest performing team was recorded at 62.3%; 20 people had not  received an assessment within the 28-day period.  Mr Badu acknowledged that they were working to improve this and accepted that there was a need to continue to improve.

(3)          Members asked about Section 136 activity and outcomes, partnership working and single point of access.

(4)          Mr Badu stated that overall, there had been a reduction in Section 136 activity.  He explained that at the point when a person had a full mental health act assessment, they were either detained or supported in another way;  less than 50% of people seen converted to formal or informal admission under the Mental Health Act.  Mr Badu noted that that Section 136 was not the best way to support patients.  Work was being done as part of the Crisis Care Concordat  regarding detention.  Mr Badu acknowledged that it was difficult for Police Officers to make assessments and that they are working to bring expertise together for early triage and identifying individuals known to existing services. He noted that Kent Police were able to use a dedicated contact line to speak with mental health practitioners about the available options.

(5)          Members asked about  out of county placements and the single point of access.  Mr Badu reported that whilst no one was currently placed out of area for acute adults or older people’s mental health beds, women who  ...  view the full minutes text for item 70.

(1)          The committee considered a written update report regarding out of hour bases in East Kent.

(2)          RESOLVED that the CCG report on out of hour bases in East Kent be noted.

(1)          The Chair notified Members that this committee meeting would be the last attended by Lizzy and expressed thanks for all the help and assistance that she has provided during her time supporting the committee.  The committee agreed and asked for these thanks to be recorded.