Agenda and minutes

1. Mr Wright declared an interest as he was a Governor at Medway Hospital Trust.

2. Mr Chard declared an interest as a Director of Engaging Kent.

1.    The Chair raised a question relating to item 9 “General Surgery reconfiguration at Maidstone and Tunbridge Wells NHS Trust”. The agenda papers stated that around 600 patients per year were directed to Maidstone Hospital for complex elective gastrointestinal surgery. However, at the HOSC meeting, Dr Lawton expressed that there were 230 such patients.

2.    The Clerk confirmed she had sought clarification with the Trust, who have provided the following explanation:

“There are currently 600 inpatients per year receiving upper and lower gastrointestinal surgery at Maidstone Hospital. Half of these will live nearer Tunbridge Wells than Maidstone and therefore not have to travel further as a result of the change. Of the 300 patients living nearer to Maidstone, around 70 will be intermediate cases some of which will be day case patients who will continue to be treated at Maidstone Hospital. The remaining 230 are the number of patients requiring complex gastrointestinal surgery that will have to travel further as a result of the change.”

3.    RESOLVED that the Committee agreed that the minutes from 29 January 2020 were correctly recorded and that they be signed by the Chair.

In attendance: Dave Holman (Associate Director of Mental Health, Children’s and Maternity Commissioning, West Kent CCG) and Gill Burns (Director Children’s Services, NELFT).

1.    The Chair welcomed the guests to the meeting and thanked them for the informal briefing that had been held the previous week for HOSC and Children, Young People & Education (CYPE) Cabinet Committee Members. The briefing provided an opportunity for Members to hear about the Children and Young People’s Mental Health Services as a whole. He reminded HOSC that the Committee would only be scrutinising NHS elements of the contract at today’s meeting.

2.    Mr Holman explained that the report was similar to a new quarterly report that was sent to Kent MPs, an arrangement that had been well received. Overall, the report showed a picture of continued rising service demand against recruitment difficulties. A Single Point of Access (SPA) had been procured two years previously and the CCG budgeted over £2m a year for that to help reduce the waiting times for general mental health conditions.

3.    For general mental health conditions, NELFT were meeting the Referral to Treatment (RTT) standard (18 weeks) by about 82% which compared favourably to other counties. Figures in relation to Neurodevelopmental (ND) referrals were less positive. The recent CQC SEND inspection had provided an opportunity for partners to carry out a deep dive and achieve greater clarity around what the issues were.

4.    There were between 6,000 – 7,000 children on the ND waiting list, mainly for diagnostics. He explained that a key driver for that was parents wanting their child to have an Education, Health and Care (EHC) Plan in school. In order to meet the demand, the following action was being taken:

a.    A new ND pathway was being led by Dr Chesover to collate a whole new way of improving access to information for children as part of their universal offer in schools. A draft pathway was scheduled for April 2020 with implementation by the end of July 2020.

b.    In relation to the waiting time for current patients, there would be a period of crossover whilst dealing with those waiting under the current system and those under the new system (as per 4a). There had been an initiative piloted in Canterbury which had been well received.

5.    The Canterbury pilot saw families and professionals coming together to discuss options for co-production and modelling of the service. It demonstrated the importance of early information in order to reduce the number of parents requesting a diagnosis. A key element to this was a handbook which would continue to be developed as well as shared with all those on the waiting list. The intention was for the Canterbury pilot to be rolled out across the county.

6.    Mr Holman felt the system needed to change its culture, away from diagnostics to meeting need.

7.    The current ND waiting list was being prioritised in order to meet the needs of the most vulnerable first. At the same time, the CCG  ...  view the full minutes text for item 25.

In attendance: Ray Savage (Strategy and Partnerships Manager, Kent & Medway, East Sussex), Tracy Stocker (Associate Director of Operations) and Steve Emerton (Executive Director for Strategy and Business Development) from South East Coast Ambulance Service NHS Foundation Trust.

1.    The Chair welcomed representatives from the Trust to the Committee. He invited them to introduce themselves and provide a short summary of the paper.

2.    Mr Emerton highlighted the following from the report:

a.    There had been a number of staff changes since the last report to the Committee, including a new Chief Executive Officer and Director of HR & Organisational Development. An operational restructure had also seen the appointment of a number of new colleagues.

b.    The 2019 CQC rating of the Trust was “Good”, with Outstanding service in Urgent and Emergency Care.

c.    The Trust continued to work hard to mobilise the new 111 Clinical Assessment Service, commencing in April 2020.

d.    Alternative care pathways were being worked on in order to reduce the pressure on A&E services.

e.    The implementation of a Clinical Education Transformation Project in response to a poor Ofsted visit in 2019.

f.     A targeted effort was underway to improve the response time for Category 3 patients.

3.    In terms of handover delays, Mr Emerton explained that the Trust understood what worked well to reduce them and more work was needed to share that best practice. 

4.    The Trust was seeing increased demand for their service (in particular due to the Covid-19 virus). Key to managing that was close partnership working in terms of working out the most suitable clinical pathway for a patient and knowing which hospitals had capacity.

5.    A Member asked how many of the “new” ambulances were located in Kent. Mr Emerton offered to bring those details back to the Committee but confirmed they were all located where the demand capacity review showed additional resource was required.

6.    A Member asked where stroke patients would be sent to as the Pembury Stroke Ward had temporarily closed. Mr Savage explained that the Kent & Medway stroke review had provided good insight into this area. Depending on their location, patients would be taken to hospital in East Surrey, Eastbourne, Maidstone or Darent Valley – wherever their nearest receiving appropriate hospital was.

7.    In response to a question about rurality, Mr Emerton explained that it was an area of challenge in terms of response times because of the prohibitive cost associated with serving the area. There was some quality work underway which would look to optimise response times in those areas. He also highlighted that this was a national challenge, not just applicable to Kent.

8.    A Member drew upon a Freedom of Information (FOI) request they had submitted to SECAmb in relation to the length of time taken for Thanet residents to get to the William Harvey Hospital after calling 999. The Member believed the figures were worrying and demonstrated a poor response time. Mr Emerton explained that all calls were categorised and responded to  ...  view the full minutes text for item 26.

In attendance: Adam Wickings (Deputy Managing Director, West Kent CCG), Janet Manuel (Clinical Head Specialist Assessments and Placements Team, DGS, Medway & Swale CCG) and Andy Lang (Lead Nurse for Continuing Healthcare, NEL).

1.    The Chair welcomed the guests and referenced the informal briefing for HOSC Members that had taken place a few weeks previously.

2.    Mr Wickings referred to a wider piece of work around developing a clear clinical model for patients with complex dementia, including quantifying future demand.

3.    In terms of the Frank Lloyd Unit, he explained that affected patients had been supported by Continuing Health Care to find a suitable alternative placement. There were currently no patients in the Unit.

4.    Ms Manuel explained that North Kent CCGs had assisted in the repatriation of five former Frank Lloyd patients. That unit had never been intended for long-term stays. By supporting and engaging partners, they were able to find suitable placements for each of the five patients.

5.    Mr Lang confirmed NEL had assisted in repatriating four Frank Lloyd patients. They were able to do this by looking for suitable placements as well as working alongside the patients and their families.

6.    Mr Bowles stated that nothing he had heard from the CCG over the course of the previous two years had convinced him that closing the unit was the right thing to do at that time.

7.    A proposal from Mr Bowles was moved and seconded by Mr Wright:

The Committee is asked to agree to refer the closure of the Frank Lloyd unit to the Secretary of State on the grounds that it was not in the interests of the local population.

8.    The Chair explained that the Committee were unable to refer the item at this meeting because Members were required by law to set out their concerns and give the CCG adequate time to consider and respond to those concerns. Members were informed that the motion proposed would therefore not be valid in this form.

9.    Members had the following concerns around the de-commissioning of the Frank Lloyd Unit:

a.    the new care model for complex dementia patients had not been fully developed nor implemented;

b.    it was unclear if there was suitable, alternative local provision for those with complex dementia. Whilst Members agreed care within the home was appropriate for some, they felt there would always be a small number requiring dedicated facilities;

c.    the proposed care model had dementia patients supported within existing care homes, but it was unclear if those care homes were ready or had the right staff to deal with complex behaviour;

d.    there had been a lack of openness around the closure of the Frank Lloyd unit, which Members understood had not been accepting referrals for a substantial period;

e.    there had not been suitable clinical evidence that the closure of the Unit was in the interests of the local population; and

f.     it was unclear what would happen to the staff employed at Frank Lloyd, but Members  ...  view the full minutes text for item 27.

1.    Members were asked to note the update on the East Kent Transformation programme. It was a similar report to that which had been shared at the Kent and Medway NHS Joint Overview and Scrutiny Committee – the Committee exercising the formal scrutiny powers over this issue.

2.    RESOLVED that the report be noted.

In attendance: Liz Shutler (Deputy Chief Executive), Dr Paul Stevens (Medical Director) and Dr Abigail Price (Consultant Paediatrician) from East Kent Hospitals University Foundation Trust.

1.    The Chair welcomed guests from the Trust and invited them to highlight any key points from the report. Ms Shutler emphasised the following:

a.    The performance of cancer care had improved markedly since the last update to HOSC. 

b.    The staff vacancy rate had reduced compared to the previous year. Also, the ratio of substantive staff to agency workers had improved, which reflected an increased use of bank staff.

c.    Over 2,000 patients had received their planned lower limb operation sooner because of the orthopaedic pilot. The Trust had secured £15m capital investment to build four new operating theatres.

2.    In relation to paragraph 1.4 of the report in the agenda a Member questioned the opening hours of Buckland Hospital. Ms Shutler believed it was open 8am – 8pm but offered to confirm outside of the meeting.

3.    A Member asked how the Trust had managed to reduce the vacancy rate. Ms Shutler explained that they had recruited staff both in this country and abroad, with particular focus on typically hard to recruit areas. Brexit had not led to any staff losses but continued to be an area of risk. One of the keys to retaining staff was to have a comprehensive training package in place. For instance, the Trust had in place the CESR pathway (Certificate of Eligibility for Specialist Registration).

4.    Finally, Ms Shutler spoke of the improvements made to children and young people’s hospital services following the CQC inspection rating of “inadequate”. In particular, she highlighted the investment in the physical surroundings as well as increasing staffing at both QEQM and William Harvey. The Trust had invested in middle grades as well as improving the on-call rota and providing additional training for all staff. Daily safety checks had been introduced with the aim of giving assurance that the fundamentals of care were being delivered.

5.    The Chair thanked the guests for their update.

6.    RESOLVED that the report be noted.

In attendance: Liz Shutler (Deputy Chief Executive), Dr Paul Stevens (Medical Director), Dr Ciaran Crowe (Consultant Obstetrician), Dr Abigail Price (Consultant Paediatrician) and Hannah Horne (Deputy Head of Midwifery) from East Kent Hospitals University Foundation Trust.

1.    The Chair welcomed the guests to the meeting and invited them to introduce themselves.

2.    Ms Shutler began by saying that in 2015 the Trust recognised that it needed to improve care under its maternity services. They commissioned the Royal College of Obstetricians and Gynaecologists to review the service and following that a number of improvements were put in place. However, the Trust recognised that those improvements were not put into place quick enough or at the scale required.

3.    Around 7,000 babies were born under the Trust’s care in any one year and Ms Shutler asserted that one preventable death was one too many. The Trust recognised it had not always provided the standard of care it should have for every woman and baby, and Ms Shutler wholeheartedly apologised on behalf of the Trust to the families who should have received a different experience whilst in their care.

4.    The Trust fully accepted the coroner’s conclusions and recommendations from the January 2020 inquest. To address those recommendations the Trust had established an externally chaired Board (a sub-committee of the main Board) which in turn had seven task and finish groups each with its own area of focus.

5.    The Minister for Patient Safety had also announced an independent review being led by Dr Bill Kirkup. The Trust were committed to participating in that review and taking on board any recommendations.

6.    Mr Inett explained that Healthwatch had attended one of the review meetings and would continue to be involved. He said the Trust appeared to be clear on the action required from the Royal College report and the coroner’s recommendations. He did not feel the Trust were sidestepping the issues or trying to come up with excuses. He also pointed out that some actions were required by the Trust as a whole, not just the maternity services.

7.    A Member asked why things had gone so wrong despite there being a Royal College review in 2015. Dr Stevens explained that themes from that report had been repeated in subsequent reports which suggested any changes that were made failed to be embedded. The seven task and finish groups would be reviewing all the recommendations in a bid to understand where actions had not been strong enough.

8.    Asked how East Kent residents could be assured that the Trust’s Board was adequately monitoring the implementation of best practice, when they failed to do so in 2015, Ms Shutler explained that the chair of the new Board was independent in order to provide external opinion as well as assurance. The seven workstreams were overseen by clinicians which Dr Price felt demonstrated a real shift. Ms Shutler also felt it was important that the Trust accepted the additional clinical support on offer. Dr Stevens also  ...  view the full minutes text for item 30.

1.    In light of today’s meeting, the following would be added to the work programme:

a.    Frank Lloyd Unit – decision around any possible referral to the Secretary of State to come to the next HOSC meeting.

b.    EKHUFT maternity services.

2.    RESOLVED that the work programme be noted and updated.