Agenda and draft minutes

To note that Mr J A Davies and Mrs B J Simpson have replaced Mr C Hibberd and Mrs P V A Stockell respectively.

It was noted that Mr J A Davis had replaced Mr C Hibberd, and Ms B J Simpson had replaced Mrs P A V Stockell as Members of the Committee.

RESOLVED that the Minutes of the meeting held on 11 May 2007 were correctly recorded and that they be signed by the Chairman.

1.         Business Plan for the Private Finance Initiative (PFI) – Pembury (Minute No. 25 of 11 May 2007)

(i)         Mr Crowther stated that there was a chapel on this site that had served the hospital for many years. It was proposed to demolish this and use the space for car parking. English Heritage had now listed the building and he believed that the Committee should express its support for the retention and protection of this building.  The Chairman said that clarification would be sought from the Trust and fed back to Members.

2.         Maidstone and Tunbridge Wells PPI Forum

(ii)        Mr Fittock mentioned a letter from the Maidstone and Tunbridge Wells PPI Forum relating to the meeting on 11 May 2007 and asked how the Committee would be dealing with it.  Mr Chell stated that he had not seen the letter but that he would talk to Mr Fittock outside of the meeting about this.

3.         Local Involvement Networks (LINks)

(iii)       Mrs Angell stated that it was important for the Committee to be kept informed about developments regarding the introduction of LINks.

(iv)       Mr Chell confirmed that there would be a full report on LINks on the agenda of the July meeting.

4.         Community hospitals in west Kent

(v)        Mrs Angell expressed regret that a stakeholder meeting in relation to the review of community hospitals in west Kent had been held on the afternoon of the County Council meeting on 17 May and, therefore, it had been difficult for Members to attend.  Mr Chell stated that the community hospitals review would be on the agenda for the next meeting of the Committee.  The good news arising from the review was that it was planned to retain all the community hospitals in west Kent.

The Chairman stated that he was of the opinion that the committee should receive representations about the renaming of the Minor Injuries Unit at Edenbridge and District War Memorial Hospital as a matter of urgency, as this change had already been made and, therefore, it was not appropriate to leave this item until the next meeting.

Jayne Macdonald, Head of Primary Care and Community Contracts and Lynne Selman, Director of Citizen Engagement and Communications, Eastern & Coastal Kent Primary Care Trust will be in attendance for this item.

(Peter Robinson, Eastern and Coastal Kent Primary Care PPIF, Jayne MacDonald, Head of Primary Care and Community Contracts, and Lynne Selman, Director of Citizen Engagement and Communications, Eastern and Coastal Kent PCT, were in attendance for this item)

(1)       Mr Robinson set out the background to the StourCare Out-of-Hours service and the change to the contract, which had been the subject of a recent review after six months of operation.  He stated that joint working between the Forum and the NHS Overview and Scrutiny Committee had led to a satisfactory outcome.  He made the Committee aware that there would be a full review of the Out-of-Hours Service in late 2007 or early 2008 for the PCT area and the existing contract had, therefore, been extended to the end of May 2008.  He stated that he believed the PPIF and the NHS Overview and Scrutiny Committee should be involved in this review at an early stage.

(2)       Ms Jones stated that, as a result of the work of the PPIF, there had been a renegotiation of the contract between the PCT and StourCare and a satisfactory result for the public in the area had been achieved.  She highlighted the fact that the PCT was part of the national pilot for the Urgent Care Review programme.  Work on this had started and the PPIF had a representative on the Project Board.

(3)       In relation to engaging with the public and organisations, Ms Selman stated that the PCT was setting up a “virtual panel” across the PCT area to use for consultation for the Urgent Care pilot.  This was a key part of their ongoing work.

(4)       The Chairman expressed the Committee’s thanks to Mr Robinson for the detailed piece of work that the PPIF had undertaken and stated that this was a good example of PPIFs being the “eyes and ears” of the NHS Overview and Scrutiny Committee.

(5)       RESOLVED that the update on StourCare Out-of-Hours Service be welcomed and noted.

(Dr A Russell, Chairman of the League of Friends of Edenbridge and District War Memorial Hospital, and Julian Ross, Director of Public Engagement and Sharon Jones, Director of Community Services, West Kent PCT, were in attendance for this item)

(1)       A petition from the League of Friends of Edenbridge and District War Memorial Hospital regarding the Minor Injuries Unit at the hospital (attached as Appendix 1 to these Minutes) was tabled, along with information supplied by West Kent PCT (attached as Appendix 2). The Chairman welcomed Dr Andrew Russell to the meeting and invited him to address the Committee.  Dr Russell made the following points:-

·              The Minor Injuries Unit at Edenbridge had been a nurse-led unit for the past nine years and had worked satisfactorily.

·              On 24 May the West Kent PCT at their Board meeting had decided, on safety grounds, that the unit should be renamed a “Treatment Clinic” with immediate effect.

·              A consultation period on the future of the Clinic was due to run from 2 July for three months and he expressed concern that the name change had occurred one month before the official consultation period had started.

·              The PCT had given the reason for the renaming as the low throughput of patients, which did not give staff adequate exposure to all types of case for the safety of patients.

·              He made the point that there had never been any question of poor safety; the unit had a 100% safety record, with no complaints.

·              He highlighted the important support given to the unit by Dr Julian Webb, the A&E consultant who covered this unit and others in the area. He audited the unit’s work regularly and visited the unit weekly to discuss the work with nurses; in the view of Dr Webb, the unit was safe.

·              The nurses at the unit rotated with colleagues at the Sevenoaks Hospital Minor Injuries Unit and, therefore, saw the same case-mix.

(2)       In conclusion, Dr Russell stated that he believed that the name change at this time, before a consultation on possible closure of the Unit, would lead people to believe that the Minor Injuries Unit had already ceased to exist.  This would prejudice the consultation that was about to take place and, therefore, was unfair.  He suggested that the question of the final closure of the Unit might be a subject for further consideration by the NHS Overview and Scrutiny Committee.

(3)       Ms J Ross was invited to speak and stated how disappointed she was that the good news in relation to community hospitals had been overshadowed by more minor issues.  She made the following points in relation to the Minor Injuries Unit at Edenbridge:-

·              The PCT had taken legal advice and they had the right to change the name of the unit.

·              Out of the 11 patients a day that were seen in the unit, 50% were sent by GPs for re-dressings or Electrocardiograms (ECGs). ECGs had actually already been paid for in the General Medical Services contract  ...  view the full minutes text for item 33.

Mr Fittock, Vice-Chairman, took the Chair for the remainder of the meeting, as the Chairman had to leave early, for which he apologised.

Mike Keen of the Local Pharmaceutical Committee, Julia Ross, Director of Public Engagement, West Kent Primary Care Trust and Jayne Macdonald Head of Primary Care and Community Contracts, Eastern & Coastal Kent Primary Care Trust will be in attendance for this item.

(Mike Keen, Chief Executive of the Kent Local Pharmaceutical Committee, Professor John Butler, the Chairman of Kent and Medway Pharmaceutical Regulations Committee, Julia Ross, Director of Civic Engagement, West Kent PCT, Jayne Macdonald, Head of Primary Care and Community Contracts, Eastern and Coastal Kent PCT and Anne Bretherton, Chief Pharmacist, West Kent PCT, were in attendance for this item)

(1)       The Chairman welcomed Mr Keen to the meeting and invited him to give his presentation.  Mr Keen’s presentation (attached as Appendix 3) covered the following:-

·              What is a Local Pharmaceutical Committee?

·              Where does it draw its powers from?

·              How does pharmacy help to improve services to patients?

·              How does pharmacy help public health?

·              What is control of entry?

(2)       Professor Butler from the Kent and Medway Pharmaceutical Regulations Committee, the body responsible for awarding contracts to applicants for pharmacies, explained that the number of pharmacies in Kent and Medway over the past 15 years had remained approximately the same.  However, the location of the pharmacies had changed; and large pharmacy companies had taken an increased share of the market.  There was a tendency to have more pharmacies in supermarkets and also to move pharmacies out of high streets and to co-locate with doctors’ surgeries, which ran in parallel with the increase in the redevelopment/relocating of doctors’ surgeries.  Professor Butler explained that in rural areas under regulations it had been possible since 1982, with consent, for doctors to dispense, as often in these areas it was not commercially viable for pharmacists to operate.

(3)       Ms Bretherton stated that in Kent the PCTs were looking at formally setting in place a Clinical Governance Framework based on the national programme.  East Kent PCT had the responsibility to carry out the performance monitoring visit.  In West Kent every pharmacy had a visit and pharmacist would go on the visit with a lay Member.  This visit would be pre-arranged and anything arising from it would form part of an action plan.  PCTs gave pharmacies help and support so that they could address any issues identified as requiring action.  In relation to a question on counterfeit drugs, she stated that the PCT had no influence as this was a national problem.  In relation to unused drugs, Ms MacDonald and Ms Bretherton stated that they headed teams of Prescribing Advisors who visited GP practices and supported GPs.  Members asked a number of questions, and received responses, regarding the following points:-

·              As regards the regulation of pharmacists, it was explained that they had a  professional code of ethics and that their professional  body, the Royal Pharmaceutical Society of Great Britain, played a regulatory role (although the regulatory and representative functions of the Society were to be separated under planned reforms to the regulation of healthcare professionals).

·              All pharmacies had to agree their opening hours with the contracting PCT. New pharmacies had to specify their total opening hours and their core contract hours, which had to be at least 40 hours per week.  When the Pharmaceutical Regulations Committee  ...  view the full minutes text for item 35.

James Nash, Director of Infection Prevention and Control, East Kent Hospitals NHS Trust, Mark Devlin, Chief Executive and Iris Smith, Director of Infection Control, Dartford & Gravesham NHS Trust and Helen Goodwin, Head of Governance and Risk with Kath Hughes, Modern Matron for Infection Control, Medway NHS Trust will be in attendance for this item.

(Rose Gibb, Chief Executive, Amy Page, Service Improvement Director, Maidstone and Tunbridge Wells PCT, James Nash, Director of Infection Prevention and Control, East Kent Hospitals NHS Trust, Mark Devlin, Chief Executive and Iris Smith, Director of Infection Control, Dartford and Gravesham NHS Trust and Helen Goodwin, Head of Governance and Risk with Kath Hughes, Modern Matron for Infection Control, Medway NHS Trust were in attendance for this item)

(1)       The Committee received presentations from each of the Acute Hospital Trusts across Kent and Medway regarding the processes and procedures that they had put in place concerning infection control and the incidence of hospital-acquired infection within each Trust (attached as Appendix 4).  Members’ questions were answered by PCT colleagues.

(2)       In response to a question from a Member, Ms Hughes undertook to provide Members with data showing the numbers of patients that had contracted Clostridium difficile and MRSA, expressed as a proportion of the total number of patients treated.

(3)       RESOLVED that health colleagues be thanked for their informative presentations.

Meradin Peachey, Director of Public Health and Mark Lemon, Policy Manager, Department of Public Health will be in attendance for this item.

(Meradin Peachey, Director of Public Health, and Mark Lemon, Policy Manager, KCC Department of Public Health were in attendance for this item)

(1)       Mr Gibbens introduced the latest draft of the Public Health Strategy for Kent, which had been circulated to key stakeholders for comment and discussion before being taken to a meeting of the full County Council on 24 July 2007.  Ms Peachey stated that she was pleased the Committee were looking at this. It was an opportunity for the PCTs and KCC to clarify what they meant by public health. The strategy set out six key outcomes for all partners to focus on.  Some of the targets were already part of the Local Area Agreement for Kent. Mr Lemon emphasised that the document was work in progress and, even when agreed, it would still be work in progress, as the strategy would continue to evolve and develop.  After the County Council meeting on 24 July 2007 the document would go out to public consultation.

(2)       Members made the following comments on the document:-

·              It would be helpful to have more discussion in the document on food – for example, the importance of adequate information being shown on food packaging, so that informed choices could be made; and also the need for information about how to find healthy, local food.

·              In relation to obesity, the “pleasure principle” was important: a healthy diet and lifestyle needed to be presented as enjoyable.

·              It was noted that KCC’s Environment and Regeneration Directorate had set a good example of encouraging staff to take exercise in an enjoyable way.

·              The Healthy Schools programme was acknowledged as another good example of promoting healthy lifestyles.

·              The Alcohol Abuse Select Committee’s recommendations would feed into the next version of the Strategy, which was due to be published in October 2008.

·              Members were pleased to see that mental health was included in the document.

·              It was noted that a lot of work had been done to reduce teenage conception rates.

·              Members who sat on Local Strategic Partnership Boards would find it helpful to have advice about how to challenge other organisations to ensure that they were working along the lines set out in the strategy.  It was noted that once the document had been agreed, there would be discussions with the Local Strategic Partnerships and district authorities.

·              The challenges around health inequalities were starkly illustrated by the different life-expectancy rates found in geographically adjacent wards in some parts of the county.

·              It would be useful to have a map of the county illustrating the different indices, so that the various aspects of health inequalities could be visually presented.

·              It was noted that Environmental Health, which was a district council function, was key to public health – but it was important to look at major public health issues where all local authorities could make a big difference to a large number of people.  One of the main issues that district councils wanted action on was air-quality improvement.  ...  view the full minutes text for item 37.

(1)       Tabled at the meeting was a paper from Ms J Ross, Director of Civic Engagement for West Kent PCT, which set out the current situation regarding Fit for the Future (attached as Appendix 5).  Work on Fit for the Future was continuing, with the health economy across Kent and Medway on track to deliver a formal update for all stakeholders in July.  At an extraordinary County Council meeting on 24 July 2007, the PCTs would have an opportunity to share more detail about next steps regarding Fit for the Future and there would be an opportunity for Members to speak to a range of clinicians and staff about the service improvements that were planned.  Once the public document was published, there would the opportunity for a full discussion with the Committee and to discuss in detail about what would happen next in west Kent.

(2)       RESOLVED that the report be noted.

(1)       Tabled at the meeting was a paper from Ms J Ross, Director of Civic Engagement for West Kent PCT, which set out the current situation regarding Fit for the Future (attached as Appendix 5).  Work on Fit for the Future was continuing, with the health economy across Kent and Medway on track to deliver a formal update for all stakeholders in July.  At an extraordinary County Council meeting on 24 July 2007, the PCTs would have an opportunity to share more detail about next steps regarding Fit for the Future and there would be an opportunity for Members to speak to a range of clinicians and staff about the service improvements that were planned.  Once the public document was published, there would the opportunity for a full discussion with the Committee and to discuss in detail about what would happen next in west Kent.

(2)       RESOLVED that the report be noted.