Agenda and draft minutes

Mr Angell declared a non-pecuniary interest as a non-executive director of the Kent & Medway NHS & Social Care Partnership Trust.

The Overview and Scrutiny Manager reported that the Minutes of the January meeting were still being prepared and he apologised to the Committee that they were not available for this meeting to consider and approve.  They would be presented to the meeting of the Committee on 9 March 2007.

Mr A Horne, Medway NHS Trust will be in attendance for this item.

(Item 3 – Mr A Horne, Chief Executive of Medway NHS Trust was in attendance for this item)

(1)       Mr A Horne, Chief Executive of Medway NHS Trust made a presentation to the Committee on the Trust’s proposed application for Foundation Trust Status.  A copy of Mr Horne’s presentation is attached as Appendix 1.  The Committee were reminded that they had authorised the Overview and Scrutiny Manager, in consultation with the Chairman, Vice Chairman and Liberal Democrat Spokesman of the Committee, to arrange a meeting and invite colleagues who represented an electoral division in Maidstone Borough Council and Swale Borough Council areas to meet with Mr Horne and other Trust colleagues regarding their application for Foundation Trust Status.  This meeting had taken place on Monday 22 January 2007 and a copy of the note of that meeting was attached to the report.

(2)       At the conclusion of his presentation, Mr Horne responded to a range of questions.

Emergency Care

            a)         In response to a question about taking on more emergency care and the capacity of the Trust to do so, Mr Horne said that the Medway NHS Trust was already taking a number of vascular emergency cases from Maidstone and Pembury hospitals.  He added that, after April 2007, the Trust would also be taking vascular emergencies from Darent Valley Hospital at Dartford.  He was confident that Medway NHS Trust could deal with, and had the capacity to deal with, transfers from neighbouring Trusts.

Flexibility and Freedoms of Foundation Trusts

            b)         Asked about the benefits of Foundation Trust Status and the role of ‘Monitor’, Mr Horne responded that if Foundation Trust Status was achieved it would enable the Trust to operate within a more flexible framework.  Foundation Trusts also had freedom to borrow money from a wider range of lenders, in addition to the NHS bank.  Monitor had been established approximately three years ago and was the body set up to assess and accredit Foundation Trusts, primarily from a financial point of view.  It was a regulatory body – as such, it was similar to the Healthcare Commission, which was responsible for looking at quality standards across NHS Trusts.

Consultation Process

            c)         Asked how widely the consultation had been undertaken and the percentage of responses received, Mr Horne acknowledged that, whilst the consultation document had not been sent to London Boroughs, it had been widely distributed amongst the catchment area for the Medway NHS Trust – including the western part of Swale and the Isle of Sheppey.  He did not have with him detailed figures regarding the rate of responses to the consultation, but would make them available to the Committee. 

Car Parking and Transportation

            d)         Mr Horne said that the car parking at the Medway Maritime Hospital was not privatised.  The car parks were run by the Trust and there were no plans to change the charges for car parking.  The Trust was continuing to look at environmental strategies, including the promotion of walking and car sharing, as well  ...  view the full minutes text for item 7.

Rebecca Sparks, Director Development and Partnerships; Michael Ridgwell, East Kent Primary Care Trust; Steve Phoenix, Chief Executive Officer and James Thallon, GP and Professional Executive Committee member for West Kent Primary Care Trust;

Lynne Selman, Director of Communications and Roger Pinnock, GP and Professional Executive Committee member for Eastern & Coastal Kent Primary Care Trust; Colette Glasson, Director of Communications, Heidi Shute, Community Cardiology Manager and Marion Dinwoodie, Chief Executive Officer for Medway Primary Care Trust

(Item 4 – Rebecca Sparks, Director Development and Partnerships, South East Coastal Strategic Health Authority; Steve Phoenix, Chief Executive, West Kent Primary Care Trust; Lynne Selman, Director of Communications and Dr Roger Pinnock, GP and Professional Executive Committee (PEC) member, Dr Robert Stewart, Medical Director, Eastern & Coastal Kent Primary Care Trust; Colette Glasson, Director of Communications, Heidi Shute, Community Cardiology Manager and Marion Dinwoodie, Chief Executive, Medway Primary Care Trust were in attendance for this item)

(1)       The Committee had among their papers a briefing note on commissioning.  It was recognised that there was not a concise definition of commissioning, since this term actually referred to a range of activities that had changed over time and were continuing to change as a result of major NHS reforms.  The briefing note referred to: the original NHS model; the internal market; commissioning and the new NHS; Payment by Results; patient choice; practice-based commissioning; the mixed economy of providers; the role of Foundation Trusts; expectations as regards PCTs undertaking commissioning and how that sat with practice-based commissioning and patient choice; how commissioning related to the reconfiguration of services; how commissioners could ensure access to services and tackle health inequalities.

(2)       Health colleagues then made a presentation to the Committee, which is attached as Appendix 2 to this set of minutes. 

Dental, Palliative and Respite Care

(3)       Following the presentation, Mr Godfrey Horne indicated that he liked the idea of the best care being available in the best place for the best value because he felt that it added meaning for the public and it was easier to understand.  He then asked a series of questions relating to how commissioning plans would improve services such as dental care, palliative care and respite care, recognising that there needed to be an holistic approach across the core agencies for delivering some of these services.  Mr Phoenix responded that there was an agreement between the Primary Care Trusts and local authorities that neither would take decisions that would impinge on, and place additional financial burdens on, the other side.  From a West Kent perspective, he said that there would be a review undertaken shortly on palliative care.  He acknowledged that dental-care provision was an issue across many parts of Kent and this was something that the Primary Care Trusts needed to tackle collectively. However, that work had not yet started. Marion Dinwoodie said that, in Medway, the Primary Care Trust ran the Wisdom Hospice; she actually had a surplus of hospice beds, because care in the community was working so well.

Patient Choice vis-à-vis Planned Hospital Care

(4)       Mr Phoenix said that there was clearly a possibility that Patient Choice would not deliver everything that was hoped.  He added that there might or might not be tensions between Choice and practice-based commissioning.  He said it was intended there would be a national set of standards, but the care pathways and the services offered would end up looking different in different areas.  He said that devolution often  ...  view the full minutes text for item 8.

Julia Ross, Director of Civic Engagement West Kent Primary Care Trust will be in attendance for this item.

(Item 5 – Julia Ross, Director of Civic Engagement West Kent Primary Care Trust was in attendance for this item)

(1)    The Committee had before them the proposals (tabled at the meeting) for a review process around Commissioning Homeopathy.  The Committee noted that, in 2006, the South West Kent and Maidstone Weald PCTs had undertaken a formal turnaround process.  The nature of turnaround was such that every possible area of savings – both efficiency improvements and the review of service provision – had to be considered.

(2)    The Turnaround Plan had identified a number of service areas for review – of which one was homeopathy.  The Primary Care Trusts had initially proposed to direct all referrals for homeopathic therapy through a Treatment Panel, so that each case could be considered on the basis of clinical need before the referral went ahead.  This proposal, however, had caused concern among some stakeholders and it had, therefore, been agreed to conduct a review of the demand for homeopathic services and the cost-benefit of such treatment.  The Committee noted that the Tunbridge Wells Homeopathic Hospital was one of only five such hospitals run by the NHS. 

(3)    Mrs Ross stated that the review was not about closing the Homeopathic Hospital, it was about reviewing and establishing the demand for homeopathic services and whether the cost-benefit of such treatments was appropriate for provision from NHS funds.  The review process would include four distinct stages:-

1.      a review of existing activity and spending on homeopathic services;

2.      an external review and evaluation of the evidence for homeopathy;

3.      a discussion phase, where both reviews were shared and discussed amongst the stakeholders, options presented and developed, and decision-making criteria agreed in conjunction with the PCT Board; and

4.      the decision-making process, where the PCT Board would apply weight, and score by the agreed criteria.

(4)    The Committee noted that a reference group of key stakeholders had been established and that Paul Wickenden was the representative for the NHS Overview and Scrutiny Committee on this reference group.  The first meeting of the reference group was to take place on 13th February 2007.

(5)    Mrs Ross said that the review might come up with a range of options.  She hoped that a decision by the PCT Board would be taken in April.  The issues around the homeopathy review were particularly sensitive. There were polarised opinions as to both the effectiveness of treatments and the use of NHS funding for providing the service.

(6)    The Committee noted that there were 400 referrals to the Homeopathic Hospital from West Kent PCT each year. This was a very small part of the commissioning done by the PCT, but it was important that the PCT looked at every service that it commissioned.

(7)    The Committee noted that the reference group included individuals who came from both sides of the debate on homeopathy, in order to ensure balance.

RESOLVED that the position be noted

(Item 6 – report by Paul Wickenden, Overview and Scrutiny Manager)

(1)    The Overview and Scrutiny Manager reported on the potential work programme for the next two meetings of the Committee, based on approaches made to the Chairman and Spokesmen of the Committee or direct to him.

Maidstone & Tunbridge Wells NHS Trust – a new direction for surgical and orthopaedic care

(2)    Following the decision of the Committee on 12 January 2007, all the evidence had been re-examined and a meeting had taken place with the Chairman, Vice Chairman and Liberal Democrat Spokesman of the Committee to agree the reasons underlying the Committee’s decision.  The Committee were invited to endorse the action which had been taken retrospectively by the Overview and Scrutiny Manager, with the approval of the Chairman, Vice Chairman and Liberal Democrat Spokesman of the Committee.

(3)    The reasons for opposing the proposals, as agreed by the Chairman, Vice Chairman and Liberal Democrat Spokesman, had been sent to Mr Phoenix, Chief Executive of West Kent Primary Care Trust and Ms Gibb, Chief Executive of Maidstone & Tunbridge Wells NHS Trust (see Appendix 1).

(4)    Members were reminded that the Committee had the power to refer matters to the Secretary of State for Health on grounds of inadequate consultation, or on the basis that what was proposed was not in the interests of health services in Kent.  However, this right of referral was only to be exercised as a last resort, once all avenues of possibility to resolve the matter locally been exhausted.

Meeting – 9 March 2007

(5)    Issues emerging for potential inclusion on the NHS Overview and Scrutiny Committee’s agenda for the meeting on 9 March 2007 were:-

·              services provided for residents of north west Kent at the Gravesham Community Hospital, and the removal of some of these to the Darent Valley Hospital; and

·              Audiology Services, which the Committee had discussed at its meeting in January 2006 and agreed to review in a year’s time. 

(6)    Other concerns had been raised relating to cancer services at the Kent and Canterbury Hospital and the proposed development of a polyclinic at Whitstable.  The Committee were asked to consider whether they would want to hold one meeting split between two locations – with the first half in north west Kent and the second half in east Kent.

(7)    The Committee concluded that it would be far more appropriate to have two separate meetings, one each to deal with the east Kent issues and the north west Kent ones.

Healthcare Commission Core Standards

(8)    The Committee considered whether it wished to make a submission in the spring for the Healthcare Commission’s annual healthcheck.  Each NHS Body was required to submit its self-assessment to the Healthcare Commission by 1 May 2007.

(9)    Three types of body had the opportunity to add a commentary to these self-assessments against the Healthcare Commission Core Standards, namely NHS Overview and Scrutiny Committees, Patient and Public Involvement Fora and Strategic Health Authorities.

(10)  The Committee  ...  view the full minutes text for item 10.