Agenda and draft minutes

RESOLVED that, subject to the following amendments:-

a)           “Mrs F Witherdew” to read “Mrs F Witherden”; and

b)           Mr Julian Brazier, MP to be shown present as an observer;

the Minutes of the meeting held on 23 March 2007 were correctly recorded and that they be signed by the Chairman.

Other Matters raised relating to the Minutes

(1)    The Overview and Scrutiny Manager responded to Mr Crowther that he had been recorded as attending the visit to the Kent & Canterbury Hospital in the afternoon but as he had not attended the formal meeting of the Committee in the morning he had not been recorded in the Minutes as being present.

(2)    In response to a question from Mr Hibberd about the appropriateness of recording Mr Shortt’s comments in the body of the Minutes, the Overview and Scrutiny Manager explained that the Committee had been responding to a range of issues raised by Mr Shortt on behalf of Concern for Health in East Kent (CHEK).

(3)    Ms Gibb, Chief Executive of the Maidstone and Tunbridge Wells NHS Trust, clarified, in respect of Minute 17 (4), that there were oncologists working across the whole of Kent and Medway; and that the point being made in her comments recorded at Minute 17 (6) was regarding the importance of having the right staff working with the right linear accelerator.

Rose Gibb, Chief Executive, Maidstone & Tunbridge Wells NHS Trust and Steve Phoenix, Chief Executive, West Kent PCT will be in attendance for this item.

(Ms R Gibb, Chief Executive, Maidstone & Tunbridge Wells NHS Trust and Mr S Phoenix, Chief Executive of West Kent PCT were in attendance for this item)

(1)       Mr Phoenix and Ms Gibb were accompanied by some consultants from Maidstone & Tunbridge Wells NHS Trust, Mr J Webb, Clinical Director – Emergency Services and Critical Care, Mr P Skinner, Clinical Director – Orthopaedics and Mr P Bentley, Clinical Director – Surgery.

(2)       Mr Angell raised a number of questions with Ms Gibb relating to:-

a)      whether the calculations regarding the proposed reconfiguration took into account fully the growth in population, the ageing of the population and the growing number of overweight people;

b)      what guarantee could be given as to whether the proposed reconfiguration would actually happen; and

c)      whether she could guarantee that there would continue to be a quality Accident & Emergency (A&E) department at Maidstone.

(3)       Ms Gibb responded that the Maidstone & Tunbridge Wells NHS Trust had given due consideration to all the demographic factors.  She said that the anticipated population growth was sufficient to affect primary care but not great enough to affect planning for hospital services.

(4)       She said that the changes could be concluded by December 2007/January 2008 if the NHS Overview and Scrutiny Committee agreed them. The Trust had the necessary finances and project infrastructure ready.  It was imperative that the core of services must be sustainable and appropriate, otherwise the Trust would be unable to guarantee the quality and range of services.  Finally, Ms Gibb concluded in response to Mr Angell’s questions that they did not know how health policy and technology would change in the future but what was clear was that we could anticipate continual change.

(5)       Mr Skinner, Clinical Director – Orthopaedics, added that all orthopaedic surgeons believed in the separation of elective and emergency orthopaedic care and a concentration of elective surgery at one location.

(6)       It was important that there was a dedicated surgical team who could operate on emergency cases without distractions.  Mr Webb, Clinical Director – Emergency Services and Critical Care, informed the Committee of an A&E middle-grade vacancy where recently there had been just one suitable applicant.

(7)       He said that the Trust were very supportive, both practically and financially.  Mr Webb informed the Committee that he had two Specialist Registrars based solely at Maidstone and four middle-grade staff at Maidstone and Tunbridge Wells. The nurse-provider service had been expanded at both locations.  F1 and F2 staff (i.e. Housemen) were on duty overnight in A&E.  He said that a 24-hour middle-grade rota at the Kent & Sussex Hospital, Tunbridge Wells would be a significant advancement.  He said that the model being proposed of an integrated physician/general practitioner/nurse practitioner team with junior doctor support at Maidstone would also be a step forward.  Mr Phoenix referred the Committee to the West Kent Primary Care Trust Board decision of 15 March 2007, which had attached conditions to the proposed reconfiguration.  Significant checks and balances had been  ...  view the full minutes text for item 24.

Rose Gibb, Chief Executive, Bernard Place, Commissioning & Healthcare Director and Laurence Bunnett, PFI Director, Maidstone & Tunbridge Wells NHS Trust and Steve Phoenix, Chief Executive, West Kent PCT will be in attendance for this item.

(Ms R Gibb, Chief Executive, Bernard Place, Commissioning and Healthcare Director and Laurence Bunnett, PFI Director, Maidstone & Tunbridge Wells NHS Trust and Mr S Phoenix, Chief Executive of West Kent PCT were in attendance for this item)

(1)       The Committee received a presentation on the Business Plan for the Private Finance Initiative (PFI) at Pembury, which is attached as Appendix 2 to these Minutes. 

(2)       Mr Horne said that the new Pembury Hospital was required as quickly as possible.  He had specific questions around the renal unit, the diabetes unit, rehabilitation and continuing life care for people with long-term conditions.  He also mentioned concerns relating to the A21 in respect of dualling the carriageway, which he saw as a big issue for the PFI project.  Mr Phoenix said that the West Kent PCT was discussing with Guys and St. Thomas’ NHS Foundation Trust in London the positioning of the renal unit in a new location, which need not be at an acute hospital site.  He referred to the West Kent PCT Board report that was being prepared for the Board’s meeting on 24 May 2007, relating to the Community Hospitals review, which would mention the renal unit.

(3)       Mr Phoenix also said that diabetes services did not have to be at an acute hospital site either.  Mr Place said that some intense short-stay rehabilitation would be at the new hospital but the rest did not necessarily have to be provided at the hospital.  Mr Bunnett said that upgrading the A21 was not a critical precondition of the hospital getting built, but there could be a helpful congruence of these two issues.  He said that issues around the A228 would also not be an obstacle to the project going ahead.  The Trust were working on the question of traffic profile.

(4)       Mr Phoenix said, in response to the question about long-term care, that this would not be provided in acute hospitals.  Once again, he referred the Committee to the proposals on Community Hospitals – although these were not necessarily the best place either for people who needed care but not medical care; they were better looked after at home or in “more homely settings”. 

(5)       Members asked a series of questions about the source of funding for the PFI; whether the building would be environmentally sustainable; and ensuring that car-parking would not be a “cash cow”. Ms Gibb responded that the construction project would not be publicly funded but, as a PFI project, would use wholly private finance.  Sustainability and environmental issues would be looked at. The government’s review of the project had stated that health issues needed to be reflected in the plan.  Local labour would be used where relevant and appropriate, but the project would be in competition for local labour with the 2012 Olympics.  Ms Gibb confirmed that cancer patients who had to attend the hospital on a regular basis for treatment would receive a car-parking pass.  In answer to a question around the funding of  ...  view the full minutes text for item 25.

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

(Mr S Phoenix, Chief Executive of West Kent PCT was in attendance for this item)

(1)       Mr Phoenix informed the Committee that the PCTs in Kent were working towards a consultation document being available by July for the whole of Kent and Medway.  This would incorporate the feedback and responses from local “co-design” meetings.  The consultation document would deal with forecasting the future financial position across Kent and Medway up to 2015–6.  Fit for the Future had been initially predicated on the assumption that there would be a severe financial crisis if nothing happened, but this was no longer the case. The emphasis would now be on the need for more care to be provided in the community.  This was about the type, levels and settings of care in the community.  He said that it would not be possible to have a once-and-for-all consultation, as things were changing all the time.  For instance, he expected very soon to have revised guidelines on stroke-handling.  The new standards would require every hospital to do things differently.  There would be a network model and not every hospital would do everything.  Fit for the Future was unlikely to propose major infrastructure changes.    Mr Phoenix offered to come to the July meeting of the NHS Overview and Scrutiny Committee for a preliminary conversation about Fit for the Future.

(2)       The Chairman asked whether there would be a common approach to Fit for the Future across the whole of Kent and Medway.  Mr Phoenix responded that there would be a single document, localised to particular areas.  Mr Horne referred to a 16,000-signature petition relating to the Tonbridge Community Hospital, as well as to similar campaigning in other areas. He asked Mr Phoenix whether Fit for the Future would cover the future of the Community Hospitals.  Regarding the renal unit, he asked how this would be paid for.  Mr Phoenix responded that Fit for the Future would reflect proposals on the future of the Community Hospitals that would be in a separate report, which was going before the West Kent PCT Board on 24 May 2007.  He said that it would have something exciting and positive to say.  With respect to the renal unit, he said that the PCT was already paying Guy’s and St. Thomas’ Trust, as a specialist provider, for the use of this service. The question was only one of how the service was to be provided in future.

(3)       Asked a question about the capital implications of providing care closer to home, Mr Phoenix said that there would be some capital implications but not many.  He said that, with the new hospital at Pembury, the county would have the most up-to-date hospital stock in the country.  Pembury Hospital would be very new; Darent Valley Hospital was new; Gravesham Community Hospital was new; and Maidstone Hospital was relatively new in NHS terms – and parts of it were very new.

(4)       RESOLVED that:-

            the position be noted.

(1)       The Overview and Scrutiny Manager submitted a report updating the Committee on the future work programme and a number of other issues. 

(2)       Asked about the establishment of a Local Involvement Network (LINk), the Overview and Scrutiny Manager said that reports would be made to the Committee in July and November on the proposal to establish a LINk. 

(3)       The Overview and Scrutiny Manager made reference to a visit by some Members to the Kent headquarters of the South East Coast Ambulance Service, which had been excellent.  He asked if the Committee would welcome a repeat visit.  He also asked whether Members would like to visit the Integrated Clinical Assessment and Treatment Service being operated as a pilot in Ashford.  The Committee agreed that both these proposed visits would be useful. 

(4)       Mr Horne raised the issues of: the lack of NHS dentists in Tonbridge; and the future of Tonbridge Cottage Hospital.  The Overview and Scrutiny Manager said that, with regard to the Community Hospitals, Fit for the Future was a standing item on the NHS Overview and Scrutiny Committee’s agenda and the Committee could maintain a watching brief on this issue under that heading.  He also reminded the Committee that its Members and all those who represented an electoral division in West Kent had been invited to a stakeholder meeting about the review of Community Hospitals in West Kent on the afternoon of 17 May at Tonbridge.

(5)       Questions were then asked about the homeopathy review being undertaken by West Kent PCT.  The Overview and Scrutiny Manager reported that the consultation document was included in the papers before the Committee for their information.  The consultation finished on 2 July and a report would be submitted to the West Kent PCT Board on 26 July.  He indicated that if Members had any comments that they wished to make they should make these direct to the PCT.  In response to comments from one of the Members of the Committee that there was too much business on the NHS Overview and Scrutiny Committee agendas and that some of the items before them could be tackled informally, the Overview and Scrutiny Manager referred the Committee to the protocols for the operation of NHS Overview and Scrutiny across Kent.  These protocols were currently being revisited by a steering group including health, Patient and Public Involvement Forum, and Borough and District authority colleagues.  Consideration would be given to delegating some of the work of the NHS Overview and Scrutiny Committee to Boroughs and Districts, which had always been the intention within the existing protocols.  He referred the Committee to the issue of the proposed Whitstable Polyclinic, which had been tackled at the last meeting of the Committee, held in Canterbury on 23 March. There was a clear willingness on the part of Canterbury City Council to take forward the overview and scrutiny of this issue.