Agenda and draft minutes

(1)       The Overview and Scrutiny Manager apologised that, because of the limited time available since the last meeting of the Committee on 9 March 2007, the Minutes had only just been prepared. He sought and gained the Committee’s approval to deal with the Minutes and any outstanding issues arising from the Minutes. The Chairman suggested that the Committee should do so at the end of the ordinary business which would allow the Committee the opportunity to read the Minutes.  This was agreed and the Minutes of the meeting on 9 March 2007 were tabled and circulated.

(2)       The Committee agreed to consider the Minutes at the end of the ordinary business and to treat the Minutes as urgent business recognising that the requisite statutory notice had not been given but it would be expedient to deal with the Minutes at this meeting.

a)      Cancer Services – Kent & Canterbury Hospital, Canterbury

b)      Chronic Pain Clinic – Queen Elizabeth the Queen Mother Hospital, Margate (to follow)

Mr D Shortt, Concern for Health in East Kent (CHEK), Ms R Gibb, Chief Executive, Maidstone & Tunbridge Wells NHS Trust, Mr M Kershaw, Chief Operating Officer and Ms E Shutler, Director of Strategic Development, East Kent Hospitals NHS Trust will be in attendance for this item.

(Mr D Shortt, Concern for Health in East Kent (CHEK), Ms R Gibb, Chief Executive Maidstone & Tunbridge Wells NHS Trust, Mr M Kershaw, Chief Operating Officer and Ms E Shutler, Director of Strategic Development, East Kent Hospitals NHS Trust were in attendance for this item)

Cancer Services – Kent and Canterbury Hospital, Canterbury

(1)       Concerns had been raised locally by Concern for Health in East Kent that the linear accelerators at the Kent and Canterbury Hospital, Canterbury were working at best only 50% of the time and that resources and staff were being moved to the Maidstone Oncology Centre.

(2)       As a consequence, patient waiting time for radiotherapy which had been down to six weeks had now increased to 12 weeks. 

(3)       Concerns were also expressed about how the provision of cancer services across Kent was managed.  The specific question raised was: is the service managed through the Kent and Medway Cancer Network or through the Maidstone and Tunbridge Wells NHS Trust?  Ms Gibb responded that management of cancer services across Kent was not via the Kent and Medway Cancer Network but was provided by the Maidstone and Tunbridge Wells NHS Trust through the Kent Oncology Centre. 

(4)       Ms Gibb added that the provision of cancer services nationally was very costly.  What Kent had was a different model of cancer services with a Kent Oncology Centre in Maidstone and a satellite centre in Canterbury as a consequence there was an oncologist working across the whole of East Kent.  Ms Gibb made it clear that the Kent Oncology Centre could only deliver work commissioned by the Primary Care Trusts.

(5)       Ms Gibb informed the Committee that as many cancer services as possible would continue to be delivered at Kent and Canterbury Hospital.  It was only the highly complex cases of radiotherapy that would need to be treated in Maidstone, generally services for cancers such as breast and lung cancer would continue to be dealt with in Canterbury. 

(6)       Mr Brazier, the Canterbury Member of Parliament, expressed the view that there was only so much money available in the PCT budgets for all health services, including cancer.  He said that the provision of cancer services at Maidstone was an expensive operation and he did question why, in some instances, very sick people were unable to access their nearest linear accelerator – instead having to travel from Canterbury to Maidstone or vice versa.  Ms Gibb responded that there was no point a patient accessing their nearest linear accelerator if what the patient was going to receive was sub optimal treatment because the staff available at the nearest linear accelerator were the wrong staff.

(7)       Ms Gibb acknowledged that cancer services were very expensive.  It was important that the more complicated services were dealt with in the most appropriate place.  What was happening across the County was that patients were receiving a London service but locally. 

(8)       In answer to questions relating to the skills required by an oncologist and  ...  view the full minutes text for item 17.

Mr D Shortt, CHEK, Mrs L Selman, Director of Citizen Engagement, Dr R Stewart, Medical Director, Dr J Ribchester and Ms A Sutton, Chief Executive, Eastern & Coastal Kent PCT and Mr M Kershaw, Chief Operating Officer and Ms E Shutler, Director of Strategic Development, East Kent Hospitals NHS Trust will be in attendance for this item.

(Mr D Shortt, CHEK, Dr R Stewart, Medical Director and Dr J Ribchester, Professional Executive Committee Member, Eastern & Coastal Kent PCT, Mr M Kershaw, Chief Operating Officer and Ms E Shutler, Director of Strategic Development, East Kent Hospitals NHS Trust and Mr J Pearce, Centres of Clinical Excellence were in attendance for this item)

(1)       Dr Stewart informed the Committee that the proposed development of a Polyclinic at Whitstable was a response to the Government White Paper on Our Health, Our Care, Our Say a new direction for community services published by the Department of Health in January 2006.  This document sets out the agenda for providing NHS care “closer to home”.

(2)       Dr Stewart said GPs were responding to this Government policy and what would be presented to the Committee by Dr Ribchester was a proposal for the provision of services more locally.  This work was evidence-based.

(3)       He added that Primary Care Trusts were working collaboratively with the East Kent Hospital’s Trust on this current policy.  Dr Stewart concluded by saying that there should be more investment in services locally.  The proposals that were to be presented by Dr Ribchester did not yet have the formal approval of the Eastern and Coastal Primary Care Trust.  Dr Ribchester of the Whitstable Medical Practice and Jonathan Pearce of the Centres of Clinical Excellence then made a presentation to the Committee on the proposal to open a new GP surgery at Wraik Hill, Seasalter, co located with a community pharmacy, an NHS ambulance response-base and a surgical polyclinic.

(4)       A copy of Dr Ribchester’s presentation is attached as Appendix 1 to these Minutes.

(5)       Mr Kershaw, on behalf of the East Kent Hospitals NHS Trust, said that a vast amount of what Dr Ribchester was proposing was uncontentious.  However, it was proposed that some surgical services would be provided at the polyclinic and this would have potential implications for services provided by the East Kent Hospitals Trust at Canterbury and Margate.  Mr Kershaw acknowledged that what was being proposed at Wraik Hill, Whitstable was linked to the national agenda.  However, it was important that preparatory work was done in collaboration to ensure that all health services were viable. 

(6)       Ms Shutler added that it was important that the Primary Care Trust, the East Kent Hospitals Trust and other partners worked together to do some joint modelling to ensure that the implications of this additional capacity in a polyclinic were being fully taken into account. 

(7)       A document produced by Centres of Clinical Excellence, entitled “Our Credo”, was tabled at the meeting.

(8)       Members of the Committee, local Kent County Council members, Canterbury City Councillors, local Patient and Public Involvement Fora representatives and others then asked a range of questions. 

(9)       Regarding whether the cost of the service to be provided by Centres of Clinical Excellence at the polyclinic would be cheaper than the NHS national tariff, the response was that the service would be delivered at NHS tariff  ...  view the full minutes text for item 18.

Ms A Harrison, Director of Assurance and Strategic Development and Ms S Brown, Project Manager for Eastern & Coastal Kent PCT and Mr M Kershaw, Chief Operating Officer and Mr H Jones, Director of Facilities for East Kent Hospitals NHS Trust will be in attendance for this item.

            (Ms A Harrison, Director of Assurance and Strategic Development and Ms S Brown, Project Manager for Eastern & Coastal Kent PCT and Mr H Jones, Director of Facilities for East Kent Hospitals NHS Trust were in attendance for this item)

(1)       Ms Harrison made a presentation to the Committee on the Dover Project and the East Kent Neuro Rehabilitation Services.  A copy of Ms Harrison’s presentation is attached as Appendix 2 to these minutes.

(2)       The Committee noted the feedback from the consultation exercise on the Dover project.

(3)       The Committee also noted:-

(a)       the commissioning framework for delivery;

(b)       the models for care;

(c)        the establishment of a local practice through “Fit for the Future”.

(4)       However, it was noted that there were still a number of complex issues which needed to be resolved before full implementation of the improved models for care could be achieved.

(5)       With respect to the East Kent Neuro-Rehabilitation Service, the Committee noted the outcome of a Neuro-Rehabilitation working group which had involved representatives from patients, carers, clinicians, Social Services, Primary Care Trusts and East Kent Hospitals Trust.  The Committee noted that a focussed discussion had taken place, in accordance with advice from the Committee on the conduct of the consultation.

(6)       A document had been produced which had been sent to past and current neuro-rehabilitation patients, staff, and supporting voluntary and community organisations.  The consultation process had begun on 14 February 2007 and would end on 30 March 2007.

(7)       The Committee noted that 203 responses had been received to date and received a summary of the responses to the four questions posed.

(8)       The Committee welcomed the update and suggested that there should be a further meeting of the Committee in the Dover area at a date to be arranged.

RESOLVED:- 

(a)               that the position be noted.

Mr P Robinson, Eastern & Coastal Kent Patient and Public Involvement Forum, will be in attendance for this item.

(Mr P Robinson, Eastern & Coastal Kent Patient and Public Involvement Forum representative was in attendance for this item)

(1)       Mr Robinson submitted a paper setting out details relating to:-

·                    the history of Out of Hours service provision by StourCare;

·                    ongoing work by the Eastern & Coastal Kent Primary Care Trust, who were reviewing the decision to close the Out of Hours base in Herne Bay;

·                    plans to co-locate the Out of Hours service with the Emergency Care Centre at the Kent and Canterbury Hospital as soon as possible; and

·                    ensuring that a weekend service remained at Herne Bay.

(2)       Work undertaken by the Canterbury & Coastal locality group of the Eastern & Coastal Kent PCT Patient and Public Involvement Forum demonstrated that the demography and geography of the area indicated the need for two Out of Hours bases.  Mr Robinson said the group would like to see that patients, whatever their location, were offered the base of their choice.  The number of patients using Herne Bay was substantial, making it clear to the Forum that patients from coastal areas should continue to be offered the option of attending either Canterbury or Herne Bay or other locations and that Herne Bay Out of Hours base should continue in existence until further notice.

(3)       The Committee noted that this recommendation had been conveyed to Ann Sutton, Chief Executive of Eastern & Coastal Kent PCT.

(4)       The Committee noted that the Primary Care Trust Co-location Review Group was to meet later on that afternoon and it was agreed that the Committee would be updated on this at its next meeting.

RESOLVED:-

(a)       that the position be noted.

RESOLVED:-

that the Minutes of the meeting held on 9 March 20007 were correctly recorded and that they be signed by the Chairman.

(1)       The Overview and Scrutiny Manager updated the Committee on the ongoing negotiations the spokesmen of the Committee and he were continuing to hold with representatives of the West Kent Primary Care Trust, members of the Maidstone Branch of the British Medical Association and correspondence with the Chief Executive of the Maidstone and Tunbridge wells NHS Trust.

(2)       He tabled and circulated:-

·                    the spokesmen’s letter to the Chairman and Chief Executive of the West Kent Primary Care Trust dated 9 March (copied to the Chief Executive and Chairman of the Maidstone and Tunbridge Wells NHS  Trust) and a response to this letter from the Chief Executive of the Maidstone and Tunbridge Wells NHS Trust dated 13 March 2007;

·                    a letter from the spokesmen of the Committee to the Chairman of the West Kent Primary Care Trust Board dated 14 March 2007 expressing concern that the ongoing dialogue with this Committee had not been reflected in the report which was to be considered by the West Kent Primary Care Trust Board on 15 March 2007 when a decision would be taken; and

·                    a copy of the West Kent Primary Care Trust Board report on this issue which was before the Board on 15 March 2007.

(3)       The Overview and Scrutiny Manager informed the Committee that he had attended the West Kent PCT Board meeting on 15 March 20007.  The correspondence set out in sub paragraph (2) above had not been referred to when the report was introduced and there was no recognition of the ongoing dialogue with the Committee.

(4)       He added that no formal vote had been taken on the Primary Care Trust Board’s approval of the recommendations set out in paragraph 39 of the PCT Board report.

(5)       The Overview and Scrutiny Manager reminded the Committee that referral of an issue to the Secretary of State should only take place once all opportunities to achieve a local resolution had been exhausted.

(6)       Several Members of the Committee expressed their extreme concern over the references to the NHS Overview and Scrutiny Committee by the  Leader of the County Council when he had been interviewed on Radio Kent earlier that morning, especially when negotiations to seek a resolution were at such a delicate stage.

(7)       Mr Angell moved, seconded by Mr Daley that the negotiations with the West Kent Primary Care Trust, Maidstone and Tunbridge Wells NHS Trust and representatives of the Maidstone Branch of the British Medial Association should continue. In moving this proposal he suggested that it might be worthwhile extending the negotiations to a wider grouping of County Councillors.

(8)       Mr Hibberd made an alternative suggestion that a full detailed report should be prepared for the Committee’s next meeting on Friday 11 May.

(9)       The Committee agreed, without taking a vote, that:-

            (a)       the spokesmen of the Committee and Overview and Scrutiny Manager should continue the negotiations; and

            (b)       a detailed report should be made to the Committee at its meeting on Friday 11 May 2007, at  ...  view the full minutes text for item 22.