Agenda and minutes

(1)       Members of the Kent and Medway NHS Joint Overview and Scrutiny Committee are asked to note the membership listed above.

(1)       Members of the Kent and Medway NHS Joint Overview and Scrutiny Committee noted the membership as set out above.

(1)       RESOLVED that Councillor T Clarke be elected Chairman.

(1)       RESOLVED that Mr M Angell be elected Vice-Chairman.

(1)       Mr Chard declared a Disclosable Pecuniary Interest as a Director of Engaging Kent.

Dr James Thallon (Medical Director, NHS England South (South East), Oena Windibank (Programme Director, Kent and Medway Vascular Services Review, NHS England South (South East) and Michael Ridgwell (Programme Manager,  Emergency and Urgent Care Strategy, North Kent CCGs)  were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Dr Thallon began by outlining the background to the review; he explained that NHS England South (South East) commissioned specialised treatment in Kent, Medway, Surrey and Sussex under the national specification for specialised vascular services. The standards within the specification were developed through a national specialised Clinical Reference Group and reflected the best practice guidance of the Vascular Society. He stated that it was rare for best practice guidance by a professional society to be implemented by NHS England as a national service specification which demonstrated the importance and power of the guidance. As part of the review, current providers were asked to carry out a self-assessment of their services in Kent and Medway; services were found not to be fully compliant with the national critical guidance or best practice specification. NHS England South (South East) was granted a derogation which allowed services in Kent and Medway to continue, although they did not fully meet the national specification, until a solution to meet the specification and provide sustainable services was found.

(2)       Dr Thallon explained that a sustainable specialist vascular services needed to work within a hub and spoke clinical network; serve a minimum population of 800,000; have 24 hour access to specialist care and staffing with sustainable on call rotas; provide access to cutting-edge technology including a hybrid operating theatre and interventional radiology. He noted that 900 people a year in Kent and Medway required specialist vascular services: two-thirds of these patients received their care from Medway NHS Foundation Trust and East Kent Hospitals University NHS Foundation Trust and one-third of these patients from West and North Kent received their care in London predominantly at St Thomas’ Hospital. Patients reported positive experiences of vascular services in Kent and Medway and in London. Services provided in London was an arrangement developed over the past five – six years as a result of links between doctors at Maidstone and Tunbridge Wells NHS Trust, Dartford and Gravesend NHS Trust and trusts in London, clinical choice and patient choice. The service provided by St Thomas’ Hospital in London was fully compliant with the national clinical guidance and best practice specification.

(3)       Dr Thallon reported that services provided in Kent and Medway were not fully compliant with the national clinical guidance and best practice specification; both providers were not treating a large enough population and were carrying out too few or borderline numbers of core procedures. He noted that whilst both providers in Kent and Medway had been placed in special measures by the Care Quality Commission; the specialist vascular services were isolated services within their trusts and their clinical quality was closely monitored. A national 6% mortality rate for elective  ...  view the full minutes text for item 9.

Oena Windibank (Programme Director, Kent and Medway Vascular Services Review, NHS England South (South East)) and Julie Van Ruyckevelt (Principal Associate, South East CSU)) were in attendance for this item.

(1)       The Chairman welcomed the guests. Ms Windibank began by outlining the case for change which established the need to review and remodel hyper acute (first 72 hours) and acute (remaining acute stay) across Kent and Medway. She explained that primary prevention and rehabilitation services were not part of the review; the review would make recommendations to the individual CCGs where those areas required further exploration. She stated that there were a number of concerns about the performance and sustainability across the seven hospitals currently treating stroke patients including access to diagnostics, specialist assessment and intervention; specialist workforce treating the minimum number of patients; and 24 hours, seven day specialist stroke services cover. She reported that none of the current services met the national strategy and guidance.

(2)       Ms Windibank stated that eight clinical options had been identified; models ranged from one to seven sites plus the status quo. She explained that the Stroke Review Programme Board had identified that the single, two site model and status quo were not sustainable. On 22 December 2015 the Stroke Review Programme Board considered the feedback from the People’s Panel; and the Review’s Clinical Reference Group and agreed that a detailed appraisal, workforce risk assessment, travel heat maps, public health incidence growth and equalities impact assessment for a five, four and three site model should be undertaken. She reported that the number of strokes was levelling out nationally and the number of strokes in Kent and Medway were expected to increase by 650 annually.  She noted that following the successful FAST campaign, the number of patients transferred to hospital with stroke like symptoms had increased; 30 – 40% of patients who attended their local Accident and Emergency department were not admitted with a stroke or transient ischaemic attack (TIA) which needed to be considered as part of any reconfiguration. She stated that the recommended options for public consultation would be presented to the Committee on 26 February 2016.

(3)       Ms Van Ruyckevelt gave an overview of the communication and engagement activity. She stated that ten Listening Events were held across Kent and Medway to share the Case for Change and raise awareness with the public; 110 participants attended including stroke survivors, families and carers of stroke survivors, voluntary sector and residential care providers. 220 participants attended 15 Focus Groups which were held in partnership with the Stroke Association and 285 participants completed the online survey. Three deliberative events were also held in November and December which tested out the criteria used in the options appraisal process and the emerging options. The events included representation from members of the public, patients, carers, the Stroke Association, stroke champions, Public and Patient Involvement leads and JHOSC members. She reported that feedback included support for the Case for Change, a recognition that the required standards were not  ...  view the full minutes text for item 10.