Agenda and minutes

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

(1)       RESOLVED that the Minutes of the meeting held on 8 January 2016 are correctly recorded and that they be signed by the Chairman.

Oena Windibank (Programme Director, Kent and Medway Vascular Services Review, NHS England South (South East)) and Dr James Thallon (Medical Director, NHS England South (South East)) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Dr Thallon began by outlining the infomation provided in the report, to address the Committee’s recommendations from 8 January 2016 meeting, including travel times, performance indicators and findings from local reviews which were centralising vascular services in accordance with the Vascular Society guidance.  He noted that the Vascular Society was exemplary in providing clear best practice guidance to its members and commissioners and the 2012 guidance was being updated in 2016. He reported that the Kent and Medway review was working with the Vascular Society guidance review group and there would be no significant changes to the guidance. He stated that improving outcomes was driving the review; whilst the two providers in Kent were within the national tolerance levels for mortality, there was a considerable range in performance.

(2)       Dr Thallon explained that there were no recommended criteria for travel times in the Vascular Society guidance as the key priority was access to specialist vascular surgery. He quoted Vascular Society guidance which stated that “patient survival after a ruptured aortic aneurysm was between 5-15 percent if they stay in a hospital with no vascular surgeon, compared to 35-65 percent if transferred to an adjacent vascular service. This advantage persists even with up to four hours of hypotension.” He noted that the review programme board favoured a network hub and spoke model with a single inpatient centre and one or more spokes; this model would be out to public consultation in the summer subject to NHS England’s internal assurance process.

(3)       Ms Windibank highlighted the ongoing work including a detailed quality assessment for the affected populations. She reported that a qualitative event with patients and relatives representatives was held in February and considered the recommended option from a patient perspective; key messages included travel times for relatives and a sustainable service remaining in Kent and Medway.  She noted that there was a draft public consultation plan and any feedback from the Committee would be reported back to NHS England as part of their internal assurance process.

(4)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A Member enquired about co-dependencies with podiatrists and interventional radiologists. Dr Thallon explained that whilst he accepted the importance of podiatry in prevention and noted that there was a shortage of podiatrists; podiatry was not in the scope of the review and was not able to be incorporated into it. He stated that he would be happy to reflect comments made about podiatry to the commissioners. He noted that one group who did have better access to podiatry services were those with diabetic foot problems who were also likely to suffer from vascular conditions. He reported that the review was aiming to create a centre  ...  view the full minutes text for item 13.

Oena Windibank (Programme Director, Kent and Medway Vascular Services Review, NHS England South (South East)), David Hargroves (Chair, Stroke Clinical Reference Group) and Lorraine Denoris (Public Affairs and Strategic Communications Adviser, NHS Dartford, Gravesham and Swanley CCG and NHS Swale CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Ms Windibank began by updating the Committee on the option appraisal process. She explained that detailed appraisals had been undertaken for a five, four and three site model and had been reviewed against a set of red flag criteria. The red flag criteria were agreed by the Review Programme Board and aligned to recommendations within the national stroke configuration guidance. She noted that workforce was the key limiting factor to providing seven day cover. She reported that a five site model was most challenging in terms of workforce and there were concerns about the capacity and sustainability of a three site model; more detailed work was being undertaken including the review of alternative clinical models. She stated that a five, four and three site model had been reviewed against the financial envelope determined by the standard tariff for stroke; if best practice guidance was met an enhancement would also be paid.

(2)       Members of the Committee then proceeded to ask a series of questions. In response to a specific question about the consultants’ letter, Dr Hargroves explained that the process embarked upon had been transparent and engaging; all clinicians had been invited to participate with variable levels of involvement. He stated that the letter had been received at a late stage. The Clinical Reference Group had responded and addressed each of the concerns raised in the letter including frail and elderly patients, alternative models of delivery and the use of technology; the Group had also reflected on the information it provided to the Review Programme Board and had concluded that it was robust and adequate.  Ms Windibank noted that the consultants had been invited to raise any outstanding concerns before the next Review Programme Board.

(3)       A number of comments were made about the public perception of travel times and the provision of rehabilitation facilities. Ms Windibank explained that safe travel times would be included as part of the public consultation; she noted that the review was not yet at the stage to go out for public consultation. She explained that the focus of the review was the acute pathway for patients but acknowledged the importance of rehabilitation. She stated that as the model was developed, pathways for rehabilitation were also being identified and the CCGs were being made aware of areas which worked well and where there were gaps. She noted that the new acute model would only work if sustained investment was made by the CCGs into rehabilitation services and the Review Programme Board would be making recommendations to the CCGs about rehabilitation. She reported that she would feedback concerns about rehabilitation facilities for patients with brain injury to the  ...  view the full minutes text for item 14.