Agenda and minutes

(1)       RESOLVED that Mr Angell be elected as Chairman.

(2)       The Chairman stated that it was with regret that he had to inform Members of the death of Mr Robert Brookbank, Chairman of the Health Overview and Scrutiny Committee and Member of the JHOSC.

(3)       Mr Brazier, Miss Harrison, Mr Daley, Mr Birkby and Patricia Davies paid tribute to Mr Brookbank. At the end of the tributes all Members stood in silence in memory of Mr Brookbank.

(4)       RESOLVED that the Committee records the sense of loss it feels on the sad passing of Mr Brookbank and extends to his family and friends our heartfelt sympathy to them in their sad bereavement.

(1)       RESOLVED that Cllr Wildey be elected as Vice-Chairman.

(1)       Members of the Kent and Medway NHS Joint Overview and Scrutiny Committee are asked to note that Cllr Wildey has replaced Cllr Clarke as a member of the Committee.

(1)       Members of the Kent and Medway NHS Joint Overview and Scrutiny Committee noted the following changes to the membership of the Committee:

(a)       Cllr Wildey replaced Cllr Clarke as a Medway Member;

(b)       Mr Brazier filled the Kent Member vacancy.

(1)       RESOLVED that the Minutes of the meeting held on 29 April 2016 are correctly recorded and that they be signed by the Chairman.

Oena Windibank (Programme Director, Kent and Medway Hyper Acute and Acute Stroke Services Review), Jackie Huddleston (Joint Associate Director South East Clinical Networks & Clinical Senate, NHS England - South (South East)), Patricia Davies (Accountable Officer, NHS Dartford, Gravesham and Swanley CCG and NHS Swale CCG) and Lorraine Denoris (Public Affairs and Strategic Communications Adviser, NHS Dartford, Gravesham and Swanley CCG and NHS Swale CCG) were in attendance.

(1)       The Chairman welcomed the guests to the Committee. Ms Davies began by outlining the background to the review. She explained that the seven sites currently providing stroke services in Kent and Medway were not consistently meeting national standards including the provision of a seven day service. She noted that a designated centralised 24/7 stroke unit with a multi-disciplinary specialist team was the most important element for stroke recovery. She reported that for the size of Kent and Medway’s population, 1.8 million, stroke care could be centralised into one or two units; however due its geography, demography and variations in deprivation one or two units would not be able to meet the recommended 120 minute call to needle standard for thrombolysis. She highlighted that only the three and four site model options had been taken forward by Review Programme Board due to workforce and travel considerations.

(2)       Ms Windibank explained that since the last JHOSC meeting on 29 April, the five site option had been removed by the Review Programme Board as it was highly unlikely to be staffed to a level where a 24/7 consultant led service was deliverable. The Board was now carrying out further detailed work for three and four site models including critical co-dependencies, workforce and travel times.

(3)       Ms Huddleston noted that patient outcome was the main focus of the review in Kent and Medway; she reported that the centralisation of stroke services in London had a significant impact on patient outcome. She stated that the South East Coast Clinical Senate had started to look at critical co-dependencies for stroke services in an acute setting which included access to CT and MRI scanning, acute medical rota and ‘hot’ emergency department to accept patients. She noted that the critical co-dependencies for other services such as critical care and vascular varied; a report by the South East Coast Clinical Senate into clinical co-dependencies of acute hospital services was used by other stroke reviews.

(4)       Ms Davies stated that the Review Programme Board was working with clinicians including Professor Tony Rudd, the national clinical director for stroke; there was agreement that a 24/7 stroke service could not be provided across seven sites. She noted the length of time to train specialised stroke nurses and consultants and the requirement for seven Whole Time Equivalent (WTE) consultants per site to be compliant. She highlighted that there would be further engagement with the public around three and four site models. She explained that stroke units would need to sit with co-dependent services in ‘hot’ sites; the location of the sites would be  ...  view the full minutes text for item 19.

Oena Windibank (Programme Director, Kent and Medway Hyper Acute and Acute Stroke Services Review), Patricia Davies (Accountable Officer, NHS Dartford, Gravesham and Swanley CCG and NHS Swale CCG) and Lorraine Denoris (Public Affairs and Strategic Communications Adviser, NHS Dartford, Gravesham and Swanley CCG and NHS Swale CCG) were in attendance.

(1)       The Chairman began by asking if there were any areas of challenge for the vascular review. Ms Windibank explained that a comprehensive review had been undertaken and a detailed plan had been established for vascular services.  She noted that it was challenging to fit the review into the wider Sustainability and Transformation Plan (STP) process particularly to move the review forwards whilst the clinical co-dependencies in the STP were being determined. She stated that since the last JHOSC on 29 April, a collaboration between East Kent Hospitals University NHS Foundation Trust and Medway NHS Foundation Trust had been confirmed to provide a network approach with a single inpatient hub and local spokes for diagnostic and outpatient care. 

(2)       Ms Windibank noted that there was a requirement to review the delivery of vascular care. Prior to the implementation of the Vascular Society’s clinical best practice guidance, outcomes for patients were poor. Since the implementation of the guidance, mortality rates had reduced from 11-13% to the internationally expected levels of 3-5%. She explained in Kent and Medway inpatient vascular surgery took place on two sites and there were concerns about the sustainability  of those services as  there were inadequate or borderline numbers of the main procedures being undertaken and inadequate numbers of specialist staffing in particular consultant surgeons.

(3)       Ms Windibank explained that the procurement exercise had identified one provider, the collaboration between the two trusts. With both the Trusts, NHS England was planning a series of public engagement events about delivery of the new model in late summer and early autumn; it was also looking to align the review with the STP process. She proposed that an update be presented to the JHOSC after public engagement events to enable both Trusts to talk through their proposals for the collaborative model.

(4)       Members of the Committee made comments about prevention, rehabilitation and care in the community. Ms Windibank explained that whilst immediate post-operative care would take place in the specialist inpatient hub; it was important to put in place rehabilitative support for patients in their own homes particularly for those who had amputations.

(5)       Ms Davies stated that from the CCGs perspective, they were keen to have a resolution as the current service was not meeting national standards. She noted that there had been a transformation, in the two trusts coming together, to deliver the new best practice model; the collaboration was a real strength and success.

(6)       RESOLVED that:

(a)       NHS England South (South East) be requested to note the comments about prevention, rehabilitation and care in the community;

(b)       NHS England South (South East) be requested to present an update to the Committee after the public engagement events.