Agenda and minutes

Health Overview and Scrutiny Committee
Friday, 8th June, 2018 10.00 am

Venue: Council Chamber, Sessions House, County Hall, Maidstone

Contact: Lizzy Adam  03000 412775

Webcast: View the webcast

Note No. Item



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(1)       Members of the Health Overview and Scrutiny Committee noted the following changes to the membership of the Committee:

Councillor Mortimer (Maidstone Borough Council) and Councillor Peters (Dartford Borough Council) had replaced Councillor Searles (Sevenoaks District Council) and Councillor Hills (Gravesham Borough Council) as borough representatives on the Committee for 2018/19.


Election of Vice-Chair

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(1)       Mr Pugh proposed and Mr Collor seconded that Mr Bartlett be elected Vice-Chair of the Committee.

(2)       RESOLVED that Mr Bartlett be elected as Vice-Chair.



Declarations of Interests by Members in items on the Agenda for this meeting.

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

(2)       Mrs Game declared an interest as the Chair of the QEQM Hospital Cabinet Advisory Group at Thanet District Council.


(3)       Ms Constantine declared an interest in relation to her work with the Managers in Partnership which supported staff in the NHS in London, the South and the South East. She confirmed that she was not undertaking work in Kent.


(4)       Mr Thomas declared an interest, in relation to any discussion regarding a new hospital in Canterbury, as a member of Canterbury City Council’s Planning Committee.



Transforming Health and Care in East Kent - Verbal Update pdf icon PDF 65 KB

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(1)       The Chair informed the Committee that following the publication of the Agenda, she had agreed to a request from East Kent CCGs to postpone consideration of the Transforming Health and Care in East Kent item until the July meeting, as the planned verbal update on the timeline was no longer available to be presented to the Committee. She read out the following statement which had been provided by East Kent CCGs:


“The request to delay the verbal update was as we wished to be able to present a more complete picture of the work required in east Kent and at this point we are midway through re-evaluating the programme. The two issues that are increasing the complexity of the programme are: understanding the requirement of the revised NHS England guidance on the assurance of major service reconfiguration; and the more complicated planning requirements of the blended capital model (i.e. the total capital cost being through a combination of public and private capital) associated with Option 2. We have commissioned external support (EY Consulting) to assist with this process and will be able to give a more detailed report to the July meeting of the HOSC.”


(2)       RESOLVED that the interim report be noted and that the East Kent CCGs be requested to provide a detailed update, including a timetable, to the Committee in July.



Medway NHS Foundation Trust: Update pdf icon PDF 66 KB

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Lesley Dwyer (Chief Executive, Medway NHS Foundation Trust) and Glynis Alexander (Director of Communications, Medway NHS Foundation Trust) were in attendance for this item.


(1)       The Chair welcomed the guests to the Committee. Ms Dwyer began by stating that the Trust last provided an update to the Committee in October 2016 prior to the Trust’s exit from special measures. The Trust had been re-inspected by the CQC in April and May 2018 and the inspection report was anticipated in June. She noted that there were no areas of immediate concern. She reported that whilst the Trust was not consistently meeting the constitutional targets, particularly in relation to A&E performance, there were early signs of improvement. She highlighted the closure of an escalation ward which had been open since December 2014 and the Trust’s work with system partners to reduce the number of delayed transfers of care (DTOC); the Trust now had one of the lowest DTOC figures in the country and was sharing its learning with other systems.


(2)       Ms Dwyer noted that workforce and vacancies had been an issue for the Trust. The Trust’s ability to recruit had been particularly impacted when the Trust was in special measures. She reported that there had been a 3% increase in the number of substantive staff and a 11% decrease in the use of agency staff. She stated that the Trust had a challenging financial position with a reported £66.4 million deficit in 2017/18 which was one of the worst NHS deficits. She reported that the Trust had agreed a control total of £46.7 million for 2018/19 with NHS Improvement. She explained that the Trust was working with commissioners about services to be provided within the available budget. The Trust had developed a three-year recovery plan to return to a breakeven financial position.


(3)       Ms Dwyer reported that the Trust had commissioned a fire safety report from Kent Fire & Rescue Service which identified a number of risks and actions required which the Trust had implemented. She highlighted the Trust’s Better, Best, Brilliant improvement programme. She stated that she was confident that the Trust’s challenges could be addressed but stressed the importance of the wider healthcare system working together. 


(4)       Members enquired about integrated discharge planning, international recruitment, Kent & Medway Medical School and NHS bursaries.  Ms Dwyer explained that the Trust worked in conjunction with Virgin Health, Medway Community Health, the local authorities and commissioners to improve patient discharge. Ms Dwyer explained that the Trust had undertaken international recruitment campaigns, for nursing vacancies, via local, national and international routes. She noted that recruitment from the Philippines had been particularly successful; the Trust had provided support packages to integrate overseas workers into the community and to support language and fluency skills. She reported that the Trust had played an important role in influencing a change to the English Language Test set by the Nursing & Midwifery Council to ensure it was more realistic. Ms Dwyer noted that the new Medical school would help to  ...  view the full minutes text for item 59.



Maidstone & Tunbridge Wells NHS Trust: Update pdf icon PDF 75 KB

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Miles Scott (Chief Executive, Maidstone & Tunbridge Wells NHS Trust) was in attendance for this item.


(1)       The Chair welcomed Mr Scott to the Committee and asked him to introduce himself. Mr Scott explained that he joined the Trust as Chief Executive four months ago from NHS Improvement. He stated that he had worked in the NHS for over 30 years and had been Chief Executive of St George’s University Hospitals Foundation Trust, Bradford Teaching Hospitals NHS Foundation Trust and Harrogate and District NHS Foundation Trust.


(2)       He presented a series of slides which provided an introduction to the Trust; updates on the Trust’s financial and operational performance; and recent CQC inspection.Mr Scott stated that the Trust had two main roles: it provided a range of general hospitals services to a population of 650,000 residents in West Kent and East Sussex and specialist cancer services to 2 million people across Kent and Sussex via the Kent Oncology Centre. He noted that both Maidstone and Tunbridge Wells Hospitals provided accident & emergency and general medical services; Maidstone provided cancer and complex surgery services whilst Tunbridge Wells provided trauma, maternity and children services.

(3)       Mr Scott explained that the Trust was placed in Financial Special Measures (FSM) in July 2016. NHS Improvement appointed a Finance Improvement Director (FID) who identified a potential deficit of £42.7 million, which equated to 10% of turnover at the time, and worked with the Trust to construct a financial recovery plan which helped to put the Trust into the position whereby the activity growth was now greater than the pay-bill and the underlying deficit had reduced to £20 million in the last financial year. Mr Scott informed the Committee that through the combination of productivity improvements and alignment of non-recurring measures, the Trust was on track to meet its control total for the current year.

(4)       In terms of operational performance, Mr Scott drew the Committee’s attention to six key points:


1.    There were no reported MRSA cases and only 25 cases of reported clostridium difficile at the Trust in the last year;

2.    Low numbers of avoidable pressure ulcers and patient falls were two key indicators of safe nurse staffing levels;

3.    There was a 10% increase in emergency admission in one year across the Trust which impacted on its ability to carry out planned work.

4.    There was an increase in Referral to Treatment Times (RTT) due to planned cases being displaced by emergency cases and pressures around cancer service access standards. In response to this, the Trust had devised a programme to increase elective surgery through increased productivity in operating theatres

5.    Improvements to access to cancer services were required particularly around early diagnosis. He noted that Kent ranked 19th out of 19 areas in England for access to cancer services.

6.    As with other NHS Trusts, Maidstone and Tunbridge Wells NHS Trust faced a number of pressures in terms of staffing and work was continuing to be done to tackle those.


(5)       Mr  ...  view the full minutes text for item 60.



NHS response to winter in Kent 2017/18 pdf icon PDF 106 KB

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Ivor Duffy (Director of Assurance and Delivery, NHS England), Bill Millar (Interim Director, Urgent Care and Primary Care, East Kent CCGs) and Mark Atkinson (Head of Acute Commissioning, West Kent CCG) were in attendance.


(1)       The Chair welcomed the guests to the Committee and noted that the North Kent CCGs had been unable to provide a representative. Mr Duffy began by stating that winter had been challenging. There had been a severe outbreak of seasonal influenza which had an unusual strain. He highlighted a successful vaccination scheme at East Kent Hospitals University NHS Foundation Trust which had donated a tetanus vaccination to UNICEF for every staff member who had the flu jab; as a result, the Trust had one of the highest flu jab uptakes in the country.


(2)       He stated that a number of reviews had been undertaken to pull together the key learning which included a greater need for consistency around escalation and working together as a system through the STP. He noted that whilst NHS England had historically been responsible for coordinating the system, local systems had now taken on the leadership role and NHS England was providing more of an advice and support role. He stated that further work to improve communication with the public on accessing primary and urgent care services was required.


(3)       Mr Millar explained that the winter and Easter periods had been challenging in East Kent with A&E performance at 60 – 70% against a standard of 95%. There was also a system focus to address discharge; EKHUFT worked with SECAmb to put in place mitigating actions for handover delays and additional funding from NHS England had been received to work with the voluntary sector to support discharge. He noted that an improvement plan had been submitted to NHS England which described the collective action being undertaken.


(4)       Mr Atkinson stated that the position in West Kent was slightly better as there were only two hospitals and flow could be moved between the sites. He highlighted a number of initiatives which had been implemented using winter monies including primary care centres at the hospital sites being managed by MTW, additional medical team to support delayed transfers of care and the introduction of a Home First scheme by a private provider to support patients in their own homes. He recognised that there needed to be better engagement with primary care; he reported that the relationship and collaboration between health and social care had developed over the winter.


(5)       The Chair enquired about additional resources for primary care. Mr Duffy explained that there had been a number of initiatives had been implemented which included GP triaging at A&E departments and extended primary care opening hours. He recognised that more work was required to tie-in these resources with the wider system and effectively communicate with the public as there had been some underused capacity. He stated that the growing demand for the 111 service was being addressed as part of the Integrated Urgent  ...  view the full minutes text for item 61.


Patient Transport Service: Key Performance Indicators (Written Briefing) pdf icon PDF 66 KB

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(1)       The Committee considered an update report from NHS West Kent CCG which detailed the new Key Performance Indicators for Patient Transport Services.

(2)       RESOLVED that the report on the new Key Performance Indicators for

Patient Transport Service be noted, and that the CCG be requested to present an update on performance to the Committee in the Autumn.