Agenda item

This item will be examined in two sections as follows:-

a)         The Future of PCT Provider Services                    10:10 – 11:20

            BREAK

b)         The Use of Community Hospitals                            11:30 – 12:40

Anne Tidmarsh (Director of Commissioning and Provision, East, Kent Adult Social Services),Ashley Scarff (Head of Business and Corporate Planning, Maidstone and Tunbridge Wells NHS Trust), David Meikle (Acting Chief Executive, NHS Eastern and Coastal Kent),Philip Greenhill (Managing Director, NHS Eastern & Coastal Kent Community Services), Phil Edbrooke (Associate Director of Quality, Performance and Corporate Development, NHS Eastern & Coastal Kent Community Services), OenaWindibank (Operations Director, NHS Eastern & Coastal Kent Community Services),Paul Duncan (Associate Director of Business Development, NHS Eastern & Coastal Kent Community Services), Alison Davis (Assistant Director of Commissioning, NHS Eastern and Coastal Kent), Ruth Brown (Lead Commissioner for Community Services, NHS Eastern and Coastal Kent), Mark Sheppard (Managing Director, West Kent Community Health), Judy Clabby (Assistant Chief Executive, NHS West Kent), Dr Mike Parks, Medical Secretary, Kent Local Medical Committee), and Ray Fullerwere present for this item.

(1)       The discussion of this item was divided into two sections, looking at the future of Primary Care Trust (PCT) Provider Services to commence with.

(2)       It was explained to the Committee that the broad direction of travel had not changed as a result of the General Election in that the separation of provider and commissioner functions of PCTs would continue.  However, PCTs as commissioners were to be abolished.

(3)       Representatives of the NHS provided further written information to assist in clarifying the timeline of developments locally (see Appendix 2).  Eastern and Coastal Kent Community Services (ECKCS) would become a separate NHS Trust from 1 October 2010.  The intention of both PCTs was that West Kent Community Health would separate from NHS West Kent and join with ECKCS and a new organisation called Kent Community Health Trust would be formed on 1 April 2011.

(4)       The Business Case for joining together of the two provider services needed to be approved by the Cooperation and Competition Panel and the judgment was expected in December.  Even with this, the Kent wide community services organisation was not a foregone conclusion and the views of stakeholders would be sought early next year.  

(5)       From the perspective of General Practice, the Local Medical Committee (LMC) believed that community services were key to local delivery and hoped that a Kent Trust could be used as a framework within which to further integrate health services and rebuild primary healthcare teams and allow for community healthcare staff to move back into surgeries.  However, many surgeries were not fit for purpose and would need improvements to deliver more services.  The LMC have been involved in the discussions over the Kent wide Trust and were relieved that vertical integration with the Acute Trusts in Kent was not the favoured option in Kent.

(6)       Concern was expressed by Members that a Kent wide Trust may miss the local dimension, particularly when contrasted with GPs who were localised.

(7)       Mr Greenhill from ECKCS explained that his organisation was currently the fifth largest provider of community services in the country and that more needed to be done to develop local structures but that work was being done to integrate community teams in a geographical area.

(8)       Mr Sheppard from West Kent Community Health (WKCH) explained that this was also the case in West Kent.  His organisation was smaller than the one in East Kent and merging with it would enable it to be regarded equally with the Acute Trusts.  The Invicta Practice Based Commissioning Cluster in West Kent was heavily involved in developing services locally. 

(9)       There were differences between the two community service providers in where services had traditionally been based, and this partly explained why ECKCS had more staff that WKCH.  Other reasons include the fact that ECKCS also provides services in Medway along with some services which are delivered in West Kent by Acute Trusts.

(10)     As a result of staff consultation, community paediatric services in West Kent were to be vertically integrated with Maidstone and Tunbridge Wells NHS Trust and Dartford and Gravesham NHS Trust.

(11)     Speaking on behalf of Kent Adult Social Services, Anne Tidmarsh welcomed the idea of a Kent wide Trust as this would enable the good work which was already happening integrating services to continue in areas such as hospital discharge pathways and a single assessment process so that the same person would not need to be assessed by a nurse and a social worker.  KASS would also continue to work with the Acute sector, particularly in the light of the increased responsibility of Acute Trusts over hospital discharges.

(12)     As a representative of the Acute Sector, Ashley Scarff noted that he recognised the importance of the community services sector and that it was important not to become too focussed on organisational form.

(13)     Members felt that the publication of the NHS White Paper raised a number of questions about how community services, and a Kent wide Trust in particular, would fit in with the move to transfer responsibility for commissioner NHS services to GPs.  The forthcoming publication of the Public Health White Paper would give further details of the developing shape of how the NHS and local authorities would fit together, with responsibility for this aspect likely to go to local authorities and that this would include health visitors.

(14)     The Committee requested that this subject be returned to at a later date and representatives from the NHS suggested early in 2011 would be timely.

(15)     The Committee then turned its attention to the use of Community Hospitals.  As an overview it was explained that in East Kent there were 175 beds across 6 community hospitals and in West Kent 130 beds across 6 community hospitals.  They all provided different services and were spread unequally across Kent.  They were seen as central to how the health economy operated in both halves of the county.

(16)     In West Kent there was joint commissioning with the local authority for integrated care and services at the hospitals were being developed to enable a wider range of patients to access care as, for example, through changing the admissions criteria so that patients with longer rehabilitation needs than the current 6-8 weeks would be able to be cared for.  Community hospitals were looked at as part of the whole rehabilitation pathway as accessing these beds would free up beds in Acute hospitals.  Mental health patients were not included in the new criteria as they were not properly resourced for this group of patients.

(17)     It was reported that similar developments were happening in East Kent.  The community hospital setting was seen as beneficial for patients, particularly where it enabled them to be closer to friends and relatives.

(18)     In response to questions from Members who felt that 1 Kent wide Trust would mean the local dimension was missing, representatives of the NHS responded that the same principles would apply in developing services whether or not the merger happened as the locality model was important.  Likewise, restrictions like the location of the hospitals and the state of the Estate would still exist.  Gravesham Community Hospital was the only new state of the art facility out of the 12 across Kent.

(19)     Dr Mike Parks of the Local Medical Committee reported that the GPs largely agreed and felt that community hospitals could, and did, do more than provide inpatient services.  They had a key role to play in diagnostics, out of hours care and other outpatient services.  GP commissioners will be looking for community hospitals to do more and will be looking for GP and District Nurse admitting rights.  Dr Parks also reminded the Committee that GP commissioners would be able to choose from ‘any willing provider’ and that the potential increase in choice between providers could be a positive thing.

(20)     Anne Tidmarsh reported that Kent Adult Social Services already worked closely with the community hospitals on integrating care pathways, but that the choice of discharging people from hospital to either their home, intermediate care or a community hospital should be based on clinical need.

(21)     In response to a specific question about the lack of a community hospital in Maidstone, Mr Sheppard reported that the Kent and Medway Partnership Trust (KMPT) property at Heathside had been considered, but that this was being developed for use by children’s and adolescent mental health services.  There were currently ongoing discussions with Kent Adult Social Services over a possible development of the Dorothy Lucy Centre.

(22)     Following a question about paediatric audiology services which had been moved from Preston Hall to other community hospitals around Kent, Mr Sheppard reported that pending agreement of a Service Level Agreement, the service would be provided in Maidstone general hospital from July 2011 and that a limited home visiting service would be available in the interim.

(23)     On behalf of the League of Friends of Tonbridge Cottage Hospital, and more broadly other Leagues of Friends in West Kent, Mr Fuller explained that the current West Kent Community Health organisation was very well regarded, and this was the sixth Trust the hospital had been under in ten years.  However, if this organisation could not continue, he favoured vertical integration as most of the community hospital’s business came from step down beds.

(24)     With or without vertical integration, Ashley Scarff reported that community hospital beds were viewed as essential for acute services and the business case for the Pembury PFI relied on the presence of community hospital beds for step down purposes.

(25)     Members felt they needed further information on the alternatives to a Kent wide Trust and how community hospitals would fit into the developing NHS and so once more asked that an opportunity be found to return to this subject early in 2011.