Agenda item

Stephanie Hood, Director of Strategy and Communications, and David Mallett, Assistant Director, “Fit for the Future”, South East Coast Strategic Health Authority, will be in attendance for this item.

(Stephanie Hood, Director of Strategy and Communications, and David Mallett, Assistant Director, “Fit for the Future”, South East Coast Strategic Health Authority, were in attendance for this item at the invitation of the Committee.)

1)     Stephanie Hood, Director of Strategy and Communications for South East Coast Strategic Health Authority, gave the Committee a presentation on the development of the South East Coast element of Our NHS, Our Future – Next Stage Review (the Darzi Review). Slides from the presentation are attached to these minutes as Appendix 3.

2)     The Chairman thanked Ms Hood for her presentation. He emphasised it should not be forgotten that the South East, despite being an affluent region overall, still had real problems of deprivation.

3)     A number of Members raised the question of polyclinics and the impact that these would have on local GP surgeries. Ms Hood responded that the work being undertaken in South East Coast around the Darzi Review was bottom-up and clinically led. It reflected what local people had told the NHS and was not being dictated from the centre. Whilst Lord Darzi had proposed a network of polyclinics for the NHS in London, this was not a blueprint for the rest of the country. Where polyclinics were proposed, it was to provide additional services, not to replace existing ones. And the Committee needed to focus on the ends that the NHS was trying to achieve, rather than on the means being employed.

4)     Regarding GP-led health centres, which had been described as polyclinics, Ms Hood accepted that PCTs were being required to introduce these – but there would only be one in each PCT area. These would provide additional services, targeted at underdoctored areas, and it would be down to PCTs to carry out appropriate consultation over their introduction.

5)     David Mallett, Assistant Director for “Fit for the Future” at South East Coast SHA, responded to a question about whether polyclinics might destabilise acute service providers by taking patients, and therefore funding, away from them. He said that the intention was now to deliver care locally both because this was cheaper and because it provided better access for patients. The NHS was now in financial surplus, having put an end to the “boom and bust” of the past, and this would enable some money to be taken out of the acute sector. Financial modelling had shown that, under Payment by Results, it would be possible to take marginal amounts of activity out of the acute sector without destabilising acute Trusts. There was no threat to the financial sustainability of any hospital in Kent and Medway, or anywhere else, caused by shifting activity into the community.

6)     Mr Mallett added, regarding polyclinics, that they were intended to enhance GP services, not to replace them. In any case, GP practices were not the NHS’s to close – they belonged to GPs as independent contractors.

7)     Responding to a question about maternity services, Mr Mallett said that, across South East Coast, consultant cover on maternity wards ranged between 15 hours per week and 40 hours per week. In the short-term, it was intended to provide 40 hours’ consultant cover per week everywhere, rising to 50 hours’ cover in the medium term and 60 hours’ cover in the longer term. In achieving this, there was an issue regarding the number of consultants available to staff the necessary rotas. He emphasised that, where there was not consultant cover, middle-grade doctors and midwives were still present.

8)     On the issue of partnership working between health and social care, Ms Hood agreed that this was very important. She said that Lord Darzi had visited West View Hospital at Tenterden and said that the hospital had the best joint working between health and social care that he had ever seen. Best practice was going on in such places, and it had to be spread.

9)     Responding to a question about the cost of public consultation around the Darzi Review, Ms Hood said that this expenditure did not come from the budget for care of patients – and she would not apologise for asking people’s views.

10)A Member asked about protocols regarding the distance travelled, and time taken, in transporting patients to receive emergency care. Mr Mallett said that in a few clinical instances there was guidance on maximum time taken in getting a patient to emergency care. However, in the main there was no evidence to support the intuitive view that shorter times produced better clinical outcomes. There was really good evidence to show that the key factor in producing better clinical outcomes was getting the patient to a centre of excellence – regardless of how long it took.

11)Regarding end-of-life care, Ms Hood said that it was not being suggested that everyone had to die at home. The intention was to allow people to die where they wanted. Mr Mallett added that currently 55% of people died in acute hospitals, and that people did not get the choice of alternative options (including hospices) early enough.

12)In response to a question about the dignity of patients and the persistence of mixed-sex wards, Ms Hood said that it was intended to address this issue.

13)Ms Hood thanked a Member for raising the issue of the NHS failing to support young carers; this was just the sort of feedback that was needed.

14)Responding to a question about personal budgets in the NHS, Mr Mallett said that there was a move to this, in line with the choice and patient empowerment agenda. Where such budgets were provided, patients would be able to choose to spend them on NHS care, social services care or third-party care.