Agenda item

Marion Dinwoodie (Chief Executive, Kent Community Health NHS Trust), Lesley Strong  (Deputy Chief Executive / Director of Operations Adults (Kent Community Health NHS Trust), Isabel Woodroffe (Head of Governor and Member Recruitment, Kent Community Health NHS Trust), Natalie Yost  (Assistant Director, Communications, Engagement and Public Affairs, Kent Community Health NHS Trust) were in attendance for this item.

(1)       The Chairman welcomed the representatives from the Kent Community NHS Trust and invited Mrs Dinwoodie to introduce the item.

(2)       Mrs Dinwoodie set out the context, their five strategic goals and the consultation process for the Foundations Trust Application and referred to the papers on their journey to become a Foundation Trust which had been circulated with the agenda.

(3)       A general question was raised about the impact of Private Finance Initiatives (PFIs) on the finances of local hospitals. Although this did not affect Kent Community Health NHS Trust directly, it was explained that local PFI hospitals were looking at getting into a stable and mature position and had a 5 year plan to get full money back into the area by year 6. 

(4)       Members requested some clarification around which properties were run by the Trust. Mrs Dinwoodie confirmed that the Kent Community Health NHS Trust FT ran services in the 12 Community Hospitals around Kent, but that there was not an equitable distribution across the county as they tended to be positioned around the perimeter of the county. These were used as step down facilities from an acute setting. She stated that there needed to be a better balance between this and step up facilities from respite. The future of the community estate was currently being considered and it was likely a new body, The NHS Property Company, would take ownership of them. Most services were provided by the Trust outside of fixed locations, in the community. This contributed to a sense in which community services were like “dark matter” in the health economy in that they held everything together but were not visible. In the future, the Trust would be asset light which would improve its flexibility.

(5)       In response to a question about information to patients on about what to expect following an operation with an example given by a Member,   Ms Strong stated that the trust would be working on care pathways to ensure that this situation patients were given this information prior to discharge.  She undertook to discuss the specific matter further with the Member outside of the meeting. She explained that the normal process was to facilitate discharge into Community Services if appropriate.  With long term conditions part of the Trust’s work was supporting self management to help the client to manage the condition themselves.

(6)       In response to a question on how the difference made by the Trust would be seen on the ground, Mrs Dinwoodie and her colleagues stated that they believed that the Trust engaged with and listened to the patient now, but there will be a greater transparency under the constitution of the Foundation Trust as there will be a membership with Governors drawn from this. The aim was to make services more personalised. So, for example, if a client has a long term condition they would see what opportunities they have if they came to a focus group or engaged and were listened to. 

(7)       Referring to the FT consultation process, a Member referred to the 12 consultation meetings and assumed that they were linked to District areas and asked what the feedback been like so far and the attendance at consultation meetings. Ms Woodroffe explained that the Trust had also sought feedback at the County Show.  The Consultation process did not just start on 30 July 2012 as the Trust already had a large panel of people who they engaged with about services via their engagements team, which is a rich source of feedback.  The Trust also sought feedback from these people in August.  The Trust had run a radio campaign on a local station which was aimed at young people.  The Trust had a small team who went out to all kinds of events with specific groups and they had been out and about in the community.  She believed that they had received about 36 written responses but had also captured the responses from meetings that they had attended. 

(8)       In relation to a question about the financial duty upon a Foundation Trust and the difference between this and the break even duty, Mrs Dinwoodie explained that the financial duty on the Foundation Trust would be rigorous and went further than the break even duty.  She explained that as a Foundation Trust they would have to demonstrate to their Board, the Strategic Health Authority, the Department of Health and Monitor, as well as the Committee that they really understood their business.  They had to show that what they were going to provide had the certainty of support from various commissioners, including KCC, and that the Foundation Trust’s strategy matched commissioners’ intentions.  Also the Foundation Trust needed to demonstrate a stable commitment over five years. This should enable the Trust to run a more stable organisation year on year than having to achieve annual break even.  If the Trust wants to pump prime anything to provide new services they needed to demonstrate how they would make a surplus, they therefore need to have a recurring balance every year.

(9)       In relation to a question about the wellbeing of staff, Ms Strong stated that there was a robust Occupational Health service available, and there were policies being developed around for example staff smoking at work. However, lifestyle choices were down to the individual, although it was possible to influence this through work polices. 

(10)     In relation to assessing community based quality of service Mrs Dinwoodie explained that this would be a matter for Monitor.  In the past the Trust had been paid as a block contract and therefore they did not know the true cost of each service.  They were now moving to a tariff regime and would therefore be able to see if a service was making a profit or loss. This in turn would help the Trust consider issues of quality and value for money. The Trust also wanted to be able to show what impact they were having with their work to try to get performance and understanding out into the open. She stated that they would keep the Committee informed of progress.

(11)     Ms Strong explained in response to a question on the equality of provision that there was a tension between how the Trust made the service locally appropriate, as they had to engage with CCGs, and the risk that the services would develop differently depending on CCG commissioning and local community needs. The aim was for people not to have to go to acute hospitals but to manage their own condition, for example via telehealth.  This could work very well at the local level but one size did not fit all.

(12)     Mrs Dinwoodie, in response to a question stated that the Trust was getting better at understanding what patients and GPs will want to choose.  The Trust was gaining the confidence of patients and partners through, for example, listening to patients and aiming to be responsive.  They were getting to the stage of seeing what offer would be in each CCG area.  They were trying to get as much sign off and input from CCGs as to what they will want to commission. Expanding the numbers of people appropriately looked after in the community was possible but limited by budgets and what could be afforded.  

(13)     Mrs Dinwoodie confirmed that there were 19 Community Trusts aspiring to be Foundation Trusts so there was a network, which enabled the Trust to produce benchmarks as well as sharing and learning from best practise.   

(14)     Mrs Dinwoodie confirmed that the Trust was taking the application to their Board and the Strategic Health Authority in November 2012. 

(15)     In response to a specific question Ms Woodroffe explained that local people would hold the Foundation Trust to account via the Council of Governors.  The Public Governors would be elected by the membership who would be balloted in March 2013 and there were already 20 people who had expressed an interest in becoming a Governor.  In November/December a workshop would be held for anyone interested in becoming a Governor. The four Staff Governors would be elected in a similar way.  The out of area Governor would be elected from people who did not live in Kent but had accessed the Trust’s services. There had been no expressions of interest for out of area Governors but these could be elected over time in the same way as the other Governors. The stakeholder Governors would be elected by their appointing bodies.

(16)     In relation to locations for services, Ms Strong explained that work was being carried out to provide services in different ways such as, for example, from Children’s Centres.  In relation to services for Adults the Trust was looking at co-locating in existing or KCC buildings.  She emphasised that the Trust wanted their budget to be spent on staff and services and did not want the expenses of running a large property estate. 

(17)     Regarding the statement in the paper that the Trust wanted to have “committed” staff, Ms Strong stated that they were going through large scale changes and that this recognised the need to take staff with them. They did this by constantly explaining to staff what was happening and why there was a need to change and do things differently.

(18)     In relation to a question on achieving financial balance Mrs Dinwoodie explained that there was a need to have a stable service which was in control of its revenue year on year and its targets to save year on year.  In relation to savings she explained that for many years they had shaved budgets but now there was a need to redesign services and to work across boundaries, this was a huge thing to get right.   Regarding the Acute Trusts, they had 70% of beds occupied by people with long term conditions; this was a drain on the health economy. 

(19)     The Chairman stated that there was an additional subject that he wished to raise with Mrs Dinwoodie.  This was stroke services at Tonbridge Cottage Hospital.  Mr Daley referred to this matter and the question of what consultation the Trust had carried out with this Committee prior to the changes being implemented. He reminded Health Service colleagues that where there was a proposed change of service provision the Committee should be informed so that they could decide if it was a significant service reconfiguration and how it might wish to be involved or consulted. 

(20)     Mrs Dinwoodie explained that when the consultation was undertaken for the new Pembury Hospital part of the change was that the ward for stroke rehabilitation would not be within the acute hospital and that it would go to a community unit in Sevenoaks.  There was subsequently a view that would be better placed at the Tonbridge Cottage Hospital, the PCT Board therefore made this decision. Ms Strong confirmed that there were still community beds at Tonbridge Cottage Hospital and others had been re provided over West Kent.  Discussions were underway with local CCGs to look at increasing the number of community beds at Tonbridge but these were at an early stage.   She gave an undertaking that the Trust would bring any proposed changes to services to this Committee at an early stage.

(21)     The Chairman emphasised that the Committee should be informed of any proposed service changes at an early stage and if the Committee decided that they were a substantial variation then it would need to be fully involved.

(22)     RESOLVED that the guests be thanked for their contributions and that the Committee looks forward to receiving further updates in the future.