Agenda item

Stuart Bain (Chief Executive, East Kent Hospitals University NHS Foundation Trust), Rachel Jones (Divisional Director for the Surgical Division, East Kent Hospitals University NHS Foundation Trust), Peter Gilmour (Director of Communications, East Kent Hospitals University NHS Foundation Trust), Paul Sutton (Chief Executive, South East Coast Ambulance Service NHS Foundation Trust), Matthew England (Clinical Quality Manager, South East Coast Ambulance Service NHS Foundation Trust), Helen Buckingham (Deputy Chief Executive and Director of Whole Systems Commissioning, NHS Kent and Medway), Helen Medlock (Associate Director of Urgent Care and Trauma, NHS Kent and Medway), and Victoria Osborne-Smith (Senior Project Manager Trauma and Critical Care, NHS Kent and Medway) were in attendance for this item.

(1)       Following the Chairman’s welcoming of the guests, representatives of the NHS were asked to introduce the items. It was explained that the East Kent Hospitals University NHS Foundation Trust (EKHUFT) clinical strategy and the development of the trauma network were both broad and distinct strategies but that there were clear overlaps between the two.  

(2)       As regards major trauma, it was explained that Kent and Medway saw around 700 cases each year, or 2-3 each week. In East Kent the annual number was round 300. The clinical evidence supported the practice of taking patients directly to a major trauma centre which for Kent and Medway primarily meant King’s College Hospital in London. There were three elements to the strategy. Firstly, the elements needed organising in a network and there was now a South East London Kent and Medway Major Trauma Network. Secondly, the systems needed to have in place the appropriate protocols. Thirdly, rehabilitation and recovery had to be considered. Shadow rehabilitation prescriptions were currently being used to identify gaps in service.

(3)       It was being recommended that Medway Hospital and Tunbridge Wells Hospital be designated as a Trauma Unit. The original intention was also to recommend designation of William Harvey Hospital. Work was ongoing with EKHUFT as this formed part of their clinical strategy.

(4)       Responding to a specific question, it was explained that Birmingham did have a major trauma centre, but that the adult’s and children’s centres were separate.

(5)       Representatives from EKHUFT explained that they were currently in the engagement stage of developing their clinical strategy but that public consultation would follow should any major changes arise from it. It was accepted that in the past the NHS was legitimately criticised for presenting ‘take it or leave it’ choices and looked to improve on this. For example, the Royal College of Surgeons was coming into the Trust to provide some objective analysis.

(6)       It was explained that along with the trauma system, there was a need to improve out of hours emergency surgery. Nationally, the mortality rate is 11-15% higher than regular hours surgery. At EKHUFT the rate was 9% higher. In response to a question about measuring outcomes in surgery, it was explained that it was more than a black and white question around mortality as longer term complications from surgery and co-morbidities needed to be factored in as well. The clinical strategy was broader than both trauma services and emergency surgery. EKHUFT was looking to stop inappropriate admissions to hospital, introduce one stop shops, establish leading edge day surgery centres, reduce length of stay, and aimed at things like rehabilitation.

(7)       By way of context, it was explained that EKHUFT was a Trust composed of 3 district general hospitals and 2 community hospitals which operated from around 20 different sites. The Trust dealt with 600,000 outpatients each year. However, the services were often fragmented so that the same patient might need to travel to different places across the area to complete one episode of care. The idea of one stops shops was to reduce the number of sites where services were offered to 6 but to offer a more comprehensive service at each. While acknowledging issues around public transport, the Trust was looking to have a one stop shop within a 20 minute car drive of everyone in East Kent. This was considered appropriate for the often rural nature of the geography.

(8)       In response to a specific question about the impact of the European Working Time Directive, the answer was given that there was an impact, particularly on shift patterns, but it was more broadly a problem with the medical training regime in England. More trust grade doctors had been appointed to ensure patient safety as there were more complex handovers. 

(9)       EKHUFT had a Hospital Standardised Mortality Ratio of 80 against the national average/benchmark of 100, which was good, and the clinical strategy was an attempt to stay ahead of the curve so that the latest advances in medicine could be adopted, such as da Vinci robots for complex surgery.

(10)     Responding to a question about staffing levels in the Trust’s accident and emergency departments (A&E), the response given was that while there were disagreements over nursing shift patterns, staffing was not being reduced. The chief Executive was not aware of any requests from the Royal College of Nursing for a meeting on this. 3 new locum consultants for A&E had been hired. 1 was a replacement, but the other 2 were new posts.

(11)     The ambulance service was changing its service alongside these changes in other Trusts and services. Ways of working were altering so that there was a need on the one hand to stabilise patients in order to take them to centres of excellence, such as a Major Trauma Centre, rather than necessarily to the local A&E, and on the other hand to treat patients on the scene to avoid the need to admit them anywhere. With regards the questions raised about the air ambulance, the response given was that the Ambulance Trust did not need to own its air ambulance as it had very good working practices with the existing ones and handled the calls to its service. The Committee were informed that the air ambulance service was working towards 24/7 capability.

(12)     A strand of comment and criticism from Members throughout these discussions was the cumulative effect of what seemed like good decisions individually. Adding them all together could change the landscape of health services completely and possibly in unintended ways. The logic could be, it was suggested, to centralise all services in London. Representatives from the NHS responded that the health landscape was changing but not all in one direction. There was repatriation and decentralisation as well as centralisation in health services. Primary angioplasty, for example, was now available in Kent. The fitting of multiple stents used to require several trips to London but could now be undertaken at a local district general hospital in Kent.

(13)     The Chairman proposed the following recommendation:

·        That the Committee thanks its guests for their valuable contributions and looks forward to further updates taking into account the comments made today.

(14)     RESOLVED that the Committee thanks its guests for their valuable contributions and looks forward to further updates taking into account the comments made today.