Agenda item

Glenn Douglas (Chief Executive, Maidstone and Tunbridge Wells NHS Trust), and Dr Paul Sigston (Medical Director, Maidstone and Tunbridge Wells NHS Trust) were in attendance for this item.

(1)       For this item, Members also had before them a copy of a presentation to which Trust representatives made reference during the discussion (see Appendix to Minutes).

(2)       The Chairman welcomed the Committee’s guests and invited the Chief Executive of Maidstone and Tunbridge Wells NHS Trust (MTW) to introduce the item. Mr Douglas reminded the Committee of the context five years previously when he took up the position of Chief Executive at MTW. The Trust was dealing with the impact of the report into Clostridium difficile. Without a new hospital, it would have been a possibility that the Kent and Sussex and Pembury Hospitals would have closed anyway but events at the Trust meant ambivalence at the Treasury and Department of Health towards building a new hospital became active support. As a result the new hospital, Tunbridge Wells at Pembury, is fit for purpose. Pictures were included in the presentation as a reminder of how much the quality of the estate has changed and improved. At the time, no alternative to the Private Finance Initiative (PFI) was available.

(3)       The 7% increase in NHS spending at the time meant the prospects for the PFI were looked at optimistically and the costs were considered worth paying. Looking at the financial figures closely, it was reported, the costs of the PFI are not the whole of the story. The PFI costs around £20 million in ‘rent’. The Pembury and Kent and Sussex Hospitals cost £7 million a year, so the new hospital adds £13 million. However, new building specifications have meant that even with the same number of beds, the hospital is 60% bigger. This in turn has meant the rates have risen from £350 thousand to £1.6 million. Running costs are also more in a bigger hospital. The Trust needs to deliver a 5% cost improvement programme each year just to stand still. The deflation of the tariff accounts for 4.5%, meaning 0.5% comes from other costs.

(4)       The Trust was one of seven where the Department of Health was looking to provide support for the PFI costs and the future success of the Trust in applying for FT status was dependent on the financial sustainability of the Trust, which was linked to the costs of the PFI. 

(5)       Mr Douglas pointed to the successful move to the new hospital and claimed that moving hospitals without closing A&E availability was one of his personal career highlights. However, the move was in some ways only the start. As the first all single roomed NHS hospital, new ways of working are needed. More nurses are needed to staff single rooms. An all single room environment is not a panacea for infection control issues. It is very effective for preventing the spread of norovirus, less so for Clostridium difficile. Being in a single room is also detrimental to some groups of patients, such as those with dementia and the possibility of establishing a tailored ward at Maidstone was being considered. Public perception was also interesting as 20% of patients still considered they were on a mixed-sex ward despite the single rooms. There were open visiting hours, although mealtimes were protected – unless relatives wished to help patients eat. A real time feedback system of patient satisfaction was used, and rates were very high at 90%.

(6)       Early problems with waiting times at accident and emergency were acknowledged, although these had been dealt with successfully. It was also acknowledged that more needed to be done to improve the appointments booking system and the way the Planned Care Office worked.

(7)       On the subject of transport it was reported that no complaints were received at Tunbridge Wells Hospital about the availability of car parking. Public transport was more of an issue. The Trust believed a recent compromise reached putting more resources into volunteer car services was an improvement on the original section 106 agreement which was reliant on finding a bus company willing to provide the service when it cost around £300 for each person travelling from Borough Green. It was also reported that the bus company, Country Lines, had just gone bankrupt. Transport to the new hospital was always prefaced on the improvements to the A21 being completed by this point in time. Work on it now could potentially be disruptive to access.

(8)       The Committee was informed that the Trust’s clinical strategy maintained the focus on developing centres of excellence at both sites. The nature of medical training meant doctors specialised earlier, but there was a valuable role still for generalists at the hospital ‘front door’. Emergency surgery was able to be carried out very quickly. In a number of areas it had been possible to repatriate services to Kent. The Trust employed the only specialised pelvic surgeon in the area. Building on the earlier debate, the Committee was informed that the Tunbridge Wells Hospital had received designation as a Trauma Unit.

(9)       In response to a specific question, it was explained that while some services had diverted patients to Maidstone from Tunbridge Wells due to capacity issues, no wards had been closed.

(10)     The Trust was also developing other services, such as the diabetes service in the centre of Tunbridge Wells and stroke rehabilitation beds at Tonbridge Cottage Hospital. The midwife-led birthing unit at Maidstone was proving more popular than expected, with 400 deliveries carried out this year. Satisfaction levels were also high here, including for those patients requiring transfer to Tunbridge Wells. The Tunbridge Wells Hospital provided some private rooms, as the Kent and Sussex had beforehand and this was used to help earn income for the Trust.

(11)     It was explained that it needed to be borne in mind that the move towards more services in the community was laudable, but did mean a reduction in income for the Trust.

(12)     The question was raised about the balance between managers from Tunbridge Wells and Maidstone in the new hospital. The answer was given that ward managers were fairly evenly divided. However, there were more Tunbridge Wells managers in the leadership of the maternity service, but the midwives managing the Maidstone birthing unit were from Maidstone.

(13)     One Member made the useful comment that Trusts made statements about the ratio of staff and performance for example, but it was difficult for an overview and scrutiny committee to fully judge whether these statements were valid and requested more context in the future where possible. In response, the East Midlands dashboard was given as a good example of capturing useful data.

(14)     The Chairman proposed the following recommendation:

·        That the Committee thanks its guests for their informative contributions, looks forward to further updates and wishes the Trust well with the challenges ahead.

(15)     RESOLVED that the Committee thanks its guests for their informative contributions, looks forward to further updates and wishes the Trust well with the challenges ahead.