Agenda item

Dr Mark Jones (Chair, NHS Canterbury and Coastal CCG), Simon Perks (Accountable Officer, NHS Canterbury and Coastal CCG), Sally Allum (Director of Nursing and Quality (Kent and Medway), NHS England) and Dr John Allingham (Medical Secretary, Kent Local Medical Committee) were in attendance for this item.

(a)       The Chairman welcomed the guests of the Committee and asked them to introduce the item. The representatives of NHS Canterbury and Coastal CCG began by setting out a short chronology. Three weeks prior to the Committee meeting, the CCG had considered the outcome of the tendering service for the Minor Injuries Unit at Faversham Cottage Hospital. There were no successful bidders and the decision was taken to serve notice and close the service. The request was made by the CCG to bring the topic to HOSC. Since the announcement two weeks before, there had been a lot of interest and concern expressed. Stakeholder meetings had been held and would continue to be held.

(b)       The Chairman then asked Mr Andrew Bowles to speak as a guest of the Committee. Mr Bowles thanked the Chairman for the opportunity to address the Committee and also thanked the representatives of the CCG for including him in other meetings which had taken place and were due to take place. He read out a message from the local MP, Hugh Robertson. Mr Robertson expressed his concern at the closure of a valued local service as well as the impact of the longer journey times to the alternative sites and the congestion which could be caused at them.

(c)        Mr Bowles added that part of the problem was that this proposal had not been known about in advance and so this had not allowed for any discussions with the Borough Council on possible solutions. Mr Bowles explained that he was Leader of Swale Borough Council and a former non-executive director of a Primary Care Trust. In light of this experience, he thought that when a procurement exercise had begun with nineteen interested parties, which then resulted in eight attending a bidder event, and ultimately one bid which was found wanting, then the whole process should be looked at again. The Council had recently voted unanimously to write to the Secretary of State on this issue which was one of great concern locally and would impact on the 28,000 residents of Faversham. The request had been made to the CCG asking them to go back to stage one of the procurement and undertake it again, consulting the Borough Council and Kent County Council (KCC), particularly in light of KCC expertise in procurement. Mr Bowles added that Estuary View in Whitstable was a good service, but it was 5-6 miles away and there were inadequate public transport links. This meant people were more likely to travel to the Kent and Canterbury Hospital, adding to the pressures at that site.

(d)       Mr Bowles also made reference to a statement issued by the local GPs in Faversham explaining that they were not in favour of the closure and had not been involved in the decision. CCG representatives explained that the local GPs had subsequently issued a new statement clarifying that they had been involved in discussions, but had not been involved in the confidential part of the tendering process.

(e)       CCG representatives further explained that the tendering process was not a short one. The original contract was for a collection of services. The treatments rooms would be remaining. The tendering exercise was only for the Minor Injuries Unit (MIU). It was explained that 300 people each month used the MIU and that it would be better to improve access to GP services for these people. The original contract for the MIU had been extended over and over by the predecessor Primary Care Trust and could not legally be extended any further. There had been lots of discussions with GPs and patients and the public and an East Kent wide specification had been developed as to what an MIU should be so this service would then be consistent across the area. The tender was for a seven day service including an x-ray service. The one bid submitted involved bussing people to Sittingbourne and cost £100,000 more than the cost envelope. The cost of the tender was set by the national tariff.

(f)         Members of the Committee then proceeded to ask a series of questions and make a number of comments. One Member observed that GP practices were also stretched and could not necessarily be asked to take on additional services. Reference was also made to correspondence sent to Members of the Committee by the Friends of Faversham Cottage Hospital and Community Health Centres. Clarification was sought as to the place of the £300,000 which the Friends had raised for an x-ray machine in the tendering. It was explained that this had been a core component of the tender. However, the building had been appraised and it was not suitable for an x-ray machine.

(g)       Observations were made about the length of time the CCG as an organisation had been operating and whether this had made an impact on the success of the procurement. CCG representatives explained that the staff supporting the procurement were experienced and had carried out procurements for Primary Care Trusts in the past. It was also explained that the tendering process had been looked at and no issues had been found and that the original specification had been drawn up in consultation with local GPs, public and patients. It therefore did reflect local need. CCG representatives explained that it was difficult to see where the process could have been stopped due to the numbers expressing an interest and it was judged that the one bid submitted was worthy of serious consideration. The process had failed only in the sense that a suitable provider had not been found. The only option would be to tender at a lower service specification.

(h)        Concern was expressed about other changes being proposed in other areas, such as at Deal Hospital, and whether the closure of the MIU at Faversham was possibly the thin edge of the wedge leaving East Kent ultimately only with three large acute hospital sites. CCG representatives explained that the broader shift was to move services out of acute hospital sites and that the CCG was a partner in East Kent Hospitals’ outpatient services consultation as they felt it was important to listen to the views of the public. The view was expressed that it was important to look at what services would be required in the future, not what had been provided in the past.

(i)         A Member of the Committee drew a comparison to Edenbridge Community Hospital where the MIU had been revamped and that this served a smaller population. In response to the points raised, it was explained that the CCG could not provide the service in house under the current rules and that the service was also not suitable for Any Qualified Provider.

(j)         Discussion also included the nature of the Faversham Hospital estate. It was explained that it was owned by NHS Property Services Limited and there were no planning applications on it. It was believed that Estuary View was privately owned by the relevant GP practice. The MIU at Faversham took up 3% of the floor space of the hospital, or two and a half rooms. There were also 2 GP practices on the site so there was no danger to the future of the hospital. This was questioned by a local Member who believed that while the GP practices were adjacent to the hospital, and linked to it, they were not part of the hospital estate as such. In response to a question, it was explained that no interest in provided services in the areas currently occupied by the MIU had been expressed.

(k)        Mr Nick Chard proposed the following recommendation:

§         That this Committee asks that the decision to close the service on 31 March 2014 is set aside. This will allow a new procurement exercise to be undertaken after taking advice and with full consultation with the people of Faversham and their democratically elected representatives.

(l)         This was seconded by Ms Angela Harrison.

(m)      This recommendation was discussed by the Committee and the view was expressed that this did constitute a substantial variation of service. The possibility of referring the issue to the Secretary of State was raised. The Researcher to the Committee explained the regulations underpinning a formal referral along with the requirements of the KCC constitution. Although it would not be a formal referral, the Committee requested that the Chairman write to the Secretary of State on this matter which the Chairman undertook to do.

(n)        AGREED that this Committee asks that the decision to close the service on 31 March 2014 is set aside. This will allow a new procurement exercise to be undertaken after taking advice and with full consultation with the people of Faversham and their democratically elected representatives.