Agenda item

Simon Perks (Accountable Officer, NHS Ashford and NHS Canterbury and Coastal CCGs), Liz Shutler (Director of Strategic Development & Capital Planning, East Kent Hospitals University Foundation Trust), Rachel Jones  (Director of Business and Strategy Development, East Kent Hospitals University Foundation Trust) and Marion Clayton (Divisional Director, Surgical Services, East Kent Hospitals University Foundation Trust) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Ms Shutler introduced the item and proceeded to give a presentation which covered the following key points:

·         The Trust’s justifications for change

·         Consultation and engagement process

·         Feedback from patients

·         Outpatient Services Strategy

·         The six proposed Outpatients sites

·         Option appraisal for the North Kent site

·         Next steps - decision-making at the EKHUFT and CCG boards

(2)       The Chairman asked Miss Harrison to comment on the optional appraisals which she attended on behalf of the Committee on 22 April and 29 May. Miss Harrison observed that she had been impressed and surprised by the thoroughness of each appraisal. The final option appraisal in May was held following the receipt of information from NHS Property services.

(3)       Mr Inett was also invited to comment. He explained that Healthwatch Kent had been working with the Consultation Institute; they had been using the consultation as a test case to look at their role as a critical friend. The focus of the consultation by the Trust had been on Landsley’s four tests for service reconfiguration. Mr Inett highlighted that if there was a legal challenge, the Gunning Principles would be applied instead. One of the Gunning Principles was that consultation must take place when the proposal was still at a formative stage. Mr Inett requested additional information regarding the public’s involvement in option development. He also sought clarification about the support for six outpatients’ clinics (question 7 on page 59 of the agenda pack) and the involvement of minority groups in focus groups. Mr Inett commented that the consultation focused on the North Kent site and that Healthwatch had been made aware of concerns from the public regarding the effectiveness of the one stop shop process. Healthwatch Kent was looking at one stop shops across the country. Healthwatch Kent were meeting with the Trust to discuss issues in detail.

(4)       Ms Shutler responded to the comments and questions raised by Mr Inett. It was explained that the six sites were modelled technically looking at patients, travel times and demographics of the local communities. Patient and professional representatives were on the working group which developed the outpatients’ strategy; patient surveys and public stakeholder meetings were also held. Concerns had been raised by elderly groups about the time appointments would take and facilities at the one stop shop. The Trust stated that giving more power to patients to book appointments would improve the flow and patient experience. The Trust commissioned the University of Kent to undertake the focus groups; the outcomes of these focus groups were detailed in the report. During the consultation period, the Trust was able to talk to other minority groups including the Nepalese community in Hythe. Ms Shutler indicated that she could provide further details to Mr Inett at their meeting.

(5)       Members of the Committee then proceeded to ask a series of questions and made a number of comments.

(6)       Members raised concerns about the Trust’s investment of £455,000 to extend and modify public transport routes provided by Stagecoach.  It was explained that the Trust had been in lengthy discussions with Stagecoach about additional services; Stagecoach had not been willing to look at additional routes without additional funding. The majority of the funding would be going to Stagecoach to provide additional routes. Details of voluntary sector transport services would be made available to patients in their information pack when booking appointments. In relation to a specific question about transport links in Deal and Walmer; it was acknowledged that the number of buses which run from Deal to Buckland Hospital per hour would be doubled. There was also a proposed route from Whitfield to Buckland Hospital which would run on to Deal, Sandwich and the QEQM Hospital. The Trust acknowledged the need to improve and invest in public transport; at present 80% of the Trust’s patients travel by car to their outpatient appointments. The Trust was working with the current patient transport service provider to improve their response rate.

(7)       A Member enquired about the quality of communication with patients. As part of the outpatients’ consultation, patient administration services had been reviewed. The Trust had found issues with communication with patients and was looking to improve this aspect of their service. It was confirmed that letter writing had not been outsourced to a foreign company; letters were written by Trust staff locally.

(8)       A Member expressed concerns that patients in Deal would have an increased journey time to outpatients’ services as set out in the proposals.  It was explained that under the proposals the number of patients from Deal, who would be able to access care within the time frame, would increase. Residents in Deal generated 30,000 outpatient appointments a year, a third of these appointments (10,000) took place in Deal Hospital. 90% of appointments at Deal Hospital were follow-up appointments; patients would not access their entire pathway at the hospital.

(9)       The Member raised a further concern that the residents of Deal had been misled in a previous consultation regarding Buckland Hospital and the service provision in Deal. It was explained that the consultation being referred to was a consultation on service provision in Dover which was led by East Kent Primary Care Trust in 2006. The consultation document looked at three options for outpatient services: services being provided as close to home as possible in a GP surgery or in a central Dover location; moving services from community to acute hospitals; and maintaining services at all sites including at Deal Hospital. The majority of respondents chose option G1 – providing services as close to home as possible in a GP surgery or in a central Dover location. Ms Shutler stated that she felt that this was a very clear consultation exercise. As a result of the 2006 consultation, East Kent Hospitals University Foundation Trust invested £23 million to develop a new hospital at the Buckland site.

(10)     A number of comments were made about the consultation events, patient mobility and the capacity of the proposed system. The Trust offered to provide the Committee with data regarding outpatients accessing patient transport services. It was acknowledged that capacity was currently underutilised. Under the proposals, the working day would be extended which would increase the utilisation of the buildings and enable patients a greater choice of appointments. The workforce would be maximised and provide a more efficient service as staff would not be required to drive to 15 different sites. The Trust had forecasted demographic growth as part of future proofing and was confident the service would not be over capacity in the future.

(11)     The Trust asked in their report for the Committee to ‘agree that the public consultation process has met the required standards as set out in the Health and Social Care Act’. The Scrutiny Research Officer was asked to provide guidance on the recommendation. She explained that the legal duty to consult local authority health scrutiny bodies was distinct from the separate duties in the NHS Act 2006 (as inserted by the Health and Social Care Act 2012) on Trusts, CCGs and NHS England to involve service users in the development of proposals for service change; and it was important that the two duties were not confused or conflated. She stated that a recommendation, asking the Trust and CCG to take on board the comments made by Members during the meeting, would be more appropriate.

(12)     RESOLVED that:

(a)       The Committee records its appreciation of the hard work the Trust has put into the consultation.

(b)       The comments made by Members of the HOSC are considered and taken into account.

(c)        The Committee asks for a return visit in September when a final decision has been taken.