Agenda item

Glenn Douglas (Chief Executive, Maidstone and Tunbridge Wells NHS Trust), Paul Sigston (Medical Director, Maidstone and Tunbridge Wells NHS Trust), Avey Bhatia (Chief Nurse, Maidstone and Tunbridge Wells NHS Trust) and Jayne Black (Director of Strategy & Transformation, Maidstone and Tunbridge Wells NHS Trust) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee and asked them to introduce the item. Mr Douglas began by giving an overview of the developing five-year strategy.

(2)       Mr Douglas stated that the biggest challenge for the clinical strategy was financial viability. The Trust was required to make an annual 5% cost improvement programme consistently over five years which was a quarter of current income. The Trust employed 5,500 staff which accounted for 80% of cost. The Trust was focusing on efficiency and a reduction of in non-elective activity to achieve financial viability. This would enable them to create capacity and deliver elective or full price non-elective care to a wider population. The Trust only received 30% of the tariff for emergency activity in excess of emergency activity in 2009 which cost the Trust £9 million each year.

(3)       He explained that the seven key drivers for change were identified:

1.    Quality issues to ensure sustainable clinical services such as the proposed development of the first hyper acute stroke unit in Kent by the Trust;

2.    Major financial challenges over the next five years;

3.    NHS West Kent CCG’s funding gap of £60 million by 2018/19;

4.    Predicted increases in demand for emergency non-elective services as the population gets older and lives longer; 

5.    Changes in technology to improve quality and efficiency;

6.    Workforce deficiencies;

7.    National recommendations including Sir Bruce Keogh’s recommendations to introduce seven day working and two levels of hospital emergency department: Emergency Centres and Major Emergency Centres. The Trust would like to establish one of two/three Major Emergency Centres identified for Kent.

(4)       He informed the Committee that a Clinical Strategy Group had been established which identified the four major work streams required to develop the strategy: emergency care; centres of excellence; seven day working; and integration & collaboration.

(5)                   He |highlighted the key messages from the strategy. The Trust needed to improve efficiency and productivity within the next two years including a reduction in the length of stay to below the national average. The Trust planned to redesign emergency pathways to achieve a reduction in non-elective activity and release 50% of capacity for other services. The Trust was aligning to West Kent’s five year commissioning strategy and engaging with local partners.

(6)       He stated that engagement with local partners included the Trust’s work with the Queen Victoria Hospital NHS Foundation Trust to establish a major hub at Maidstone Hospital. The Trust was working with Brighton and Sussex University Hospitals NHS Trust and High Weald Lewes Havens CCG to look at providing additional services at the Tunbridge Wells Hospital. The Trust was also in discussions with Medway NHS Foundation Trust to move some elective care to the Trust. It had developed strategic links with EKHUFT through the Kent Pathology Partnership.

(7)       He confirmed that the Trust was continuing to develop the clinical strategy. Work planned for July – September included the development of implementation plans, a new model of care for stroke services and plans for a paediatric A&E at Tunbridge Wells Hospital.

(8)       Members of the Committee then proceeded to ask a series of questions and made a number of comments. Mr Pearman thanked the guests for facilitating a visit to the Tunbridge Wells Hospital in March 2014 with Mr Crowther. He wanted to acknowledge the enthusiasm and professionalism of the staff he had met. He believed that the implementation of the strategy was dependent on front end delivery and was confident that this would be achieved by the staff. Mr Douglas thanked Mr Pearman for the compliment and highlighted the work of the Trust’s staff. The Trust ranked fifth out of 90 Trusts in the NHS Trust Development Authority's Patient Experience Survey which was testament to the staff.

(9)       A comment was made about pathway management for patients with multiple long term conditions. Mr Douglas acknowledged the need for the Trust to work closely with GPs and community services to provide pathway management. GPs required additional infrastructure from organisations such as acute trusts to support the co-ordination of patients with multiple long term conditions. Mr Ridgwell reminded the Committee that a paper on the strategic development of GP services would be brought to the September meeting.

(10)     In response to a specific question on the PFI initiative at the Tunbridge Wells Hospital and the cost of individual rooms, Mr Douglas explained that PFI was the only option to build a new hospital as the hospital at the old site was unsustainable. An option appraisal had been carried out by the Department of Health and the Treasury, using a Public Sector Comparator, which was supportive of the PFI initiative. It was explained that whilst a single room cost more as there was a larger area to clean with an en suite bathroom, nursing costs had remained the same. All new hospitals had a significant number of single rooms which patients responded well too. 

(11)     A question was asked about traffic congestion in Tunbridge Wells and its impact on the Hospital. Mr Douglas explained that ambulance timings had not been affected by congestion; they were able to get through the traffic. He noted that staff and patients were impacted by traffic congestion. The old site, the Kent & Sussex Hospital, was located in the centre of Tunbridge Wells which was significantly impacted by congestion. Mr Douglas expressed concerns about the impact on the hospital with the construction of dual lanes on the A21 from Tonbridge to Pembury.

(12)     A number of comments were expressed about the CQC inspection at Maidstone and the involvement of the Trust in the Maidstone’s Borough Council’s Local Plan. Mr Douglas stated that he was disappointed by some of the comments made by the CQC particularly in regards to 24 hour consultant paediatrician cover at Maidstone Hospital. The comment by the CQC was made despite knowing that the paediatric service had moved to Tunbridge Wells and the Trust had closely followed the guidance set out by the Royal College of Paediatricians.  Following the CQC inspection, the Trust had reviewed the paediatric pathway and was looking to introduce a paediatric A&E in Tunbridge Wells Hospital. Mr Douglas acknowledged that the Trust needed to take a more active role in the community. He explained that he had responded to the Bluebell Wood planning application as there had been a desire by staff for the wood to remain next to the hospital. He stated that he felt that the Trust was not treated as a partner by the Borough Councils despite being one of the largest local employers which generated economic growth.

(13)     RESOLVED that the guests be thanked for their attendance and their contributions, and that there be on-going engagement with HOSC as plans are developed with a return visit to a meeting of the Committee at the appropriate time.