Minutes:
Patricia Davies (Chief Accountable Officer, NHS Swale CCG and NHS Dartford, Gravesham and Swanley CCG) and Dr Fiona Armstrong (Clinical Chair, NHS Swale CCG) were in attendance for this item.
(1) Ms Davies began by providing an overview of the short term proposals to assist Medway NHS Foundation Trust to implement recommendations made by the CQC for the A&E.
(2) Following the issue of a Section 31 Notice by the CQC (which could fully or partially close the A&E), Kent and Medway commissioners and providers met with NHS England to develop a plan to support the Trust. It was reported that the full or partial closure of Medway A&E would have a severe impact on local and neighbouring health economies.
(3) Proposals included the reduction of elective activity at Medway NHS Foundation Trust to increase internal capacity. Maidstone and Tunbridge Wells NHS Trust agreed to offer Swale patients the option to be seen at Maidstone Hospital for their elective outpatient appointments in three specialties – care of the elderly, respiratory and cardiology. Ms Davies applauded Maidstone and Tunbridge Wells NHS Trust for their support.
(4) Members of the Committee then proceeded to ask a series of questions and make a number of comments. Mr Angell and Mr Inett enquired about the issue of the Section 31 Notice by the CQC. Ms Davies explained that the Notice had been issued but not enacted. Following a meeting with the CQC, Monitor and the Trust, she stated that she did not believe that it would be enacted until a further unannounced inspection had taken place. She noted that the CQC were conscious about the impact on the wider system if the A&E at Medway Maritime Hospital was fully or partially closed.
(5) A Member asked for clarification about the outpatient proposal. Ms Davies confirmed that elective outpatient appointments at Maidstone Hospital for Swale residents in three specialities would be introduced imminently and would be enacted by patient choice.
(6) A number of comments were made about lack of improvement at the Trust. Dr Armstrong explained that the Trust had employed Dr Laurence Gant and two A&E nurses from the Homerton University Hospital NHS Foundation Trust for two days a week to support the Emergency Department and investigate patient flow. The Trust was looking to extend their contract to four days a week to enable them to develop a fit for purpose system for patient flow. It was reported that the Homerton A&E was one the best A&Es in the country and the first to be rated as Outstanding by the CQC. It was based in a deprived area of London and had poor transport link similar to Medway.
(7) Ms Davies reported that Member Practices’ in NHS Swale CCG also had concerns about the lack of improvement and the referral of patients to the Trust. The proposals were developed in response to those concerns and looked at different options to make improvements. Ms Davies expressed her support for Dr Philip Barnes; she stated that he had a refreshing focus on quality. She noted that he needed time and support to deliver changes to the Trust.
(8) The Chairman asked Mr Bowles, local Member for Swale East, to speak. Mr Bowles informed the Committee that he had signed off a letter to the Secretary of State for Health, as Leader of Swale Borough Council, expressing his disquiet at the speed of change at Medway NHS Foundation Trust. He stated that he was increasingly concerned about Swale residents being referred to the A&E at Medway Maritime Hospital. Ms Davies commented that NHS Swale CCG had a good relationship with Swale Borough Council and the local Health and Wellbeing Board was making every endeavour to support Medway NHS Foundation Trust.
(9) In response to a specific question about partnership working, Ms Davies explained that the CCG was working very closely with partners to deliver service change including the CCG Accountable Officers and local authorities. A further question was asked about the knock on effect of the proposals. Ms Davies reported that the shift of elective outpatient appointments would not have a wider negative impact. She reported that only 5% of NHS Swale CCG population receive their treatment in East Kent.
(10) A question was asked about staffing shortages at the Trust A&E. Ms Davies explained that Dr Gant’s view was that medical staffing levels were not poor comparatively. He believed that the department needed to relearn the most appropriate patient flow and care.
(11) A number of comments were made about the excellent work carried out by the staff at Medway Maritime Hospital. Dr Armstrong reported that there were pockets of excellence at the Trust; A&E was the main area of concerned. She stated that NHS Swale CCG was committed to working with the Trust to enable it to make changes and provide quality of care for patients. Ms Davies thanked the Members for their support.
(12) RESOLVED that the Committee are supportive of the decision to take urgent action at Medway NHS Foundation Trust, that the CCG be thanked for their attendance at the meeting and that they be invited to attend the Committee in January with a progress report.