Agenda item

Glenn Douglas (Chief Executive, Maidstone and Tunbridge Wells NHS Trust), Dr Paul Sigston (Medical Director, Maidstone and Tunbridge Wells NHS Trust) and Ian Ayres (Accountable Officer, NHS West Kent CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Mr Douglas began by giving an update on the clinical strategy. The strategy was being finalised and written. The Trust was required to produce a clinical strategy for the NHS Trust Development Authority (TDA) as part of their assurance process for clinical quality and sustainability. He stated that the Trust believed that they had a viable future.

(2)       Initial findings of the strategy had found that the Trust should focus on establishing a strategic hub for emergency care; improving productivity; serving a larger population base and developing patient pathways and community focus. There was an opportunity for the Trust to develop a Keogh Centre for emergency care at Tunbridge Wells Hospital to serve West Kent and parts of East Sussex. The Trust had already made £22.4 million of savings on the 2014/15 budget of £400 million; it was acknowledged further savings could be made through improving productivity and serving a larger population base including Medway and East Sussex. The Trust was also looking to carry out more elective surgery and outpatient services or expanding their emergency. It was stated that the Trust did not need to merge with the Conquest Hospital, Hastings or Medway Maritime Hospital to become a financially viable organisation.

(3)       Four key enablers had been identified to achieve the strategy: improving capability; promoting innovation to reduce costs; seizing opportunities for development and growth such as proactive care management; and being able to compete in tender processes. The Strategy will be taken to the Trust’s Board in December for approval. Mr Douglas stated that the strategy would be a dynamic document which would be regularly refreshed. An implementation plan, including a comprehensive stakeholder engagement plan, was being developed in addition to a review of the Trust’s governance structure.

(4)       Dr Sigston gave an update on the Trust’s plans for stroke service improvement as part of the clinical strategy. He explained that stroke was a major focus and concern for the Trust’s Board. A Stroke Improvement Board, Stroke Clinical Steering Group and Engagement Group had been established. He stated that the Trust was conscious of the need to meet the Government’s four tests for service reconfiguration. The Trust had undertaken early engagement with stroke patients and survivors, staff, GPs and MPs.

(5)       The Trust found that patients thought the service was good but the Trust had identified improvements. A clinical case for change had been developed. Both hospital sites did not meet stroke standards as measured by Sentinel Stroke National Audit Programme (SSNAP) data; improvements had been made during the last nine months with both sites moving from the lowest rating ‘E’ to ‘D’. The Trust had identified significant delivery options to improve their SNNAP performance to the highest rating ‘A’. The Trust was also required to meet the stroke specification issued by the South East Coast Clinical Network. The specification included a hyper acute service, similar to London, and a seven day rapid access to transient ischaemic attack (TIA) service which was currently lacking.

(6)       It was explained that the Stroke Clinical Steering Group had developed a long list of options for delivery. Early patient and public engagement would help inform a shortlist of options before public consultation on the options in May 2015. He noted the importance of taking time to engage with the public in order to reach a consensus.

(7)       Mr Ayres stated that NHS West Kent CCG, as lead commissioner of the Trust, welcomed the development of the strategy. He explained that there had been a joint CCG and Trust appointment to develop the strategy. He stated that the CCG believed that the Trust had a sustainable long term future without the need to merge and were keen for the Trust to develop a Centre of Excellence. He noted that the CCG would lead on the public consultation and that the clinical strategy would need to return to HOSC prior to public consultation in May 2015.

(8)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A Member enquired about engagement with GPs and implementation of the strategy. Dr Sigston explained that GPs were engaged with the strategy through NHS West Kent CCG, NHS High Weald Lewes Havens CCG and the Stroke Clinical Steering Group. Mr Douglas acknowledged that there was a long timescale for implementation. The Trust had hoped to consult sooner but was restricted by the 2015 General Election. He explained that the Trust was carrying out extensive pre-consultation engagement prior to the election and would go out to public consultation as soon as practical after the election. Once the public consultation had concluded, the implementation process would begin. He stated that in the interim, the Trust would continue to make improvements to the stroke service.

(9)       In response to a specific question on the hyper acute service in London, Mr Ayres explained that 30 local hospitals in London, which had previously received stroke patients, were reduced to eight hyper acute stroke units. Once stabilised the patient was transferred to a Stroke Unit in the same hospital or closer to home. Dr Sigston stated that this may involve a longer ambulance journey, passing several hospitals, but enabled patients to be assessed by a specialist, have access to CT scan and receive thrombolysis. This acute stroke care model had improved outcomes for patients in London. A similar model for cardiac patients had been developed in East Kent. Mr Douglas confirmed that there was no hyper acute stroke unit in Kent based on the London model. He stated the Trust’s intention to develop a hyper acute stroke unit on either of its sites with improved rehabilitation and community services for stroke patients.

(10)     A Member asked for clarification on mergers. Mr Douglas explained that the Trust was financially viable without the need for mergers and acquisitions. He noted that there were issues in Hastings and Medway and the Trust had been drawn into relationships with these Trusts. The Trust had recently opened up outpatient appointments to Swale residents via the Choose and Book system. There had also been an increasing number of referrals and births at Tunbridge Wells Hospital following a reconfiguration at Conquest Hospital, Hastings. He acknowledged that the Trust may be required to merge with other Trusts in the future but the Trust would be able to merge on their own terms. He stated that there was more synergy with Medway than East Sussex. Mr Ayres stated that the Trust was a standalone trust and that there was no reason for it to merge at this time.

(11)     A number of comments were made about advanced warning of strokes, the use of technology and private sector equipment. Dr Sigston explained that GPs were aware of patients with co-morbidities who would be prone to stroke. He stated that it was difficult to know in advance when an arterial bleed or clot would occur. A transient ischaemic attack (TIA) was a warning sign that unless urgent preventative action was taken, a major stroke could occur.  He noted that the Trust was moving towards a new IT system which would be implemented within the next 18 months. Dr Sigston explained that a seven day access carotid Doppler imaging machine was required as part of the South East Coast Clinical Network’s Stroke Specification. Private hospitals such as the Kent Institute of Medicine and Surgery (KIMS) were not able to provide this facility as their staff worked for other Trusts which would prevent seven day access.

(12)     There was discussion about a return visit by the Trust to the Committee before purdah. Mr Wickenden advised that the purdah period typically began six weeks before the scheduled election; an informal briefing to the Committee could be organised during purdah if required. Mr Douglas suggested a return visit to the Committee on 6 March 2015 with a shortlist of options for stroke services. A Member requested additional information on rehabilitation and community services for stroke patients to be brought to the March meeting.

(13)     RESOLVED that:

(a)      there be ongoing engagement with HOSC as the Trust’s five year clinical strategy and strategy for stroke is develop.

(b)       the Trust return to the Committee in March  2015 with a shortlist of options for stroke services and additional information on rehabilitation and community services for stroke patients.