Agenda item

Ian Ayres (Accountable Officer, NHS West Kent CCG) and James Graydon (Account Director, Kent Care Services, NSL) were in attendance for this item.

(1)       Mr Ayres began by giving an update on the latest performance figures. He noted that there had been little improvement.  Whilst ‘Discharges/Transfers booked “On the Day” collected within 2 hours – 80%’ performance had improved, this had a negative effect on the other key performance indicators. He noted that there was a peak of discharges daily at 14.00 hours. He explained that Trusts were not booking discharges ahead of time; the majority of discharges were booked on the day as the Trusts struggled to clear beds for emergency admissions. 

(2)       Mr Ayres commended NSL for their support in helping Medway Maritime Hospital discharge patients. He noted improvements in the service since the appointment of James Graydon in July who provided local operational leadership. He stated that a discrete ring-fenced renal service would be introduced and tested in East Kent. 

(3)       Mr Ayres confirmed that CCGs in Kent and Medway, in discussions with providers, had agreed to re-procure at the end of the existing three year contract. A working group of CCGs and providers had been developing the project plan for re-procurement and the service specification. The group was aiming to complete the final draft service specification by the end of January 2015 in order to commence procurement from April 2015. He stated that there was no intention to change the eligibility criteria but there were discussions about options for the future delivery of the service – a Kent and Medway wide service or an individual service for each Trust.

(4)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A Member enquired about extreme waits for discharge. Mr Ayres explained that extreme waits were reducing slowly, since August there had been a focus on discharges. On an average day, there would be 30 – 40 booked discharges for Medway Maritime Hospital; recently there had been 100 discharges booked on one day as the Trust struggled to clear beds for emergency admissions.  He commented that PTS was an enabler of quality within a Trust; if PTS worked well, it enabled the hospital to perform better but if PTS did not work well, it put pressure on the rest of the hospital.

(5)       A number of comments were made about planned discharge. Mr Ayres explained that all Trusts estimated an approximate discharge date for each patient when admitted. He stated that it was much easier for NSL to plan if they were given the approximate discharge date in advance, even if it was later cancelled and rescheduled, than being booked on the day of discharge. He noted that the new specification would require a discharge protocol to be agreed between the PTS provider and each Trust.  Mr Graydon highlighted that NSL was engaging and reviewing the discharge policy with each acute trust to improve the booking of discharges. It was difficult for NSL to plan without advance booking due to the geographical spread of the seven acute sites in Kent and Medway. However Mr Ayres stated that the target to collect 98% of patients discharged from hospital within two hours was found to be reasonable when benchmarked against other providers.

(6)       A Member highlighted the work of the Integrated Discharge Team at Dartford and Gravesham NHS Trust. The Member enquired if there was a cut off time for returning patients home at night. Mr Ayres explained that patients should be returned home with support in place by 21.00. He acknowledged that patients who lived closer to the hospital, who had support in place, could be returned home by 22.00. In addition, he stated that patients should be readmitted to the hospital, if they are unable to be transported at a sensible time. He noted that some residential homes did not accept admissions beyond 17.00; NHS West Kent CCG was in discussions with KCC contracted residential homes to extend the admission time.

(7)       A Member noted the deterioration in performance for renal patients. Mr Graydon explained that if a patient arrived more than 30 minutes before their appointment, NSL would fail their Key Performance Indicator.  He noted that 90% of renal patients arrived within 20 minutes of their appointment. He highlighted that from the week commencing 1 December 2014, PTS for renal patients was being ring-fenced. This would mean that renal patients would be given their own transportation which could not be knocked out by a discharge or transfer.

(8)       A Member enquired about the culture at NSL. Mr Ayres explained that within NSL there were two groups: front line staff and the leadership. In his view, the front line staff did a great job; they had been through a period of significant change when they were TUPEd across from other Trusts to NSL. Mr Ayres expressed his concerns about the quality of local leadership, prior to Mr Graydon’s appointment, as demonstrated by the poor performance.

(9)       In response to a specific question about terminating the contract, Mr Ayres explained that there was a no fault clause in the contract which allowed a 12 month early termination. Under procurement law, the CCG would have to then advertise the contract in the European Journal for 15 – 18 months which would result in a termination six months early and would require a new provider to take over the service during the middle of winter. If the CCG terminated the contract on a faults basis, there was a risk of legal action by NSL. He confirmed that lessons learnt from the previous procurement would be incorporated into the re-procurement. If a contract variation was required prior to re-procurement, this would be negotiated between NHS West Kent CCG and NSL.

(10)     A number of comments were made about voluntary transport services and patients who were not eligible for PTS. Mr Graydon confirmed that NSL used 35 voluntary car service drivers. Mr Ayres stated that NSL had a responsibility to signpost patients, who were not eligible for PTS, to non-NHS funded voluntary sector transport. Funding for PTS was restricted to patients who were eligible.

(11)     A Member requested that the Chairman should write to all Trusts, on behalf of the Committee, about the importance of pre-booking discharges in advance with NSL. Mr Ayres suggested that he return to the Committee in March 2015 with the service specification, a more detailed performance summary and focused analysis of discharges by each Trust. He noted that there was good practice and a Trust by Trust analysis would identify specific Trusts who needed to make improvements. The Member agreed to this proposal.

(12)     RESOLVED that the report be noted and that CCG colleagues be invited to attend the March 2015 meeting of the Committee.