Agenda item

Liz Shutler (Director of Strategic Development and Capital Planning, EKHUFT), Rachel Jones (Director of Strategy and Business Development), Mary Tunbridge (Divisional Director, Clinical Support Services, EKHUFT), Dr David Hargroves (Chair, Improvement Plan Delivery Board, EKHUFT), Simon Perks (Accountable Officer, NHS Ashford CCG and NHS Canterbury and Coastal CCG) and Hazel Carpenter (NHS South Kent Coast CCG and NHS Thanet CCG) 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 (included within the Agenda pack) which covered the following key points:

·         Case for Change

·         Integrated Care Strategy

·         Staff, Patient and Public Engagement

·         Overview of design and development of options for  the clinical strategy

(2)       Ms Jones reported that the Trust had learnt from the Outpatients Clinical Strategy and was keen to engage with patients and the public on the two – ten year Clinical Strategy. The Trust had been supported by Healthwatch Kent with nine engagement events with community groups, 800 face to face contacts and 180 speak out forms being completed. The Trust would shortly be developing a joint engagement strategy with the East Kent CCGs to agree an East Kent Health Economy wide approach. Ms Shutler noted that the Trust would be holding a formal public consultation in January to March and would be reaching a conclusion at the beginning of the next financial year.

(3)       Mr Inett reported that Healthwatch Kent had now spoken to over 1000 people as part of their engagement events. He noted that there had been significant press coverage with regards to service centralisation. He stated that he was satisfied that the Trust was genuinely engaging with the public. He advised that service and site centralisation was different and need to be communicated with the public.

(4)       A Member raised concerns about the potential closure of the Emergency Department at the William Harvey Hospital and its impact on the Chilmington Green development in Ashford. Ms Shutler stated that the Trust had begun engaging early with staff, patients and the public in the development of the strategy and options which had led to a lot of speculation in the press. She stated that there would be ongoing engagement and that no decisions about service centralisation had been taken. She acknowledged that there would be major change on all three hospital sites. The Trust was working with the CCGs to develop a coordinated approach. She noted that £1 million had been allocated to address the issues raised in the CQC inspection about the Accident & Emergency department at William Harvey including a paediatric unit. Mr Perks stated that the CCG and NHS England were now involved in the Chilmington Green development; Dr Jim Kelly was leading on the work for NHS Ashford CCG. The CCG had only recently become involved due to a split in the commissioning of primary and secondary care. The CCG was developing ideas for primary and secondary care provision in the development. He noted local innovation with the Whitstable Medical Practice being selected as one of 29 national vanguards.

(5)       A Member enquired if the proposed changes would be large scale or a series of smaller proposals for specific services. Ms Shutler explained that there would probably be a combination of large and small scale proposals. Once the model of care was established; implementation would take place in a number of stages. She stated as stages were developed, the Trust would engage with staff, patients and the public. She noted that she would return to the Committee in October prior to formal public consultation to share the proposed options. Ms Carpenter highlighted her presentation to the Committee in January 2015 on the development of an integrated care organisation in NHS South Kent Coast CCG area. She requested that she return to the Committee in October with the Trust to enable the Committee to consider both proposals together.

(6)       A number of comments were made about IT integration and the Hospital at Home service. Ms Shutler explained that the Trust was able to view the primary care records of its patients. All four CCGs in East Kent had signed up to the integrated clinical knowledge system with 80 – 90% of GP practices allowing the Trust to view their patients’ records. Mr Perks noted that all GP practices in Ashford and Canterbury & Coastal had signed up to read only primary care records being available to the Trust due to the better outcomes it delivered for patients. Ms Shutler  explained that some acute services could be shifted closer to patients’ homes. The Hospital at Home service was an example of this and had enabled the Trust to reduce its reliance on hospital beds and had extremely good outcomes for patients. Ms Jones noted that the Trust offered the service to all patients in East Kent  and had been received very positively.

(7)       In response to a specific question about workforce constraints, Ms Shutler explained that the Trust was having difficulty recruiting consultants, junior doctors and nurses. She reported that as consultants were becoming more specialised, they were unwilling to remain on the general medical rota and the Trust was facing difficulty covering rotas with adequate consultants across three sites.  She noted that the Trust was using expensive senior doctors to cover junior doctor vacancies and there was a worldwide shortage of nurses.

(8)       A Member stated it would be challenging selling service change to the public. Ms Jones acknowledged that as options were developed, it would become more challenging for the Trust to allay concerns. She accepted that there would have to be compromises and the Trust would have to consider the most acceptable compromises to the staff, patients and public. She reported that the Trust had been engaging with Trusts in Leicestershire and Northumbria to learn from their reconfigurations.

(9)       A Member requested that the Committee was provided with a draft copy of the public consultation to enable the Committee to make comments to the Trust in advance of its launch. Ms Shutler agreed to this request.

(10)     RESOLVED that there be ongoing engagement with HOSC as the EKHUFT’s clinical strategy is developed including a draft copy of the public consultation and a return visit to the Committee prior to public consultation to enable the Committee to determine if the options for proposal are a substantial variation of service.