Agenda item

Dave Holman (Head of Mental Health Programme Area and Sevenoaks Locality Commissioning, NHS West Kent CCG) and Wendy Irons (Assistant Head of Specialist Assessments and Placements, NHS Dartford, Gravesham & Swanley CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Mr Holman outlined the background to the planned service change. Mr Holman explained that Kent and Medway NHS and Social Care Partnership Trust (KMPT) gave notice on the current contract for the West Kent Neuro Rehab Unit (WKNRU) in April 2015 due to issues involving service quality, safety and cost. The unit was accessed by 29 patients in 2014/15 and was used as an intensive rehabilitation service for patients who had had a stroke or been involved in road traffic accidents; interventions were for approximately three months. On receiving notice, the CCGs explored a range of alternative providers such as the Raphael Medical Centre in Hildenborough, Strode Park Foundation in Herne and the Hothfield Brain Injury Rehabilitation and Neurological Care Centre in Ashford. He stated that as there was sufficient capacity with these alternative providers, the CCGs did not feel the need to reprocure. KMPT then informed the CCGs that there would not be safe staffing levels over the Christmas period and it was agreed the unit would shut on 24 December; emergency action was taken to bring forward the new service from April 2016 to December 2015. He stated that the decision was made without allowing time for full consultation with the HOSC because of a risk to safety and that the CCGs would continue to consult and provide regular updates to the Committee.

(2)       Members of the Committee then proceeded to ask a series of questions and make a number of comments.  In response to a specific question about the number of patients currently accessing the service and plans for their discharge, Ms Irons explained that there were 4 - 5 West Kent patients, 2 Medway patients and no Dartford, Gravesham and Swanley patients. Each patient had an individual discharge plan which identified length of stay, treatment completion date and referrals. Mr Holman noted that all the patients would be discharged by 24 December. He stated that it was a change of organisation providing the service rather than a service change and would have a positive impact on the patient due to a range of support and choice of service providers in the bespoke model.

(3)       Members enquired about the cost of the bespoke model and the locations of the alternative providers. Mr Holman explained that there was a financial envelope and the new service would not be more expensive than the previous service.  Mr Holman noted the large geographical area covered by West Kent CCG and Dartford, Gravesham and Swanley CCG. The alternative providers were located in Ashford, Herne and Hildenborough.

(4)       A comment was made about the care pathway for patients. Ms Irons stated a flowchart detailing the care pathway could be provided. She explained that a proportion of patients would never go to the unit in Sevenoaks: some patients would be sent for specialist services at Kings College in London or assessed and referred to the private and voluntary sector if their care was expected to last longer than 12 weeks. She noted that as part of her role she assessed individuals who required very specialist services and found a suitable bed in very specialist units across the country; Dartford, Gravesham and Swanley CCG currently commissioned four independent sector specialist beds. She reported that the alternative providers had capacity and provided additional services such as hydrotherapy which were not available at the current unit. Patients would also have the choice of which provider they used.

(5)       The Chairman invited Mr Inett to speak. Mr Inett enquired about accessing services at home, patient involvement and travel distances. Ms Irons explained that the provision of services in patients’ homes was a long term aim; this was not able to be implemented before Christmas.  Ms Irons stated that the CCGs had been engaging with Headway and each patient would have an individual assessment before being placed with a provider. The CCGs had been unable to consult due to the need to take urgent action. She reported that patients and their families travelling from Dartford, Gravesham and Swanley already had to travel over 20 miles to the Sevenoaks unit. Patients and families were prepared to travel to access specialist services.

(6)       RESOLVED that:

(a)       the Committee does not deem the new service model for specialised neuro rehabilitation in North Kent, West Kent CCG and Medway CCG to be a substantial variation of service.

(b)       NHS Dartford, Gravesham and Swanley CCG and NHS West Kent CCG be invited to submit a progress report on implementation and a flowchart detailing the patient pathway to the Committee at its March meeting.

(c)        NHS Dartford, Gravesham and Swanley CCG and NHS West Kent CCG be requested to consult the Committee about their longer term plans for the neurorehabilitation provision andwork with Healthwatch Kent as part of their engagement plan.