Agenda item

Matthew Kershaw (Chief Executive, East Kent Hospitals University NHS Foundation Trust), Rachel Jones (Director of Strategy and Business Development, East Kent Hospitals University NHS Foundation Trust) and Hazel Carpenter (Accountable Officer, NHS South Kent Coast CCG and NHS Swale CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Mr Kershaw began by outlining the background to the Emergency Care Centre. He explained that when the Emergency Care Centre model was developed 10 years ago, it was considered innovative with its specific criteria for accepting patients including cardiac and minor injuries.   He reported that there had been a growth in the breadth of the criteria and doctors now were assessing and treating a very wide range of condition over and above those included in the original criteria. He noted that Health Education England Kent, Surrey and Sussex undertook visits to assess the quality of education and training by Local Education Providers; during a review of the Trust’s core medical training at the Kent and Canterbury Hospital junior doctors raised concerns about the creep of criteria. Health Education England Kent, Surrey and Sussex concluded that it was no longer acceptable for medical trainees to be confronted with acute medical problems they were not equipped to manage and a change was required. He reported that if changes were not made to the Emergency Care Centre it could result in the removal of medical trainees from the Kent and Canterbury site by Health Education Kent, Surrey and Sussex and the General Medical Council which would destabilise acute hospital services with East Kent and result in the closure of the Emergency Care Centre and removal of other services on the site.

(2)       Mr Kershaw stated that the Trust was proposing to reiterate the criteria for accepting patients and was working with South East Coast Ambulance NHS Foundation Trust to cease the referral of all patients with acute abdominal pain, alcohol intoxication and patients with primary mental health problems to the Emergency Care Centre. He reported that this equated to approximately nine patients a week and those patients would be taken to the William Harvey Hospital, Ashford or the Queen Elizabeth Queen Mother Hospital, Margate. Patients that self-presented to ECC would still be assessed and if they required ongoing care, they would be stabilised and transferred.   He noted that if patients were seriously comatosed due to alcohol, as opposed to being drunk, they would be transferred to a site with an Accident & Emergency site.

(3)       Mr Kershaw noted that the proposal had the full support of the Trust’s Commissioners. The Trust would be presenting the proposal to Health Education Kent, Surrey and Sussex in March as part of a re-inspection and the reclarified model of care implemented by the end of June 2016. Mr Kershaw stated that he was looking for the Committee’s support to the reclarified model of care - ceasing the referral of all patients with acute abdominal pain, alcohol intoxication and patients with primary mental health problems to the Emergency Care Centre. He noted that the new model of care needed to be implemented before there was a wider discussion ahead of the permanent clinical strategy for East Kent.

(4)       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 communicating the reclarified model of care to the public particularly to students, Ms Jones explained that two-thirds of patients self-presented to the Emergency Care Centre and the Trust would be working with Healthwatch Kent, Public Health and Commissioners to develop an information and awareness campaign. Steve Inett confirmed that Healthwatch Kent would be raising awareness of this issue and was looking to increase its number of volunteers as part of the communication and engagement for the wider strategy for East Kent.  Andrew Scott-Clarke stated Public Health would be leading on discussions with the universities about the impact of alcohol on public services and with Canterbury City Council as the licensing authority. 

(5)       A Member enquired about the number of patients who currently self-presented with acute abdominal pain, alcohol intoxication and primary mental health problems and if the reclarified model of care would have a significant impact on junior doctors. Mr Kershaw explained that there were a similar number of patients who self-presented and arrived by ambulance with acute abdominal pain, alcohol intoxication and primary mental health problems – approximately 20 per week in total. Mr Kershaw stated that the revised model of care would reduce the number of patients to a level similar to other hospitals; it would not take away the element of surprise associated with emergency care which was encountered by all medical trainees nationally. 

(6)       A number of comments were made about sustainability. Mr Kershaw noted that the reclarified model of care had the full support of the Commissioners. He stated that there was a significant risk of destabilisation across the Trust if medical trainees from the Kent and Canterbury Hospital site were removed. He recognised that there would be an ongoing issue of stability until a sustainable long term strategy for East Kent was developed through the East Kent Strategy Board.

(7)       RESOLVED that:

(a)       the Committee is supportive of the decision to take urgent action by the East Kent Hospitals University NHS Foundation Trust as set out in the Trust’s paper;

(b)       East Kent Hospitals University NHS Foundation Trust and East Kent CCGs be requested to keep the Committee updated as the reclarified model of care is developed.

Cllr Lyons, in accordance with his Other Significant Interest as a Governor of East Kent Hospitals University NHS Foundation Trust, withdrew from the meeting following Matthew Kershaw’s presentation and took no part in the discussion or decision.