Agenda item

Ian Ayres (Accountable Officer, NHS West Kent CCG) and Michael Ridgwell (Programme Director, Kent & Medway Sustainability and Transformation Plan) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Members of the Committee then proceeded to ask a series of questions and make a number of comments. A Member enquired about emergency & elective care provision and patient choice. Mr Ridgwell explained that although emergency and elective services provided different services, they were intransigently linked. He noted that whilst emergency and elective services could be provided on the same or different sites, it was important that medical, rather than surgical services were co-located with emergency care. He reported that the current acute emergency medical pathway was unviable due to workforce pressures. He stated that whilst patients had the right to choose their healthcare including the use of private providers; in emergency provision it was more important to have a sustainable workforce.

(2)       A number of comments were made about centralisation of services. Mr Ayres stated that a number of specialist services in Kent had already been successfully centralised including cancer and major trauma. He noted that in West Kent, the CCG was working with district and borough councils to improve primary care estates to enable community services to jointly use the same sites. He stated that it was not sustainable for the seven acute sites in Kent & Medway to continue to provide all services. Through the STP process some services would need to be centralised and some would need to be provided locally.  He reported that engagement work for the Kent and Medway STP would begin in the autumn, prior to public consultation to be held after the County Council elections in May 2017. Mr Ridgwell noted that the East Kent system was further advanced and had its own timetable.

(3)       In relation to the cost effectiveness of centralisation, Mr Ayres gave an example regarding the centralisation of elective care by the Epsom and St Helier University Hospitals NHS Trust. The Trust previously provided elective care specifically hip and knee replacements across five sites. Following centralisation quality had improved; there was no hospital acquired infection; length of stay had reduced; professionals were working with each other to improve services; and patient satisfaction had increased. Due to its cost effectiveness, the centralisation had also enabled Accident & Emergency centres to be maintained on the other sites. He noted that specialist centres were attractive to workforce and stressed the need to engage with local people.

(4)       Members enquired about collaboration, out of hospital care, A&E attendance and population growth & decline. Mr Ayres explained that through the STP the local system was required to balance the budget collectively which may result in commissioners and providers having a surplus or deficit. Mr Ayres stated that out of hospital care and general practice had diminished over the last 20 years which had put pressure on acute providers; both community and primary care services  needed to be improved going forward. He noted that there would be a clearer local and national picture regarding the STPs following a further submission to NHS England in October

(5)       Mr Ridgwell explained that a large number of patients attending A&E had a primary care need and it was important for that cohort to be diverted to a more appropriate resource. He stated the importance of redesigning provision to include better access to primary care and to promote behaviour change. Mr Ayres noted that the STP was using current population and demographic growth including 57,000 new residents to the Ebbsfleet development. He noted that there was a likelihood that there will be an overall population decline but not within the next 20 – 30 years. Mr Ridgwell added that Ebbsfleet was a new town, rather than an infill development, which meant that it provided an opportunity for new, rather than existing infrastructure, to be developed. 

(6)       The Chairman invited Steve Inett and Andrew Scott-Clark to comment. Mr Inett explained that Healthwatch Kent was keen to engage with the public regarding the STP. He stated that the report provided to the Committee did not do the full STP justice. He stated the importance of communicating the positives to the public particularly the reinforcement of community and primary care services. Mr Scott-Clark stressed the importance of embedding prevention into the system in order to maintain services. He noted that there was a good history of collaboration in Kent with the Catheter Centre in Ashford.

(7)       RESOLVED that the report on the Kent and Medway Sustainability and Transformation Plan be noted and an update be presented to the Committee in November with a detailed plan including finance.