Liz Shutler (Director of Strategic Development and Capital Planning, East Kent Hospitals University NHS Foundation Trust), Natalie Yost (Director of Communications, East Kent Hospitals University NHS Foundation Trust), Lesley White (Divisional Director, East Kent Hospitals University NHS Foundation Trust) and Simon Perks (Accountable Officer, NHS Ashford CCG and NHS Canterbury & Coastal CCG) were in attendance for this item.
(1) The Chair welcomed the guests to the Committee. She began by reminding Members that the Committee did not consider individual complaints relating to health services and acknowledged receipts of letters from Concern for Health in East Kent (CHEK), Faversham Health Matters, Helen Whately MP and Rosie Duffield MP.
(2) The Chair invited Ida Linfield, Elected Member for Canterbury City South, to address the Committee. Ms Linfield stated that the Kent & Canterbury Hospital was located in her division and she had been contacted by staff, residents and politicians with their concerns regarding the emergency transfer of services. She raised concerns about recruitment of consultants, disciplinary action against staff who made public statements and the introduction of an additional 20 ambulances. She requested that the Committee establish a Task and Finish group to look at the operational issues in more detail.
(3) The Chair reminded the Committee that the focus of the item was the operational issues being faced by the Trust and its response to it. The longer term strategy would be contained with the STP item and the Chair asked that Members consider this when asking their questions.
(4) Ms Shutler began by highlighting the key issues with regards to the Trust’s operational issues. She stated that the decision to remove 38 junior doctors from the Kent & Canterbury Hospital site was taken by Health Education England (HEE) and the General Medical Council (GMC) in March 2017. In June 2017 the Trust decided to temporarily move emergency medicine services from the Kent & Canterbury Hospital site as it was not able to safely provide those services without the junior doctors. The emergency transfer of services was scrutinised and overseen by the Trust’s commissioners and regulators. In order for services to return to the Kent & Canterbury Hospital site, the Trust must be assured the services can be provided safely which would require the return of the junior doctors. A decision to return the junior doctors by HEE and GMC could only be taken once they were satisfied that the Trust could adequately train and supervise of the junior doctors. She noted that the Trust was continuing to recruit consultants across the Trust to fill vacancies and provide the required support to junior doctors. She reported that the Trust was encouraging staff to talk to the senior management team directly about their concerns and denied that staff had be warned about disciplinary action if they made public statements. She concluded by explaining that an investigation into a transfer of a patient, following the implementation of the emergency transfer of services, did not delay their treatment.
(5) Mr Perks provided clarification regarding the transportation of patients; he reported that CCGs were commissioning an additional 30 conveyances of patients who would have previously transported to the Kent & Canterbury Hospital site at a cost of £450,000 a month. The number of additional ambulance and crew would vary from day-to-day.
(6) Members then proceeded to ask a series of questions and make a number of comments. Members enquired about the impact of the emergency transfer on the Trust’s capacity and other sites. Ms Shutler confirmed that an oversight group had looked at all of the options before a decision was made to move services from the Kent & Canterbury Hospital site. She stated that all the sites were very busy particularly with the heat and number of elderly and frail patients but stated that this was not related to the transfer of services. The Trust was looking at ways to improve patient flow and bed capacity and was listening to staff suggestions for improvements.
(7) Ms White reported that consultants from the Kent & Canterbury Hospital were being used to provide additional emergency cover at other sites but were continuing with their elective work at the Kent & Canterbury site when not providing cover. She reported that the Trust had worked closely with partners to create additional capacity into the system. A new medical model had been implemented which meant that there was seven-day consultant input onto the wards for the big five specialities and eight hour gastroenterology consultant cover on a Saturday & Sunday which had helped to improve discharge and capacity. She stated that she was recently on call at the William Harvey Hospital and 45 patients were discharged on a Sunday; the Trust had previously discharged approximately 15 patients from the site on a Sunday . She noted that the introduction ambulatory care unit, led by acute physicians, were managing low risk medical patients as day cases which was also leading to improvements to patient flow.
(8) Mr Perks stated that the Trust was making significant operational improvements to manage its capacity; measures to enable early discharge such as additional support for patients in their own homes and care homes and partnership working with SECAmb to reduce handover delays had been implemented. He confirmed that the roadworks between Ashford and Canterbury had not interfered with SECAmb conveyances.
(9) In response to a specific question about the impact on junior doctors, Ms Shutler confirmed that the junior doctors, moved from the Kent & Canterbury Hospital site, were helping to cope with the additional workload at the two other acute sites following the emergency transfer of services. Ms White stated that the Trust had ensured that the junior doctors had been able to continue in the medical speciality of their rotation if they wished too; four junior doctors had opted to move to the Accident & Emergency departments, two had moved to the Intensive Care Unit (ITU) and two had moved to Paediatrics. Ms White reported that there had been no junior doctor resignations following their transfer to the other sites and the preferences of nurses who wanted to remain or move sites had also been accommodated. Five Senior House Officers (SHO) and Specialist Registrars (SPR) remained on the site for patient safety in addition to the consultants; none of these doctors had resigned but a number were leaving to go onto training posts. She noted that a new cohort of junior doctors would join the Trust in August which would include rotations at the Kent & Canterbury Hospital.
(10) Members asked about engagement with the public and recruitment. Ms Shutler stated that the Trust had been engaging with the public over the last two years and held a series of public events prior to the removal of the junior doctors and emergency transfer of services. The decision to remove the junior doctors by HEE and GMC was not expected and the Trust had to respond immediately to enact the changes by 19 June deadline. Mr Perks stated that the Trust had to take emergency action to respond to the regulatory demands; before the decision was made by the HEE and GMC, the Trust did give advanced warning of this possibility including at a CHEK event in April. He stated that consultation would take place on the longer term proposals which would be led by the CCGs. Ms Shutler stated that the Trust was finding it difficult to recruit staffing due to its current configuration as staff were required to be on call more frequently due to its three sites. Ms White explained that the Trust was actively recruiting staff from the UK and abroad to fill vacancies. Ms Shutler highlighted national recruitment campaigns in the BMJ and a website to promote East Kent as a place to live and work as measures which had been implemented as part of its recruitment strategy.
(11) Ms Shutler confirmed that the Trust was still actively seeking a solution to reinstate services and return the junior doctors to the Kent and Canterbury Hospital site.
(12) RESOLVED that the reports be noted and East Kent Hospitals NHS University Foundation Trust be requested to:
(a) provide an update to the Committee on its response to regulatory action and emergency transfer of services;
(b) present an update to the Committee about its long term strategy for acute sustainability in East Kent.