Agenda item

Hazel Smith (Accountable Officer, NHS South Kent Coast and Thanet CCGs) and Michael Ridgwell (Programme Director, Kent and Medway STP) were in attendance for this item.

(1)       The Chair welcomed the guests to the Committee. Ms Smith began by explaining that whilst there had been no substantive change since the update in November, the papers provided additional information on local care which had been requested. She acknowledged that further work was required, to demonstrate the model for local care was the same across East Kent, with GPs working together to develop primary and community care to support their local populations of 30,000 – 60,000. In terms of the potential Kent and Medway Medical School (KMMS), confirmation regarding the bid’s success would be received on 31 March 2018.  If successful, the new undergraduate programme would begin in September 2020 with first year students undertaking placements in community hubs. She noted that the public listening events that had taken place last year were broadly supportive of the proposed transformation in East Kent; areas to address included the need to develop local care; transport and access; and specialist centres.  

(2)       Members enquired about the local care model in Herne Bay; the potential third option, proposed by Paul Carter, Leader of Kent County Council, with A&E services being provided on three sites; and the commissioning of an impact assessment. Ms Smith explained that the model in the Herne Bay area was the same as the Encompass vanguard but was run by a separate organisation of GPs and reflected the needs of its local population. She explained that the East Kent CCGs had met with Paul Carter to discuss his proposal; she noted the importance of looking at all the viable options. She stated that following the meeting the medical directors across Kent & Medway had written to Mr Carter stating that the provision of A&E services on three sites was not clinically deliverable. Mr Ridgwell noted that there had not been A&E services on all three sites in East Kent for 13 years. Mr Ridgwell advised Members that public consultation would be undertaken before any decision was made.  Ms Smith committed to circulating the letter from the medical directors to the Committee. In response to a question about the impact assessment, Mr Ridgwell explained that an integrated Impact Assessment was being undertaken by Mott MacDonald; the final report would be shared with the Committee. He suggested that a Deloitte report into social-economic impact, referenced by a Member, was a historic document and would seek further information about it.

 (3)      Following a reference to option 2, the offer to build a new hospital in Canterbury from a developer, as a ‘super hospital’, Ms Smith stated that it was not a term being used by the East Kent CCGs. She confirmed that the CCGs were not looking to commission a tertiary hospital; where specialist tertiary services were required, they would be continued to be purchased from the London hospitals. The Chair stated the importance of clear terminology in the public consultation.

(4)       Members asked about the planning for population growth, training programmes and the merger of CCG management functions. Ms Smith confirmed that predicted population growth had been used in the planning and review of the long list of options. She noted that there were a number of primary care facilities in East Kent that required refurbishment or rebuilding; the CCGs were seeking for investment to facilitate this. Ms Smith informed the Committee that training programmes were in place to help develop and train staff, including the Health Navigator Programme. She committed to bringing back the comprehensive workforce plan with the Committee later in the year. Mr Ridgwell confirmed that discussions were being undertaken around shared CCG management functions; he committed to providing a paper on this to the Committee at its next meeting.

(5)       In response to a question about stroke services, Mr Ridgwell stated that the national view, which had been upheld by the South East Coast Clinical Senate, was that specialist stroke services should be co-located with other specialist services. The proposal for East Kent was the provision of one specialist stroke unit at the William Harvey Hospital. He stated that whilst NHS funding was a national challenge, the stroke review in Kent & Medway was driven by quality and workforce rather than finance. Evidence from stroke services which had already been reconfigured indicated improved outcomes for patients and a societal benefit as patients did not require as much support as part of their recovery. The Chair noted that the concerns about accessibility particularly in East Kent had been raised at the JHOSC and requested that the JHOSC minutes be shared with the Committee once available.

(6)       Members commented about workforce, services in Thanet, sub-acute provision in South Kent Coast, and public transport. Ms Smith reported the importance of evidencing a deliverable workforce as part of the business case. She highlighted the work of the Acute Response Team in Thanet, a group of GPs who were implementing enhanced primary care services to reduce hospital admissions; it was anticipated that when the team was fully operational, it could reduce attendances by 25%. She noted that development of primary care hubs in Cliftonville and Westwood Cross; local discussions were taking place about which GP practices would look to relocate, provide core services or extend services. As part of the development of sub-acute provision, Ms Smith noted that from 1 April 2018 patients in South Kent Coast CCG area would be able to access emergency GP appointments from primary care hubs; this would enable GPs to spend more time with patients with complex needs. She explained that direct conversations with bus companies would be planned. She noted that as part of the reconfiguration of outpatient services in East Kent, bus services to hospitals were initially funded by the NHS but now attracted enough business to run sustainably without subsidy.

(7)       In response to questions about the viability of option 2 and the timetable for the identification of a preferred option, Ms Smith explained that the CCGs were working with KCC to understand if option 2 could be taken forward by the end of February.

(8)       RESOLVED that:

(a)       the report on Transforming Health and Care in East Kent be noted;

(b)       a full update be presented to the Committee at the earliest opportunity but no later than April;

(c)        the Committee be provided with the rationale as to why the provision of A&E services on three sites is not clinically deliverable.