Agenda item

Caroline Selkirk (Managing Director, East Kent CCGs) and Johnathon Bates (Chief Finance Officer, East Kent CCGs) were in attendance for this item.

(1)       The Chair welcomed the guests to the Committee. A Member enquired whether the financial recovery programme had had an impact on patients.  Ms Selkirk explained that the focus of the recovery programme was to reduce waste and provide services more locally. She reported that a whole systems approach would improve patient outcomes and the sustainability of services. She noted that whilst there had been an impact on elective surgery over the winter period; additional capacity had been purchased from the private sector to manage the backlog.

(2)       Members asked about the reduction to the number of GP surgeries and timeline for implementing local care. Ms Selkirk acknowledged that whilst access to primary care was challenged; she explained that it was due to the number of GPs rather than the number of practices. She explained that local care models were being implemented in East Kent, in which practices were working collaboratively to provide greater access to and delivering sustainable services to populations of 30,000 - 50,000. Ms Selkirk explained that local care models were being implemented over the next three years and involved the delivery of services from hubs by multidisciplinary teams which could include services provided by the acute and community trusts. She noted the importance of local care as part of wider service reconfiguration in East Kent.

(3)       Members enquired about the external determination process with East Kent Hospitals University NHS Foundation Trust  and Section 106 contributions. Ms Selkirk explained that the CCGs and the Trust had now agreed to count activity in the same way going forward. Mr Bates confirmed that Section 106 contributions had been received across East Kent, including in Thanet were the contributions had been used for local care buildings. Mr Bates noted that contributions remained relatively small in comparison to overall budget.

(4)       Members raised concerns around the decision to move the macular degeneration clinics from Buckland Hospital and the consultation with the Committee. Ms Selkirk explained that when the CCG had put the service out to procurement, several companies expressed an interest. The contract was awarded but it did not specify that the service had to be provided in Dover.  The CCG was reviewing a number of options to resolve the issue. In response to whether the Committee was permitted to have sight of the contracts, Mrs Chandler advised Members that advice would be sought and feedback would be provided to the Committee.

(5)       The Chair expressed concerns about the deliverability of the recovery plan in recovering the deficit, delivering savings and continuing to provide services without detrimental effect to patients given the financial challenge faced in East Kent. Ms Selkirk noted that many health economies were facing deficit and stated the importance of the local care model in making services more sustainable in East Kent.

(6)       Members enquired about the robustness of local care plans, business rates and governance. Ms Selkirk noted that in Medway, work had been undertaken with the Kent Fire and Rescue Service to assess patient homes and ensure that preventative measures were taken to reduce the number of frail and elderly fallers; this programme had created elective capacity through financial savings.  She explained that evidence from the Encompass Vanguard showed that local care models could be implemented at scale, reduce A&E attendance and improve access to patients. Mr Bates noted that the detailed reviews had been undertaken to ensure that business rates paid by GPs were at the correct level; substantial adjustments in favour of the health service had been awarded. Mr Bates stated that he would review if CCGs were eligible for business rate exemption. Ms Selkirk reported in terms of governance, the system was more effectively working together which included reducing the number of meetings which had achieved a more focused approach.

(7)       A Member raised concern about patients sitting in isolation in hospital beds without access to television rooms. Mrs Selkirk agreed that the provision of televisions was not an expensive solution and stressed the importance of health and social care working with communities to tackle social isolation. She noted that in East Kent care navigators were being implemented who ensured that people had the correct support to help them live independently. She welcomed Paul Carter’s request for social care colleagues to work in collaboration with NHS to tackle the issues around independent living at a hub level.

(8)       Mr Inett asked if the saving initiatives detailed in the paper would be brought to the Committee, Mrs Selkirk confirmed that any service changes would be brought back to the Committee for scrutiny.

(9)       At the conclusion of the discussion, the Chair stated that she was still concerned about the impact of the recovery plan on patients. A number of potential recommendations were discussed, and the following was agreed by the Committee:

(10)     RESOLVED that:

(a)       the Committee expresses concern about the financial recovery leading to a diminution of service to patients in East Kent;

(b)       the East Kent CCGs be requested to provide an update about financial recovery in November;

(c)        an update about direct GP access to MRI scans in East Kent be circulated to the Committee;

(d)       Swale CCG be requested to provide a written response regarding acute contract overperformance at Medway NHS Foundation Trust.