Agenda item

In attendance for this item: Gerrie Adler (Director of Strategic Transformation), Dr Sarah MacDermott (Clinical Chair) and Dr Nigel Sewell (Clinical Lead for Urgent Care), Angela Basoah (Head of Communications and Engagement) from NHS Dartford, Gravesham and Swanley CCG

1)    The Chair welcomed Cllr Downing and Cllr Diment from Bexley Council. They had been invited to attend and participate in the meeting because the Bexley health scrutiny committee had deemed the DGS CCG (Dartford, Gravesham and Swanley Clinical Commissioning Group) urgent care proposals to be a substantial variation of service for their residents. This would be the final opportunity to have their views taken into consideration in the CCG’s Decision-Making Business Case.

2)    Kent County Council’s full Council would be considering an item at its meeting on 17 December 2019 on the establishment of a Kent and Bexley Joint Health Overview and Scrutiny Committee (JHOSC). The JHOSC would then consider the CCG Governing Body’s decision in late January.

3)    Dr MacDermott and Ms Adler introduced the item and provided a summary, making especial reference to the public consultation that had taken place. The CCG had received almost 16,500 responses to the survey, many of which were received in the final 72 hours.

4)    The public consultation demonstrated a preference for option 1 (an Urgent Treatment Centre (UTC) at Gravesham Community Hospital). Option 2 was for a UTC at Darent Valley Hospital.

5)    Consistent themes throughout the consultation related to ease of access, namely: proximity to site; amount of traffic; and parking availability. It was also clear that communication would be needed with whichever option was chosen, to ensure members of the public knew where to go with different medical needs.

6)    Ms Adler explained that the next steps would be for the CCG Governing Body to consider the Decision-Making Business Case on 16 January 2020 and make their final decision (the exact timing would be confirmed and circulated to Members of the Committee). That decision would be communicated with the Bexley and Kent JHOSC in late January. There was a hope that the new urgent care model would be in place from July 2020.

7)    Cllr Diment explained that Bexley’s concerns were around the cross-boundary movement of patients as a result of any change to current services. If option 1 were implemented, he was concerned that residents in the east of the county would use the UTC at the Queen Mary’s Hospital in Bexley, which was already very busy.

8)    Ms Adler explained that the CCG had hoped to carry out some intensive work within the Bexley boundary in order to better understand how people access healthcare services and what the impact may be on Bexley services should a Kent service close or relocate. Unfortunately, it had not been possible to do that work before the end of the public consultation. The CCG were however carrying out survey work at Bexley health services on 16 and 17 December as well as in the new year. The information gathered would feed into the Decision-Making Business Case.

9)    The CCG had analysed what had happened in the past when Darent Valley Hospital had been under pressure and there was no correlation with those patients travelling west to access Bexley services. Dr MacDermott stated that residents in West Kent tended to go south to the Sevenoaks Community Hospital.

10)In response to the question about patient flow, it was clarified that Medway Council had not deemed the changes to be a substantial variation of service for their residents. They were not therefore involved in the JHOSC arrangements for this issue.

11)Both options 1 and 2 would see the closure of the White Horse walk-in centre (at Fleet Health Campus). Dr Sewell explained that the contract had expired, and an interim 1-year contract was currently in place. That would expire in June 2020. There was no intention to close Fleet Health Campus. Other services were currently available at the site and would continue to be so. 

12)Members questioned what would happen in the interim between the walk-in clinic closing and the new UTC model being implemented. Dr Sewell explained the walk-in centre could easily be relocated to Gravesham Community Hospital, and there was room within the Minor Injuries Unit there. There would however be additional patients at the Hospital. The challenge was for GPs to see more patients in order to reduce the demand on the walk-in centre.

13)Dr Sullivan, local member for Northfleet and Gravesend West, addressed the Committee. She felt that the walk-in centre had had a positive impact on the local community. She was concerned around access issues, especially when Northfleet became gridlocked, as it often did. The upcoming Ebbsfleet development would also see an increase in population, and additional health care services would be needed to meet their needs. She argued that the correct infrastructure must be in place before any changes were made. She reiterated the public preference for option 1 (as demonstrated in the public consultation).

14)Dr MacDermott agreed that access to healthcare services was vital. There were several workstreams underway, including the expansion of 111 services and expanding access to GPs. It was accepted that transport and accessibility were real issues. For example, in Gravesend Rural there were no bus connections to Gravesend on Sundays or Bank Holidays. The lack of accessibility was a wider issue and had to be addressed by many organisations.

15)Ms Adler explained that there been no final decision made yet in relation to the urgent care options, but that the preferred model would take into account all the information gathered during consultation exercises. The UTC model was recognised and supported by NHS England.

16)The Chairman thanked the guests for attending the Committee, and their work on the public consultation. He summarised the Committee’s views for inclusion in the final Decision-Making Business Case document.

17)RESOLVED that the report be noted and asks that DGS CCG take the following views into account in their Decision-Making Business Case.

The Committee highlighted:

·         concern around parking and public transport

·         questions as to whether the solution would properly accommodate the rapid recent and future growth of Ebbsfleet and North Bexley

·         concerns as to whether there were adequate staffing levels and provision of consultants at the proposed sites

·         access to wider services at Darent Valley Hospital

·         the need to retain walk in GP services

·         the wider impact on both Erith and Queen Mary Hospitals in Bexley

·         it had noted the preference for option 1 from the public consultation