Agenda item

In attendance for this item: Dr Amanjit Jhund (Director of Strategy, Planning and Partnerships, Maidstone and Tunbridge Wells NHS Trust), Dr Greg Lawton (Chief of Surgery, Maidstone and Tunbridge Wells NHS Trust), Adam Wickings (Deputy Managing Director) West Kent CCG

1)    Mr Wickings began by clarifying that the reconfiguration was down to the sustainable delivery of the service, not a change in the provision of that service.

2)    Dr Lawton explained that when the surgery department was configured in 2011, complex emergency inpatient surgery was allocated to Tunbridge Well Hospital (TWH) whilst complex elective gastrointestinal surgery went to Maidstone Hospital (MH). The emergency surgery saw around 6,000 patients a year compared to around 230 for elective surgery. Despite this, the team of 12 consultant surgeons was split nine to MH and just three to TWH.

3)    The drawbacks of the current configuration were:

a)    The three consultant surgeons based at TWH were near burn-out;

b)    Patients at TWH were seen by numerous consultants, adding to their length of stay at the hospital and reducing their quality of care (as each consultant wanted to understand the background to the case);

c)    Difficulty in recruitment.

4)    The proposed reconfiguration would see the complex elective surgery patients (the 230) treated at TWH, with all 12 consultants being based from that one site.

5)    Dr Lawton pointed out that a proportion of the 230 patients were closer to the TWH site the MH, so the additional travel would only impact around half that number. Both sites in the Trust were increasing their car parking capacity which would benefit those families having to travel further.

6)    The benefits of the reconfiguration included:

a)    A better service to patients who would have one dedicated consultant surgeon;

b)    Less time on the ward for patients, due to the efficiencies of just having one surgeon;

c)    Better teaching opportunities for junior doctors;

d)    Improved recruitment prospects;

e)    The possibility of developing the service in the future, in order to become a specialist provider.

7)    A Member questioned if there were enough beds at TWH to deal with the elective patients. It was explained that the length of stay for the emergency patients was expected to reduce (because there would not be numerous consultants assigned to one case) and therefore beds would become available more quickly. The site had also expanded its Intensive Treatment Unit (ITU) for one additional dependency, as well as creating six enhanced level care beds in the ward for elective patients. Dr Jhund confirmed the changes would not be implemented until after the winter pressures had passed.

8)    Mr Inett questioned the urgency behind the need for change, particularly from a non-clinical point of view. He was unclear what made this change different to those that had happened at other Trusts, where public consultation (or at least engagement) had taken place. His concern was that if this approach was increasingly taken for smaller changes, there be an erosion of opportunity for patients to be involved unless it was a consultation. 

9)    Dr Lawton explained that one need for the urgency was that the three surgeons based at TWH were almost burnt out due to the size of their workload. This was unsustainable and he went so far as to say if no action was taken there was a real risk that there would be no surgical service offered at the Trust in the future. This was in large part down to the difficulty in recruitment. He added that the Deanery was behind the move in recognition of the difficulty of training doctors across two sites. He felt the surgery should never have been configured in such a way back in 2011.

10) Whilst Mr Inett accepted the premise that staff should not be burnt out through workload, he questioned how this differed to similar pressures on staff in Stroke services or at the East Kent Hospitals University Foundation Trust, where consultations had been held. However, Mr Inett felt the risk around the Deanery added a different complexion to the situation and suggested that the best way to describe the change was that it was in fact needed to manage an imminent risk to patient safety.

11) Members questioned if transport links between the two hospital sites would remain. Dr Jhund confirmed that they would, and the Trust were also considering enhancements to the service.

12) The Chair, who had visited both sites with the Clerk the previous week, expressed the mixed view from nursing staff, but said that he felt the Trust had dealt with the reconfiguration in a professional manner.

13) RESOLVED that

a)    the Committee deemed that proposed changes to the configuration of general surgery services across the Maidstone and Tunbridge Wells NHS Trust sites were not a substantial variation of service.

b)    NHS representatives be invited to attend this Committee and present an update at an appropriate time.