Agenda item

In attendance for this item: from NHSE/I Specialised Commissioning: Fiona Hughes (Programme Lead), Su Woollard (Transformation Delivery Manager), Sue Whiting (Chief Operating Officer), Carol Wood (Deputy Regional Head of Communications and Engagement). From East Kent Hospitals University Foundation Trust: Simon Brooks-Sykes (Strategic Programme Manager), Noel Wilson (Lead Vascular Surgeon). From Medway Foundation Trust: David Sulch (Medical Director).

1)         The Chair welcomed the guests to the meeting and asked that they introduce themselves and provide a brief synopsis of the service change.

2)         Key points from the agenda papers included:

a.         The clinical need for change was driven by national standards set by the Vascular Society.

b.         The review covered East Kent and Medway.

c.         The broad clinical agreement was for an arterial centre to be situated in East Kent, though the exact location would be decided as part of the East Kent Transformation Programme.

d.         The proposed interim model, discussed at the previous JHOSC meeting, was for a single arterial centre to be housed at the Kent and Canterbury Hospital site.

e.         Since the last meeting, there had been an emergency move of the Abdominal Aortic Aneurism Repair (AAA) service from Medway Maritime Hospital to the Kent and Canterbury Hospital. This was required following staff shortages in December at the Medway site which led to concerns over patient safety. Patients would still receive their assessment at Medway Maritime Hospital, it would only impact AAA intervention and emergency surgery.

f.          The number of emergency patients had reduced over recent years, in part down to the success of the screening programme.

g.      There was no evidence that outcomes at Medway Foundation Trust were poor.

3)         Members voiced their disappointment at the amount of time the proposed move had been underway – the process had begun in 2014. One Member commented that in its early stages, the evidence had supported Medway receiving the main arterial centre, but over time the numbers had fallen and that was no longer viable.

4)         Dr Sulch explained that the county’s population was not big enough to sustain two Main Arterial Centres. Two thirds of the population that accessed vascular services were nearer to East Kent than Medway. One of the benefits of the changes would be the standardisation of the patient experience, with service users receiving the same level of care regardless of where they are from.

5)         Members noted a typing error on page 15 of the agenda. Ms Hughes acknowledged that the wording in the second paragraph should read “move the AAA service from Medway” as opposed to “to Medway”.

6)         Dr Wilson explained that the AAA Screening Programme was offered to all men when they reached 65 year of age. In Kent and Medway, around 11,000 men were screened per year, across 35 venues, with an up take of around 82%. Around 1% of those screened found a swelling in the aorta, down from 3-4% in the past. Dr Wilson felt that this was a positive sign the population was getting healthier.

7)         Dr Wilson addressed Members’ concerns about staffing levels by confirming that there was adequate staffing at both sites, with Medway consultants working from Canterbury, as well as providing support at the Medway and Maidstone sites. For the clinical team, emergency surgery was not their main source of work. There was a full-time specialist nurse at Medway and Vascular services would not be removed from that site. It was very much intended to create a strong system across all sites that would benefit all patients.

8)         Members were informed that there were four Interventional Radiologists based at Medway. In addition, all new vascular surgeons were receiving training in that area of medical imaging, which added to the security of delivering the service.

9)         Members noted the Equality analysis data from page 25 of the agenda. Referring to the increased risk of developing vascular disease if a person was from a black or ethnic minority community, members pointed out that the ethnic mix of the local population continued to grow and change as people moved into the area. A Member expressed a view that Medway had a relatively high ethnic minority population compared to many parts of Kent. A Member considered that the likelihood of increased prevalence made the possibility of Medway not having full vascular provision more concerning.  Concern was also raised about the ability of the model to sustain day surgery in Medway and the availability of preventative support. Dr Sulch confirmed that those trends had been taken into consideration when designing the new service and that there would still be non-urgent vascular provision in Medway. It was considered that the model would provide a good level of vascular surgical support for other services.

10)      A person’s risk was also higher if they had diabetes. Dr Wilson acknowledged that on-going support would be required by those suffering with diabetes, and that support would continue to be provided locally.  He highlighted the importance of prevention and primary care in trying to combat the rising numbers.

11) Dr Sulch referred to the general improvement in the management of public health. However, he warned that there was a risk for population growth to overtake those improvements.

12) A Member highlighted the continued push from central government to build more houses and questioned how that policy correlated with the NHS drive to make savings. Dr Wilson confirmed the NHS did factor population trends into their future planning. They were looking to develop their staff and resources in order to make the service sustainable for the future population.

13) In terms of pre-engagement, Members were disappointed to read that attendance at the patient and public events had been low. Ms Hughes said this was not through a lack of effort on the team’s part. Over 200 letters had been sent out. Ms Wood explained that the service area did not generate the same level of engagement that other services might, especially if people accept the rationale behind the change.

14) During the next round of engagement, Ms Wood explained they would look to involve organisations in the third sector, such as Diabetes UK, the British Heart Foundation and Healthwatch. She was still expecting the events to be user focussed, drawing on the views of those who understood the risks and benefits. But the wider population, if interested, would be able to provide feedback via online consultation material.

15) The Chairman expressed a view that the Kent and Medway Stroke Review Consultation had not taken into account concerns raised and hoped that engagement in relation to vascular services would be a more positive experience. Another Member asked whether the planned engagement would take place across Kent and Medway or in specific areas and whether it would be possible to engage with those that had used the screening programme. Ms Wood said she would look into the idea of engaging with those that had accessed the screening programme. Two engagement events had been planned but locations had not yet been determined. 

16) In terms of the next steps, Ms Hughes explained that the detailed proposal for the interim model was being worked through with the CCGs and STP. She hoped the next set of engagement would commence around April/May time and that they would come back to the JHOSC around that time. She agreed to circulate the dates of the engagement events once confirmed.

17)      The Chair asked the Committee and its guests to note the content of an email from a member of the public regarding the proposed changes (appended to these minutes). There were no additional comments. NHS attendees undertook that a response to the questions raised would be provided to Members following the meeting.

18)      RESOLVED that the report be noted.