Agenda item

Dr Amanjit Jhund, Director of Strategy, Planning and Partnerships (Maidstone and Tunbridge Wells NHS Trust); Dr Laurence Maiden, Chief of service for medicine and emergency care and Consultant Gastroenterologist (Maidstone and Tunbridge Wells NHS Trust); Dr Laurence Nunn, Consultant Cardiologist (Maidstone and Tunbridge Wells NHS Trust); Dr Paul Blaker, Consultant Gastroenterologist (Maidstone and Tunbridge Wells NHS Trust) and Mark Atkinson, Director of Integrated Care Commissioning - West Kent (Kent and Medway CCG) were in attendance for this item.

1.    Dr Nunn outlined the proposed service changes set out in the report and addressed the challenges which affected the existing service. He broke down the key areas of cardiology and confirmed that under existing arrangements services were split or duplicated across the Maidstone and Tunbridge Wells sites. It was noted that patient travel between both sites was common and had caused delays to treatment which put services outside of national guidelines in particular instances. He verified that neither site had a specialist cardiology ward and that it had been proven that patient outcomes were better in specialist facilities. The benefits of the proposed staffing arrangement were detailed, Dr Nunn confirmed that a 24-hour service would be operated, which had not been previously possible with a split workforce. He added that service consolidation allowed scope for the future development of other specialist services.

2.    Dr Jhund confirmed that three months of partner and community engagement had been planned.

3.    Following a question from the Chair, Dr Jhund gave assurance that there would be no service closure as a result of the proposed change, and provision for some services (such as outpatients) would remain on both sites.

4.    There had been discussion within the Trust around whether the proposal was significant, and it had been decided that a 3 month engagement exercise would be held. The Chair thought the public would appreciate an inclusion of the preferred site, from the Trust’s point of view, in the engagement documents. Dr Jhund did not want to prejudge any outcome but offered that clinically the preferred site was Maidstone Hospital because of its adjacency to the planned hyper-acute stroke unit (HASU) and it benefited from better transport links. Dr Nunn noted that clinicians had recognised the transport and location advantages of a centralised service at Maidstone Hospital.

5.    Members asked whether a public accessibility impact assessment had been undertaken. Dr Jhund confirmed that specialist and outpatient services would remain unchanged on both the Maidstone and Tunbridge Wells sites. He added that work had been undertaken to improve bus routes and car parking for patients and visitors.

6.    Dr Maiden highlighted the quality of care and value for money benefits of the proposed service centralisation. A comparison was made with the service improvements at HASUs and ASUs. He argued that due to increased productivity (by having specialists on one site all the time) access to services would actually increase.

7.    Dr Nunn noted that there was significant pre-existing patient travel between the Maidstone and Tunbridge Wells Hospitals, and that patients would be better off with the proposed re-location.

8.    A Member was concerned that the community impact of service changes was not given enough weighting in decision-making, and asked that such impact be considered to a greater extent in future decisions.

9.    Members asked what lessons had been learnt from previous consultations that could be applied to the upcoming one. Dr Jhund highlighted the importance of engaging early and widely, as well as understanding where there is a gap in expertise and going out to find it. He confirmed the public engagement pack would be more accessible than the pack included in the Committee’s agenda and added that a bank of former patient stories had been maintained which would be drawn upon to provide context.

10.Members believed that whilst the proposed changes were significant, they were not substantial.

11.RESOLVED that:

a)    the Committee does not deem the proposed reconfiguration of cardiology services across Maidstone and Tunbridge Wells NHS Trust to be a substantial variation of service.

b)    the report be noted.