Agenda item

Rose Gibb, Chief Executive, Maidstone & Tunbridge Wells NHS Trust and Steve Phoenix, Chief Executive, West Kent PCT will be in attendance for this item.

(Ms R Gibb, Chief Executive, Maidstone & Tunbridge Wells NHS Trust and Mr S Phoenix, Chief Executive of West Kent PCT were in attendance for this item)

 

(1)       Mr Phoenix and Ms Gibb were accompanied by some consultants from Maidstone & Tunbridge Wells NHS Trust, Mr J Webb, Clinical Director – Emergency Services and Critical Care, Mr P Skinner, Clinical Director – Orthopaedics and Mr P Bentley, Clinical Director – Surgery.

 

(2)       Mr Angell raised a number of questions with Ms Gibb relating to:-

 

a)      whether the calculations regarding the proposed reconfiguration took into account fully the growth in population, the ageing of the population and the growing number of overweight people;

 

b)      what guarantee could be given as to whether the proposed reconfiguration would actually happen; and

 

c)      whether she could guarantee that there would continue to be a quality Accident & Emergency (A&E) department at Maidstone.

 

(3)       Ms Gibb responded that the Maidstone & Tunbridge Wells NHS Trust had given due consideration to all the demographic factors.  She said that the anticipated population growth was sufficient to affect primary care but not great enough to affect planning for hospital services.

 

(4)       She said that the changes could be concluded by December 2007/January 2008 if the NHS Overview and Scrutiny Committee agreed them. The Trust had the necessary finances and project infrastructure ready.  It was imperative that the core of services must be sustainable and appropriate, otherwise the Trust would be unable to guarantee the quality and range of services.  Finally, Ms Gibb concluded in response to Mr Angell’s questions that they did not know how health policy and technology would change in the future but what was clear was that we could anticipate continual change.

 

(5)       Mr Skinner, Clinical Director – Orthopaedics, added that all orthopaedic surgeons believed in the separation of elective and emergency orthopaedic care and a concentration of elective surgery at one location.

 

(6)       It was important that there was a dedicated surgical team who could operate on emergency cases without distractions.  Mr Webb, Clinical Director – Emergency Services and Critical Care, informed the Committee of an A&E middle-grade vacancy where recently there had been just one suitable applicant.

 

(7)       He said that the Trust were very supportive, both practically and financially.  Mr Webb informed the Committee that he had two Specialist Registrars based solely at Maidstone and four middle-grade staff at Maidstone and Tunbridge Wells. The nurse-provider service had been expanded at both locations.  F1 and F2 staff (i.e. Housemen) were on duty overnight in A&E.  He said that a 24-hour middle-grade rota at the Kent & Sussex Hospital, Tunbridge Wells would be a significant advancement.  He said that the model being proposed of an integrated physician/general practitioner/nurse practitioner team with junior doctor support at Maidstone would also be a step forward.  Mr Phoenix referred the Committee to the West Kent Primary Care Trust Board decision of 15 March 2007, which had attached conditions to the proposed reconfiguration.  Significant checks and balances had been put in place to ensure the maximum confidence of clinicians.

 

(8)       The Chairman then referred to the ongoing negotiations that had taken place between the spokesmen of the NHS Overview and Scrutiny Committee and the Chief Executives of both Maidstone & Tunbridge Wells NHS Trust and West Kent Primary Care Trust, and members of the Maidstone Division of the British Medical Association (BMA).  Mr Phoenix referred to the most recent letter from the Committee spokesmen and said that a reply was in the post.

 

(9)       As regards the spokesmen’s stipulation that there should be an independent chairman for the external review panel that had been referred to in the conditions agreed by the PCT Board, Mr Phoenix said that he was happy to see one of the three independent members of the panel as the chairman.  Regarding the involvement of the BMA in the panel, Mr Phoenix said they were a trade union and, therefore, including them on the panel would stop it being external and impartial, as they were an internal stakeholder.  However, Mr Phoenix added that he was happy to actively involve the Honorary Secretary of the BMA in the process, while keeping the BMA’s views external to the process.  Regarding the NHS Overview and Scrutiny Committee reserving the right to re-open the issue, he said that this was a constitutional matter which would need to be considered.  Regarding the request for clarification as to why the Trust intended that Maidstone A&E department would be staffed by A&E specialists for 15 hours per day, rather than 16 hours or more, Mr Phoenix said that 15 hours per day was the existing extent of cover.  Mr Phoenix then referred to the Committee spokesmen’s request to see the document detailing the changes to Ambulance Service resources that would be necessary if the proposed reconfiguration were to go ahead. Mr Phoenix said that it had been agreed to make this document available to the Committee.

 

(10)     Responding to a further question about the chairing of the external review panel, Mr Phoenix confirmed he had accepted that an external clinician would chair the panel.  A question was asked as to whether there would continue to be a 24-hour A&E service in Maidstone. A further question was asked about the distance between Maidstone and Tunbridge Wells with reference to what was commonly known as “the magic hour”, referring to the time during which it was critical that an emergency patient receive treatment. Mr Webb said that the doors of the A&E department at Maidstone would be open 24 hours a day.  He added that what used to be done in hospital within “the golden hour” was now being done by ambulance crews.

 

(11)     He went on to refer to some of the major specialties, such as brain, burns and cardiothoracic services that had already been centralised.  This meant that Maidstone Hospital already routinely transferred all sorts of emergencies.  As a specific example, he referred to the instance of a leaking aneurysm. In the past, this would have been dealt with by a general surgeon at a district general hospital.  Now, however, it was undertaken by a specialist vascular surgeon.  Increasing specialisation was the direction in which medicine in general was headed.

 

(12)     Mrs Stockell returned to the issue of staffing of A&E and how it was dependent on the external review agreed by the PCT Board.  She asked whether the NHS Overview and Scrutiny Committee would get the opportunity to come back to the matter when the outcome of that external review was known.

 

(13)     She also asked about the growth of population, which the Trust was acknowledging it had failed to take full account of.  Mrs Stockell further asked whether A&E at Tunbridge Wells would also be open 24 hours a day.

 

(14)     Mr Phoenix responded that A&E at Tunbridge Wells would be a 24-hour service.  In response to an interjection by Mrs Stockell, Mr Phoenix confirmed that trauma services would be concentrated at Tunbridge Wells.  Responding to the point raised about population growth, Mr Phoenix said that Maidstone would be experiencing an increase of 10,000 in the number of households over the next ten years.

 

(15)     He said that 500,000 was now considered the optimal catchment population for acute services.  A 10,000 to 20,000 increase in the population would not require a material alteration in the shape of the service.  An increase in patient volume on that scale could be accommodated without configuring acute services differently.

 

(16)     He went on to add that work on projected population changes had already been undertaken in planning for the Private Finance Initiative (PFI) at Pembury.  He said that population forecasting was not an exact science.  The PCT was planning to invest more in primary and community care to take account of population changes.

 

(17)     In response to Mrs Stockell’s point about revisiting the issue once the external review panel had completed its task, Mr Phoenix said that, in his view, the Committee was not best placed to review operational staffing matters.  He added that it was for the PCT to performance-manage the outcomes of the external review panel, but he would be happy to report the outcomes back to the NHS Overview and Scrutiny Committee.

 

(18)     Mr Fittock said that he did not want to revisit all the issues which the spokesmen of the Committee had addressed with Mr Phoenix and Ms Gibb already through the negotiations.  Appendix 2 to the report before the Committee represented the spokesmen’s understanding of the current position with regard to these negotiations.  However, he went on to say that he would welcome the NHS Overview and Scrutiny Committee Chairman, Mr Chell, being an observer on the external review panel.  Mr Fittock said the Committee spokesmen had “moved the goalposts” somewhat by stipulating that specialist cover must be present at Maidstone A&E department for a minimum of 17 hours per day.

 

(19)     With regard to the spokesmen’s concerns around Fit for the Future, he felt that the Trust and the PCT had covered this.  This left the questions relating to the Ambulance Service and he understood that the Ambulance Service had responded.

 

(20)     The Overview and Scrutiny Manager then read to the Committee a message from Geraint Davies, of the South East Coast Ambulance Trust, a copy of which is attached as Appendix 1 to these minutes.

 

(21)     Mr Phoenix responded that he did not have a problem with Appendix 2 to the report.  He said that this was an accurate reflection of the negotiations which had taken place between the spokesmen of the NHS Overview and Scrutiny Committee and the Trust and PCT. 

 

(22)     He added that he had no problem with a representative of the NHS Overview and Scrutiny Committee observing the external review panel.  Ms Gibb said that the comments on Appendix 2 to the NHS Overview and Scrutiny Committee’s report were from the Committee’s perspective.  She added that the assurances that the spokesmen had sought on behalf of the Committee had been given by the Trust and PCT.

 

(23)     In response to Mr Fittock’s question about specialist cover in Maidstone A&E, she said that 15 hours would actually represent an increase on the current situation.  She added that the external review panel would not itself determine the levels of staffing but that it would determine whether the proposals about this put forward by the Trust were appropriate and safe.

 

(24)     Mr Vye said that he understood the arguments being made about getting patients to specialists who were equipped to provide the best outcome.  However, he added that time-to-surgery was still an important consideration.  He sought confirmation that there would still be the capacity to deal with some emergency surgery cases at Maidstone Hospital, where necessary; and also that it would be possible to stabilise patients before transferring them, where necessary.  He asked how these situations would be handled during those parts of the day when relevant specialist cover was not being provided, given that such cover was not going to be available on a 24-hour-a-day basis.  Ms Gibb responded that they did not at the current time have a proper 24-hour service – people often had to wait for a specialist.  She listed again the specialist services that the Trust did not provide, such as dealing with head injuries.  She added that if a patient needed immediate surgery and no surgeon was on site, then the patient would be stabilised while a surgeon was sought and a theatre opened.

 

(25)     Mr Bentley, Clinical Director – Surgery, informed the Committee that Maidstone would have the best specialist major surgery centre in the area.  He said that two new specialist consultants had recently been appointed who were “utterly brilliant” and patients would flood in.  He added that the on-call surgeons at Maidstone would not be the same surgeons who were on-call at the Kent & Sussex Hospital, Tunbridge Wells.  If necessary, surgeons would be called in to Maidstone and patients would be stabilised and then treated; but often it was actually dangerous to treat patients straightaway.  He said that stabilisation of a patient could take four, six and sometimes 10 hours.  He reassured the Committee that patients at Maidstone would be properly covered.  Mr Horne said that the proposals before the Committee had turned out to be very contentious.  Mr Phoenix had said that the Committee was not well placed to know about operational matters. However, Mr Horne said, the Committee was well placed to represent the views of the public – and they were very worried.  He said that the Trust’s role was to reassure the public that the proposed service changes were in their best interests. 

 

(26)     If the service to be provided at the Maidstone Hospital A&E department was only for 15 hours then people would feel that the service was being reduced.  Mr Horne also expressed concern that these proposals had been put forward before the Fit for the Future consultation process had been concluded.  He said that he needed to be convinced that the Trust and PCT were looking at improving services not reducing them.  He said that the medical profession had also voiced doubts and concerns.  Ms Gibb responded that change was never easy and was always painful.  To demonstrate the point, she referred to the consultation some years ago on the provision of vascular services across Kent and Medway when there had been a huge outcry at what people had seen as a loss of services.  People had said that the service would fall apart and that, as a result, patients would die.  However, the reality was that this had not happened; the outcome had been better services, and patients had been convinced.  Hearts and minds would change, she said, when people saw the service in operation.  Ms Gibb said that she was still hearing confusion from Members present at the meeting.  For example, she said, specialist staff were not available now 24 hours a day – or even 15 hours a day.  Changes could be seen as a reduction in services, but if you saw the right specialist at the right time, the outcome was better; and UK and international evidence showed that.  Mr Phoenix added that, having spent nearly 30 years in the National Health Service, he saw many buildings that were still the same, but what went on in them had changed beyond recognition.  He said that during the last five to 10 years the pace and scope of change had been much greater than before. He emphasised that clinical testimony was very important.  He referred the Committee to the fact that the PCT had had signed letters from all the surgeons in the Trust supporting these proposals.  Mr Hirst said that change was very difficult and that the Committee was caught between the electorate and reality.  He said that the electorate was living in the past, with a lack of comprehension of the consequences of not changing.  He said that County Councillors were “going with the flow” and following the electorate.  He said that they had been through all of this in Canterbury and they now had a service there that was far better than they had had before.  Was the Committee going to go through this with every Trust?  What would it do to the NHS if elected Members blocked every necessary change?  Ms Gibb responded that it was not possible to ignore the factors that were driving change and that similar changes were taking place up and down the country.  If the Committee were to support the changes there would be a sound service.

 

(27)     Ms Gibb referred to the work of Professor Sir Ara Darzi, which showed that some services would have to change even more.  A “critical mass” catchment population of 500,000 people was vital to delivering good-quality health outcomes. Across England, and Scotland too, there was the same process of change, leading to centralisation.  Mr Hibberd said that he was surprised by the amount of public protest by the medical profession.  He had been informed that the BMA still had reservations.  He asked the Trust and PCT representatives whether they were satisfied that medical staff were behind them.  Ms Gibb said that it was not always possible to get 100% staff support – but 100% of the surgeons were in favour.  Some concerns were being expressed by physicians, which had also been the case in respect of the changes in Canterbury.  She said it was not unique for clinicians to oppose proposals; this had also occurred in Maidstone & Tunbridge Wells NHS Trust in 1999 and when the vascular review had been undertaken.  It was actually rare to get what had been achieved in the present case, namely 100% agreement from the surgeons. 

 

(28)     Ms Harrison said that at the last meeting of the Committee there had been a lot of myths; for instance, some people had believed that the hospital was closing.  She had thought that the Committee had nailed those myths.  There was a need to spell out in words of one syllable what was proposed.  The Committee could have done a lot to help public understanding.  Trust staff were saying that fewer people would die as a result of the changes.  Unless the Trust was telling the Committee a pack of lies, the proposals would actually improve services.  Yet the newspapers were reporting that the hospital was closing.  Ms Harrison found similar misleading perceptions about NHS services in the area that she represented.

 

(29)     Ms Gibb responded that they had had a clear and consistent message to give and she did not know how it could have been said in simpler terms.  The confusion perhaps arose in these matters when people started negotiating. 

 

(30)     Mrs Rowbotham spoke about provision for the repatriation of patients to Maidstone if the proposals were implemented. The general public were concerned about bus services not running in the evenings. Would people find themselves stranded?  Mr Phoenix responded that the Trust already dealt with travel difficulties now according to people’s circumstances.  He said that south west Kent had a level of car ownership that was amongst the highest in the county.  He also informed the Committee that the changes being proposed would not be affected by car-parking charges. 

 

(31)     Mrs Loveday, Chairman of the Patient and Public Involvement Forum for the Maidstone & Tunbridge Wells NHS Trust, said that a Trust representative had attended one of their meetings to explain the proposed change.  She felt that there were considerable benefits in the proposals being put forward by the Trust as regards dealing with the issues of cross-infection and mixed-sex wards.  She said she felt people that were currently opposing the change would come round to supporting it when it was in place. 

 

(32)     Mr Germain, Chairman of Maidstone Borough Council’s external scrutiny panel, was then invited to comment.  He said that he would not deal with the technical matters as he did not fully understand them – and he suspected that most people present did not either.  He said that he agreed with Mr Horne that the Trust had not convinced people that their county-town hospital was not being downgraded.  He said that, when consulted, the people of Maidstone rejected the proposals; so he questioned what the point of consultation actually was.  Mr Phoenix made it clear to the Committee that it was the PCT that had responsibility for the consultation process and not the Trust.  He said that they had had to put in place a comprehensive process of consultation, which they had done; he was sure that, with the benefit of hindsight, they could they have done things better.  He said that it had been West Kent PCT Board’s responsibility then to take a decision, in the light of responses received, in the best interest of patients.  A lot of the comments that had been received had been predicated on wrong assumptions.  The decision had had to be made on the quality, rather than the weight, of opinion expressed.

 

(33)     The PCT Board believed that the proposals would be more convenient and safer than current arrangements, reducing cross-infection and mortality.  Twenty-four-hour A&E cover at the Kent & Sussex Hospital, Tunbridge Wells would be an improvement on the current situation.  Mr Phoenix acknowledged that a lot of people were frightened and misunderstood the proposals.  He acknowledged that the easiest thing that the Trust could have done would have been to take the path of least resistance; but he could not in all conscience have done so.

 

(34)     Dr Thom, representing the Maidstone Division of the BMA, then addressed the Committee.  He said that the NHS Overview and Scrutiny Committee had played an enormously helpful role in counterbalancing the corporate management view.  The issue was to balance the need for centralisation against the need for local services. This was a national issue. 

 

(35)     From the BMA’s perspective, the missing ingredient in the proposals had been a clear idea of what was needed for a viable emergency hospital.  There had now been considerable improvement in the way the proposals were elaborated.  However, Dr Thom pointed out that there remained some areas of concern:-

 

a)      medical staffing in A&E – if staffing levels were maintained, then rotas could be sorted out to allow A&E to be staffed adequately;

 

b)      general medical training;

 

c)      provision for surgical assessments to be carried out at Maidstone when necessary.

 

(36)     Dr Roger Hart, Honorary Secretary of the Maidstone Division of the BMA, said that he was very impressed with the conditions that the PCT Board had imposed on the Trust’s proposals. These conditions had taken into account a lot of the questions raised by Maidstone BMA.  However, what was missing was the detail.  He insisted that the planned external review must be genuinely external and he made a suggestion that it should be for the College of Emergency Medicine to appoint the chairman of the review panel.  Dr Hart wished to state that 44% of BMA members in Maidstone had voted in their ballot on the reconfiguration, although the Trust and PCT had tried to dismiss this vote as unrepresentative.  He also wished to state that Maidstone A&E was clearly being downgraded from a Level II Trauma Centre to a Level III centre. This was indicated by the fact that the helipad at Maidstone Hospital would no longer be used.  Mr Phoenix replied that the PCT seemed to have been “damned with faint praise” for actually moving the matter on. The BMA did appear to be saying that the conditions agreed by the PCT Board had in fact addressed their concerns.  As regards the helipad, he said that the use of the Air Ambulance was actually a rare event; and the helipad at Maidstone would still be used for transfers of patients.  There were informal arrangements to land the Air Ambulance at the back of the Kent & Sussex Hospital, Tunbridge Wells, although he accepted that this was not the same as having a helipad.  He reaffirmed that the external review panel must be genuinely external.  Ms Gibb said that there had been dialogue, which was what consultation was about.  The Trust had listened, and modified and changed its position during the consultation.  There were still concerns about the details, but the Trust needed to have a decision so they could move on and deal with those details.

 

(37)     Mr Marsh informed the Committee that he was a substitute at the meeting but he had had 22 hours to study the papers.  He said that the issue was not about politics but about people.  He said it was not about getting a message across but about care.  He said it was condescending to say that people did not understand. The Trust and PCT ignored the people of Kent at their peril.  He felt it was also condescending to say that the Committee could not understand the details. Members could certainly represent the people of Kent.  For the Committee to respond after the external review, he thought, would be “shutting the stable door after the horse had bolted”.

 

(38)     Mrs Tweed talked about the underestimation of the projected population growth in Maidstone and the additional pressure that that could place on A&E services at the William Harvey Hospital, Ashford.  

 

(39)     Mrs Stockell said it was wrong to say that people did not understand the issue. The BMA were experts and they were opposed too.  She also asked about journey-to-hospital times, and accused the Trust and PCT of using “woolly and weasely” words that were not very convincing.  She stated that Maidstone Hospital was being downgraded and that was a fact.  Mr Phoenix responded that his comments about Members not understanding had actually been a response to comments that Members themselves had made about their difficulty in understanding technical matters. He said that Mr Marsh had twisted some of his words and he would leave it at that.  Ms Gibb added that she recognised that people had a passion for bricks and mortar.  Mrs Stockell responded to that comment by saying the issue was not about bricks and mortar but about services.  Ms Gibb replied that the Trust had invested heavily in Maidstone Hospital.  Downgrading of Maidstone Hospital had been talked about on several occasions and she once again referred to the review of vascular services, which had not led to a downgrading of the service but rather the creation of a centre of excellence.  Comments in the press to the effect that A&E was closing or that Maidstone Hospital was closing were not accurate or true.  That was, however, what people had written in and protested about.  Mrs Stockell asked again about travel-to-hospital journey times.  Ms Gibb answered that the Ambulance Service did not think there was a problem.  Blue-light ambulances could get through quickly – and certainly more quickly than a car could.  She pointed out that a lot of people would need to travel from Tunbridge Wells to Maidstone for elective surgery in future under the proposals, so the change would not be all in one direction.

 

(40)     The Chairman, Mr Chell, informed the Committee that a lot of progress had been made. In his view, the proposals now before the Committee, having been amended through negotiation with the Trust and PCT, were now close to being acceptable – subject to clarification of some minor details and to the conditions that had been imposed on the Trust by the PCT Board.  He moved that, on this basis, the proposed reconfiguration proposals be accepted, subject to clarification of minor details and the outcome of the external review.  This was seconded by Mr Fittock.  The matter was put to the vote, with five votes for the motion, eight votes against and two abstentions.

 

(41)     Mr Fittock then asked that the Overview and Scrutiny Manager record the way that Members had voted. 

 

For:-          Mr M J Fittock, Mrs C Angell, Ms A Harrison, Mrs E D Rowbotham, Mr M J Vye.

 

Against:-   Mr M J Angell, Mr A D Crowther, Mr C Hibberd, Mr G A Horne, Mr R A Marsh, Mr M Northey, Mrs P A V Stockell, Mr R Tolputt.

 

Abstain:-   Mr A R Chell, Mr D A Hirst.

 

(42)     Mr Fittock then said that he felt it was unconstitutional not to have debated the motion before voting.  Mr Wild advised the Committee that, a vote having been taken, the item of business was now closed and the Committee should move on.  Mrs Stockell moved, seconded by Mr Northey, that, the negotiations having been exhausted without a satisfactory outcome, the proposed reconfiguration and the decision of the West Kent Primary Care Trust Board should, therefore, be referred to the Secretary of State for decision.  In debating the motion, Mr Fittock said that the Committee spokesmen had set out for the Trust and PCT a number of reasons for opposing the reconfiguration.  The Committee’s three spokesmen had worked hard to pursue these objections and other issues, which had all been dealt with satisfactorily.  Mr Northey said that he did not like the separation of clinical and human factors, as regards it being more difficult for patients to receive visitors by virtue of being in hospital further away from home.  Patient visits were part of the healing process. It was not true that people did not understand.  People knew when something was being taken from them.  He said that Maidstone was the county town of a major county of England.  He referred to the reconfiguration of services in Canterbury, which he said had left the local population with a feeling that they had no longer got what they once had.  Mr Hirst asked why the Kent & Canterbury Hospital had ended up with such a huge deficit.  He said it all went back to what was being talked about here. There had been a protracted fight, but no extra money had been forthcoming from the Secretary of State. In this instance too, the Secretary of State would not bail them out.  All that was happening was that the inevitable was being delayed. There was only so much money, and everything had to be balanced.  He felt it was not appropriate to transfer the responsibilities of the NHS Overview and Scrutiny Committee to central government and that matters should be resolved locally.  Mr Vye said that referral would delay bringing into being services that would save lives. The Committee needed to move on. There was not a huge number of the highest qualified surgeons in the country. The service was not sustainable on two sites.  He said that the issue of Maidstone’s county-town status was not relevant and the issue of visitors for patients was a separate matter.  Ms Harrison said that Members had clearly not read the papers before them and they were just being political.  Members did not want to take a decision that would be unpopular.  She said that the proposals were about “need” not “want”.  Her constituents wanted 24-hour A&E facilities, but the clinical need was not there.  The Committee was being told that this was an improvement of services.  Members had made their minds up two-and-a-half hours ago – if not months ago.  If Members of the majority party wanted to make the Committee political, then Opposition Members would do the same.  She said that the proposals were in the best interests of Maidstone, Tunbridge Wells and Kent – but not, it seemed, the Conservative Party.

 

(43)     Mr Hibberd said that the Committee had not reached an agreement, so referral was the best way to get out of this tangle.  Mrs Stockell said that she was sorry about Ms Harrison’s comments; Ms Harrison did not represent people in Maidstone as she (Mrs Stockell) did.  What was before the Committee was better than before, but it was still full of “maybes”.  She said the experts had said that the hospital was being downgraded from Level II to Level III. There had been some improvement in the proposals, but they were being told to “take it or leave it”, which she found to be antagonistic.  Mr Angell said that the Committee had reached a defining moment in its life. Referral to the Secretary of State was a last resort.  The Committee had had good relations with the Trust and PCT, and meetings had always been cordial and cooperative.  However, the reasons given for the changes were weak.  Mrs Angell said that saving lives was not a “fundamentally flawed” reason for change.  She referred to one of the other items on the agenda, where reference was made to the protocols for the operation of overview and scrutiny of the NHS across Kent; there was talk about approaching things on a partnership basis and working with NHS bodies, not against them.  The attitude of some Members on this issue was not in that spirit.  Mrs Rowbotham said that the issue was to achieve proper care in the proper place.  She wondered if opening hours could be extended during school holidays.  As regards the high level of car ownership, which had been referred to, she was concerned about the environmental impact of any policy that caused people to use their cars more.

 

(44)     The Chairman then put to the vote the motion proposed by Mrs Stockell, and seconded by Mr Northey, that the proposed reconfiguration and the decision of the West Kent Primary Care Trust Board be referred to the Secretary of State.   The vote was taken and the result was eight votes for, five against and two abstentions.  Mr Fittock then asked that the way Members had voted be recorded.

 

For:-          Mr M J Angell, Mr A D Crowther, Mr C Hibberd, Mr G A Horne, Mr R A Marsh, Mr M Northey, Mrs P A V Stockell, Mr R Tolputt.

 

Against:-   Mr M J Fittock, Mrs C Angell, Ms A Harrison, Mrs E D Rowbotham, Mr M J Vye.

 

Abstain:-   Mr A R Chell, Mr D A Hirst.

 

                  RESOLVED:-

 

that the proposed reconfiguration and the decision of the West Kent Primary Care Trust Board be referred to the Secretary of State.