Agenda and minutes

Members of the Kent and Medway NHS Joint Overview and Scrutiny

Committee are asked to note the membership listed above.

Members of the Kent & Medway NHS Joint Overview and Scrutiny Committee noted the membership listed on the Agenda.

Apologies were received from Mr Bartlett.

(1)          Mrs Chandler proposed and Cllr Purdy seconded that Cllr Wildey be elected as Chair of the Committee.

(2)          RESOLVED that Cllr Wildey be elected as Chair.

(1)          Mr Pugh proposed and Mr Daley seconded that Mrs Chandler be elected as Vice-Chair of the Committee.

(2)          RESOLVED that Mrs Chandler be elected as Vice-Chair of the Committee.

There were no declarations of interest.

RESOLVED that the Minutes of the meeting held on 12 October 2018 are correctly recorded and that they be signed by the Chair.

Stuart Jeffery (Deputy Managing Director, NHS Medway Clinical Commissioning Group) and Michael Griffiths (Programme Lead, Children and Families, NHS Medway Clinical Commissioning Group) were in attendance for this item.

(1)          The Chair explained that as he anticipated that the discussion in relation to this item would be relatively short, he had decided to vary the order of the Agenda and take this as the first substantive item of the Agenda.

(2)          NHS representatives explained that the consultation previously discussed with the Committee was on hold. There were several barriers to further progression. However, the need to make certain changes had been flagged up and Kent and Medway was now in line with the law and the rest of the country.

(3)          In response to a question it was clarified that the IVF offer across Kent and Medway was the same. It was further explained that the contract was out of date so on behalf of all the Kent and Medway CCGs, NHS Medway was moving ahead with a procurement on the basis of the existing policy. This was not expected to change as the CCGs moved to becoming a single CCG.

(4)          In discussion with Members, it was explained that demand for ART had remained steady over recent years, but changes have meant new groups, such as same-sex couples, have become eligible and this may increase demand. It was also established that once the CCGs were ready to progress, the normal consultation and engagement process would be followed.

(5)          RESOLVED that the report be noted.

Simon Brooks-Sykes (Senior Strategic Development Manager and Programme Manager for the Kent and Medway Vascular Clinical Network, East Kent Hospitals University NHS Foundation Trust (EKHUFT)), Fiona Hughes (NHS England and NHS Improvement - Specialised Commissioning), Dr David Sulch, Interim Medical Director, Medway NHS Foundation Trust), Liz Shutler (Deputy CEO for EKHUFT and Executive Lead for Programme), and Dr Noel Wilson (Consultant Vascular Surgeon, EKHUFT) were in attendance for this item.

(1)          The Chair introduced the topic and expressed concerns that there did not seem to have been much detail in the report as to what progress had been made since the last time the Committee met to discuss this topic almost a year ago previously and that information requested at this previous meeting had not been provided.

(2)          In providing an introductory overview on behalf of the NHS, Fiona Hughes said that she appreciated that there had not been an update in the interim period and that the focus of NHS Specialised Commissioning was the need to reinvigorate the process.

(3)          NHS representatives then proceeded to provide the background. In 2012, the Vascular Society produced service specifications for the UK. These were revised in 2015 and updated in 2018. The core feature was that as a result of the clinical complexity and population demand, there needed to be a centralisation of high-risk care. A single arterial centre (the ‘hub’) would need to be established with other hospitals in the geographical areas delivering non-arterial services; these hospitals would be the ‘spokes’ in the proposed vascular networks. The overriding difference between the hub and spokes is that the former would be the only one with inpatient beds so that patients requiring a bed would be directed there. This applied to both planned and unplanned care. Other care would be delivered closer to home with day case and outpatients still being delivered at local hospitals along with diagnostics.

(4)          Moving on to the service standards for vascular work, it was explained that these were very clear and covered the volumes of activity, timelines for interventions, and the need for equitable service across the network.

(5)          On the geographical spread of the network, it was explained that patients seen at Tunbridge Wells and Darent Valley Hospitals had a patient pathway that directed them to St. Thomas’ in London for specialist work.

(6)          Clinical representatives explained that vascular surgical work mainly focused on three areas – aortic aneurysms, peripheral vascular disease, and carotid endarterectomy.

(7)          Several comments and questions from Members referred to the recent proposals for acute and hyper acute stroke services and the connections and comparisons with vascular services. It was explained that while vascular disease covered a broader range of conditions, including cardiac care and dementia, the total amount of inpatient care and vascular surgery (planned and unplanned) was around a third the number of stroke patients. This meant fewer consultants were needed and a single hub. The only surgical intervention that was of direct relevance to stroke care was carotid  ...  view the full minutes text for item 16.