Agenda item

Hazel Carpenter, Accountable Officer, South Kent Coast CCG and Thanet CCG to present.

PLEASE NOTE that this item will be taken ahead of Agenda Item 4 (Agree terms of reference of the QEQM Hospital Cabinet Advisory Group) in the main agenda.

Hazel Carpenter, Accountable Officer for Thanet CCG and South Kent Coast CCG led discussion with a PowerPoint presentation, which is hereby attached as Annex 1 to this minute item. She explained that the Clinical Commissioning Group (CCG) was a grouping of General Practitioners from whom one GP is elected chairman to lead the group. They hold a National Health Services (NHS) budget for Thanet which was currently at £200 million per year. This budget excludes services like primary care or specialist services where cases are usually referred to London.

The Thanet CCG was currently working with three other CCGs in the South East Kent to develop approaches for future integrated working. EKHUFT has been discussing proposals for a health service strategy for the future. However the Trust cannot go it alone. There is a need for a more holistic approach moving forward that would involve engaging the various CCGs who hold the legal obligation to consult in cases where new health delivery strategies are being proposed.

Case for Change

Hazel Carpenter said that there was a rising demand for care in a situation where service provision was fragmented and there was a need reconsider how health services can be provided in a seamless way to enhance the patient experience. Care Quality Commission (CQC) performance results show poor performance. Whilst the constitutional performance targets for A&E are a four hour wait for 95% of the people, QEQM Hospital’s A&E results are more likely to be under 70% in some weeks. There was shortage of specialist skills in the NHS and locum staff are being used to fill in the gaps, and this was not sustainable in the long run.

There were inequalities in health standards. For example, in Thanet life expectancy goes down 17 years as one moves from one area to another. There was therefore a case for addressing these issues through a holistic re-organisation of health service delivery. Chief Executives and Medical Directors of all major health organisations (Ambulance Services, NHS, Social Care Services etc), Kent County Council, four clinical Commissioning Groups Chairs meet as a Strategic Board chaired by Sarah Philips to come up with a model for integrated working which is sustainable and closes the current gap of quality, affordability and inequalities.

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The Board is building a case for change through understanding the various needs and gaps at local level (Thanet level), sub-district level and county level. They are looking at some work streams which are:

a)  Maternity and Paediatrics;

b)  Mental health care;

c)  Urgency and Emergency care;

d)  Prevention and self care;

e)  Learning disabilities;

f)  Long term conditions and frailty;

g)  Planned care and Specialist care;

h)  End of life care

The Board is looking at what the best should be like for each of these services and developing a model for integrated care. In the process the board is developing a Kent Integrated Data set that allows for the analysis flow across health and social care. This facility is new and unique nationally.

Time Scale

Originally the governance arrangements were scheduled to be in place by Easter. These arrangements would enable Thanet CCG to make a decision on this matter. By end of April – early May clinical models need to have been described and set out. Stakeholders and the public will be engaged in the process. A Patient Panel will be set up to keep patients informed of the progress.

By June 2016 there should be a Plan to take to public consultation. The intention is to have one service, one team and one budget.

After the presentation by Hazel Carpenter, Members asked questions that she responded to. She said that although the end of life care budget in the slides reflected 0%, that budget is covered for within the hospital budget, community budget and primary care budget. There was a general shortage of GPs nationwide, but plans are being worked out to address the problem.

Doctors do not have the right contacts that would incentivise them or the right staff to work with. At a national level an additional £60,000 for each GP is to be allocated. This includes attempts to bring together GPs to work together as a group of surgeries. For example in Thanet, four localities (Margate, Broadstairs Ramsgate and Quakes Locality) have come together and are to receive CCG allocated funding to incentivise them working together.

Hazel Carpenter said that there will be criteria for the public consultation for the changes in services across east Kent. This included looking at safe service, same service standards, access to services by the local community (including non health seeking community) Clinical outcomes are critical in the proposals for a new model of working and service change. The GP members and managers are very clear about that and aware of that requirement. However some very specialist services need concentrating to ensure the right number of patients are being seen and specialist skills can be brought together in safe clinical rotas.

With regards to patients being referred to William Harvey for certain appointments and not at QEQM Hospital, GPs can see the patient information on how many individuals would take an earlier appointment at William Harvey rather than sit back and wait for a longer waiting time appointment at QEQM Hospital. These issues will be taken into consideration when working out the new model.

Speaking under Council Procedure Rule 20.1, one Member asked what the CCG was doing to address the issue of low morale in the NHS, recruit and retain staff, improving moral and tackling agency spend (and reduce the financial gap). Early change management programme would need to be used to fully engage NHS staff right from an early stage of the change process.

Hazel Carpenter said the Board was already looking at ways of promoting and developing opportunities to work in those health sectors and support the work of the NHS without encouraging employees leaving some organisations in great numbers.

Members observed that if the Cabinet Advisory Group waited for the public consultation in order to feed into the process might be too late as some significant decisions would have been made. There is a need for the sub group to look at the right points to influence the change process. Hazel Carpenter said that she welcomed the input from the Council. She said that there was no likelihood of the A& E Department being moved away from QEQM Hospital. The Chairman said that it was good news that the department would not be closing down.

GPs across Thanet are currently working on an initiative that would set up the Thanet Hub which will based in QEQM Hospital, which will be at front door and the A&E would then be moved to an area within the QEQM Hospital behind the Hub.

Hazel Carpenter said that after the closure of the GP surgery in Garlinge, all the patients will receive notification letters advising them where they have been allocated a registration with another GP. She also said that the NHS has got an internal recruitment agency and it was worth noting that 70% of recruitment is passed on between NHS organisations.

With regards to shortage of consultants at the A& E, Hazel Carpenter advised the meeting that plans were being drawn up to address this across the Trust. She urged Members to write to the CCG and NHS to raise these clinical concerns. A new medical model is being implemented to enable consultants to attend A& E within the expected best practice time scales.

Members received and noted the presentation. The Chairman also thanked Hazel Carpenter for her presentation.