Agenda item

This report at Appendix 1 submitted by Kent and Medway CCG informs the Committee of the work being undertaken by the East Kent Transformation Programme and, in particular, considers the out-of-area patient flows to East Kent Hospitals University NHS Foundation Trust (EKUHFT), i.e. the patients from outside the east Kent area that use the services provided by the Trust. The greatest impact on the Medway population will potentially involve four specialities; Haemophilia outpatient services, Renal Inpatients, Primary Percutaneous Coronary Intervention and Paediatric surgery (dental extractions).

The Committee is asked to discuss and note the contents of the report and indicate whether the changes in location of East Kent services represent a substantial development of, or variation to the health service for residents of Medway.

At its meeting on 21 September 2018, Kent County Council HOSC determined that it was a substantial variation. If this Committee agrees that the proposed changes represent a substantial change to, or variation of the health service in Medway the matter will have to be dealt with by the Kent and Medway NHS Joint Overview and Scrutiny Committee.

Discussion

Transforming Health and Care in east Kent involved reviewing the delivery of health and social care services provided in that area. Two options were being considered which would see differing configurations of services at William Harvey Hospital, Ashford, Queen Elizabeth the Queen Mary Hospital, Margate and the Kent and Canterbury Hospital, Canterbury. A range of specialist services would be impacted by changes. Services that would be impacted, for which more than 5% of the total number of patients treated came from Medway, included coronary procedures, renal inpatient services and haemophilia outpatient surgeries. Services which fell just below the 5% threshold included paediatric surgery and vascular services. The impact of the proposed changes on travel time for the Medway population had been considered with a detailed analysis of travel times based on Super Output Areas (SOA) having been provided to the Committee as a supplementary agenda. This considered the differences between the William Harvey Hospital and Kent and Canterbury Hospital for the ten most impacted SOAs in Medway. A simpler analysis of train travel times had also been provided.

The Chairman advised that the Kent Health Scrutiny Committee had determined the proposals to amount to a substantial variation to the health service in Kent and that, therefore, if Medway also deemed them to amount to a substantial variation, the matter would need to be further considered by the Kent and Medway Joint Health Scrutiny Committee.

The Programme Director of the Kent and Medway Sustainability and Transformation Partnership advised that for service users in East Kent, the changes proposed covered the whole of their healthcare provision, where as for Medway, only a relatively small number of patients would be affected. It was therefore the view of Sustainability and Transformation Partnership that the proposals did not amount to a substantial variation in the health service for Medway residents.

A Committee Member said that quality of care and accessibility should be the most important factors in determining the location of services. The Member accepted the prevailing view that larger scale, specialised health services would be better able to provide services and that the changes in travel times for Medway patients travelling to East Kent hospitals would be relatively small but she was concerned about other services, such as stroke and vascular service, which if current proposals came to fruition, would move away from Medway Maritime Hospital. As the largest urban area in the South East, outside London and with a growing population, it was important for services to be provided locally. It was therefore important for Medway to be fully included in the decision making process for the East Kent proposals. Consequently, the Member considered that the proposals amounted to a substantial variation to the health service in Medway. The Member was also concerned about the future accessibility of Ashford in view of the likelihood of sections of the M20 between Maidstone and Ashford being closed at times for lorry parking, a particularly in the event of a no deal Brexit.

The Programme Director noted that the proposed reconfiguration would not involve any services moving away from Medway, rather they would be moving from one East Kent hospital to another. There were many acute hospitals across the country that provided 24/7 emergency care without the provision of stroke or vascular services. Health services had undertaken planning for Brexit including looking at the ability to move patients at speed between hospital sites in different parts of Kent and Medway

In relation to travel times, for services moving from the Kent and Canterbury Hospital to the William Harvey Hospital, 7.58% of the Medway population would have a car journey travel time of 5-7 minutes longer, 31.82% of 0-5 minutes longer, 33.41% of 0–5 minutes shorter and 27.20% of 5-12 minutes shorter. These figures would be reversed for services moving from William Harvey to Kent and Canterbury.

Other Members agreed that the proposals amounted to a substantial variation. Although the number of Medway patients affected was relatively small, the Members felt that they had a duty to protect the interests of the people of Medway and help to ensure that services were provided in the appropriate place. One Member was concerned that Kent and Canterbury Hospital was not yet suitably equipped to effectively deliver extra services while another felt that the needs of more rural areas, such as the Hoo Peninsula had not been properly taken into account. Another Member asked what the implications would be for delivery of the changes should the Committee determine that the proposals amounted to a substantial variation, in view of the fact that the Kent HOSC had already done so.

In relation to the Hoo Peninsula, the Committee was advised that the mapping exercise had considered all areas, including rural areas. There was a mandated process that had to be followed in relation to the proposals. This included a pre-consultation case for change, which had been completed, followed by the submission of a pre-consultation business case to NHS England. Once approved, clinical commissioning groups would then decide whether to go ahead and consult on the proposals. The intention was to present the pre-consultation business case to NHS England by the end of the year.

Decision

The Committee:

i)     Discussed and noted the contents of the report.

ii)    Reviewed and commented on the activity flows into east Kent.

iii)   Agreed that the changes in location of east Kent services represented a substantial development of, or variation to the health service in Medway.