Agenda item

Discussion

The Committee considered a report which advised that DMC Healthcare had been providing dermatology services to Medway patients since April 2019. On 22 June 2020 the DMC dermatology contract had been formally suspended by Kent and Medway Clinical Commissioning Group (CCG) due to serious concerns regarding patient care. The paper provided the background to this development and detailed the action the CCG had taken to ensure an effective interim service was in place.

Members raised a number of questions which included:

Dermatology contract and Harm Review – it was asked why DMC Healthcare had been awarded the North Kent contract for Dermatology Services given that there had been significant concerns about its performance in relation to primary care. It was also asked why DMC Healthcare had previously said they had incorrect information about patient waiting times and the acuity of patients and what performance monitoring would be undertaken of the interim provider, Sussex Community Dermatology Service (SCDS), to ensure that problems would not be repeated. In relation to the Harm Review process, it was asked when this would be complete and requested that details be provided to the Committee.

The Kent and Medway CCG Deputy Managing Director (Medway) had given notice on the North Kent Dermatology contract two years previously and that there had been seven months to re-procure the service. At the point of contract award, there was already a contract in place with DMC for the level 1 and 2 dermatology services with there having been no significant complaints or concerns raised about these services and there had also been good feedback about DMC provided primary care services at St Mary’s Island. The procurement process was conducted blind and therefore those making the contract award decision had made it on the basis of the tender scores, without having been aware of the identity of the provider. The CCG could not say why DMC Healthcare had felt that they had not been given correct information about patient waits or acuity. There was some uncertainty about the content of a public meeting that had taken place at the Sunlight Centre and who had been responsible for running the centre at the time. The Kent and Medway CCG Deputy Managing Director (Medway) said he had checked and could confirm that Medway Community Healthcare had been responsible for running the Centre at that point. Further details of this meeting would be provided outside the Committee.

The Chief Nurse advised that the Harm Review process had commenced with over 1,000 patients having been reviewed so far in the very urgent and urgent groups. For patients where risk of potential harm had been identified a 1^st stage review had been completed. The second stage of the process would look at patients waiting over 52 weeks or people with a potential cancer diagnosis who had experienced a 104 day wait. The whole process was expected to take several months. GPs had been asked to review patient lists as there was concern that these did not include all patients. Appeals had been made via the media for patients who might not have been included in the lists to make contact and a telephone helpline had been set up.

The transfer of patient data from DMC to SCDS had been a significant piece of work. 7,463 patient records had been transferred and 1,285 patients out-of-area patients identified who were not in Medway or north Kent and should therefore not have been on DMC’s list. 600 patients on the list had previously been seen and discharged by DMC but the records had not been updated. The total outstanding backlog of patients to be seen inherited from DMC was therefore 5,575. 1,600 had been seen by SCDS to date. This included all patients with potentially life-threatening conditions who had been seen and where necessary, either treated or scheduled for treatment. The remaining 4,018 patients on the DMC backlog list were due to be seen by the end of September with all these patients having been deemed to have routine conditions. All new patients being referred on a two week wait pathway were being seen within the required timescale and there was 100% compliance against the 31-day cancer treatment standard. It was anticipated that the target for completing the backlog of clinical reviews by the end of September would be met and that all routine patients would be seen in under 12 weeks by September. Service performance was better than nationally with a helpline having received 26 calls relating to complaints or patient harm reviews, which was a low number.

Accountability and future provision – it was asked who would be held responsible if any patients who had not gone through the harm review process suffered harm, how psychological harm was measured and what future provision of the service would look like.

The Chief Nurse said that all patients identified as requiring a harm review had been seen. If any avoidable deaths were identified, these would be considered on an individual basis, but none had been so far. However, some harm could occur many years later. Harm Reviews did aim to take psychological harm into account, but it was acknowledged that this was difficult to measure. The service put in place with SCDS was for emergency provision and a termination of the DMC contract was currently being negotiated. The aim would be to put in place a long-term contract for provision of the service.

Decision

The Committee noted and commented on the report and requested that Kent and Medway CCG update it regularly on the development of the dermatology service.