Meetings, Agenda and Minutes

Between 7.30pm and 7.55pm a petition was presented and the Panel received questions from the public.

Petition

Ms Grace Edwards presented a petition containing 800 signatures requesting that the Primary Care Trust allow the Churchill Medical Centre to open a branch surgery in Tudor Drive. The Churchill practice had previously operated a temporary caretaker surgery in Tudor Drive whilst the Primary Care Trust went through the formal process of commissioning a new GP practice. Although unsuccessful in tendering for the vacant GP practice, the Churchill Medical Centre had purchased a property in the area and wished to open it as a small branch surgery. Ms Edwards spoke in support of the surgery being allowed to open, noting that it had already been equipped and that some patients had difficulties when using public transport to reach the existing Tudor Drive GP surgery.

The petition was passed to the Primary Care Trust for consideration and to provide a response to the lead petitioner and the Panel. The Panel noted that issues surrounding patient choice in primary care was a potential topic on the Panel’s work programme.

Public Questions

Mr Carl Kember asked questions relating to dementia services and plans for a ‘memory clinic’ in Kingston, the provision of a Dermatology Clinic at Kingston Hospital and matters arising from the local authority’s contract with Kingston Citizens Advice Bureau as the host organisation for the provision of a Local Involvement Network.

Penny Taylor, Director of Performance Kingston NHS, advised that dementia services had been reviewed as part of the Primary Care Trust’s Operating Plan for the current year and a business case was being drawn up for the provision of a memory clinic in Kingston. It was agreed that an item updating on dementia services would be included on the Panel’s work programme.

It was noted that the questioner had received a response to his question about a Dermatology Clinic when he had raised the matter on a previous occasion in 2008.

Questions relating to the management of the contract between the local authority and the host organization for the local involvement network could best be answered by the Executive, as this is where responsibility for the contract lies, and so had been passed to the Executive to provide a response at their next meeting.

RESOLVED that the minutes of the meeting held on 24 March 2009 be confirmed as a correct record. 

There were no declarations of interest. 

Presentation from Kate Grimes, Chief Executive, Kingston Hospital Trust 

The Joint Health Improvement Programme (JHIP) is a new Kingston-wide programme that was set up in March 2009 by Kingston Primary Care Trust and Kingston Hospital NHS Trust. Kate Grimes, Chief Executive of Kingston Hospital Trust, updated the Panel on the work that would be taking place as part of the Joint Health Improvement Programme.

The JHIP is a joint programme which has the overall objective of bringing together key stakeholders from KPCT, KHT, GPs, hospital consultants, social service staff and other healthcare staff from across the borough to redesign existing services to provide improve healthcare in Kingston. The JHIP will be clinically led and involve significant service redesign to deliver services in a different way to existing services where it is considered beneficial to the local health economy.

The programme aims to progress improvements in health outcomes by working jointly across local health organisation structures. The programme is headed by David White, JHIP Programme Director, and consists of eight projects; Sexual Health Services, Unscheduled Care, Maternity Services, Community Paediatrics, Long Term Conditions (Diabetes), Long Term Conditions (COPD - Respiratory), Right Price Services and End of Life.

Members of the Panel welcomed the joined up approach being taken by the programme and, in particular, the focus on improvements in services for children with disabilities as part of the Community Paediatrics project. It was anticipated that the redesign of services would be completed by October 2009 with the new services available by April 2010. The Panel was advised that it would be kept informed with regular updates.

The Panel AGREED that the update be noted.

Update by Andrew Seddon, Director of Finance and Information, Kingston Hospital Trust. 

Kate Grimes, Chief Executive of Kingston Hospital Trust, gave an update on the Trust’s most recent financial position. The Hospital Trust achieved a small surplus of £800k for the year ending 31 March 2009. This was lower than the £1.5million efficiency target identified at the start of the year but represented an improvement from the mid-year position of a deficit and breakeven forecast. The improvements in the financial position in the second half of the year were due to improved cost control measures and an increase in income.

The Hospital Trust was aiming for a planned surplus of £1.9million in the current financial year. The Trust would like to invest in the fabric of the Hospital and is required to produce a surplus in order to carry out any capital developments. The Hospital Trust is also required to pay a public dividend of £3.6million back to central government. This is an annual payment equivalent to the interest on the NHS assets used by the Trust (3-4% per year).

The Panel AGREED that the update be noted.

Report by Kingston Hospital Trust 

The Healthcare Commission published a review of Maternity Services in January 2008 which rated Kingston Hospital Trust, along with the majority of hospital trusts in London, as ‘least well performing’. The Panel reviewed the reasons for this rating at its meeting in March 2008 and received a further update on the steps being taken to improve the service to residents in January 2009.

The Panel considered further details submitted by the Hospital Trust on the actions being taken to improve maternity services based on the points of concern highlighted in the review by the Healthcare Commission. Lynn Smith, Head of Midwifery, and Helen Dirilen, Director of Nursing & Quality, answered Members questions on Maternity Services.

Members noted the actions which had been taken to improve the service. Improvements included altering the referral process, such as taking over the administration for bookings at Roehampton, to enable a greater proportion of women to receive a maternity care appointment within 12 weeks of their first contact with their GP (from 54.6% in October 2008 to 80.8% in April 2009). Members also noted that changes in the way health services are provided in the community, including the use of polyclinics, could change the way women access the service eg some maternity services might be provided in children’s centres. However, some questions and concerns remained. These included the policy of informing women to expect that it is normal to return home two hours after delivery and the ratio of midwives to women which, although much improved, was still below the national standard of 1:28.

Lynn Smith advised that the guidance to women about their return home after delivery was in line with patient choice. Most women wanted to return home as soon as possible and, as long as there were no complications and they were feeling ok, this opportunity should be offered to them.

In terms of the ratio of midwives to women, the national standard was viewed as an aspirational target. This target was not being met nationally and variations were expected according to the needs of an area and models of service provision. Kingston’s new service model was based on different ways of working and the Trust was looking to recruit a further 70 members of staff (including supervisors, trained midwives and maternity support workers) to better meet the needs of the new service. Kingston has made a considerable investment in new recruitment and would target its recruitment strategy around the points in the year when midwives completed training. This is an issue challenging many trusts across London and London NHS has procured an agency to recruit midwives from both the UK and abroad.

Kate Grimes, Chief Executive of Kingston Hospital, advised that the improvement in staff ratios from 1:43 to 1:34 was a major achievement, particularly given the rising birthrate. The midwife ratio represented only one service indicator amongst many and a range of benchmarks need to be considered to get an accurate picture.

The Panel also discussed the plans to  ...  view the full minutes text for item 5.

Update from Kate Grimes, Chief Executive, Kingston Hospital Trust. The Trust’s consultation document was not available to be circulated with this agenda but will be sent to Members separately once finalised. 

Kate Grimes, Chief Executive of Kingston Hospital Trust, advised the Panel that the Hospital Trust had launched a 12-week public consultation on its plans to become an NHS Foundation Trust. The Trust is seeking the views of patients, staff and local residents on how the foundation trust should be set up and around the arrangements for members and governors. It had been decided to carry out a further full formal consultation due to the amount of time which had passed since the Trust’s initial consultation in 2006 (which had been updated in 2008).

A Foundation Trust remains part of the NHS but local people and patients are able to become members of the Foundation Trust (including voting and standing in elections to the new Board of Governors) and have more say in the shape of the services provided in the future. Foundation Trusts have a greater degree of independence in what is done at a local level and how it is done. They can also borrow money to invest in developments, change the way things are done and make services better, quicker and with greater choice for local people.

The authorisation process involved in becoming a Foundation Trust was expected to take well over a year to complete. This would mean that a final decision date was likely to fall close to the Government’s target of the end of 2010 for all Hospital Trusts to become Foundation Trusts. Any hospital trust which has not been successful in becoming a Foundation Trust by the end of 2010 risks being acquired and run by another trust which has Foundation status. Potential threats to meeting this deadline included the sector level review of providers and the need for Kingston Hospital to have implemented its new computer system (a major change which had proved problematic in other hospitals). The Trust advised that it would welcome the Panel’s views and involvement in these areas. Financial difficulties in the public sector could also further raise the bar for Foundation Trust applications, with even greater levels of efficiency being expected of new applicants.

The consultation period started on Wednesday 24 June 2009 and will end on Wednesday 16 September 2009. Copies of the consultation document were circulated to Members and have been made available to view on the Hospital Trust’s website (www.kingstonhospital.nhs.uk)

The Panel AGREED to note the update and requested that further updates be brought forward as appropriate.

The final draft of the Working Group’s report and recommendations is attached. The report is presented to the Health Overview Panel for any comments prior to the report being published.

ACTION BY THE PANEL

The Panel is asked to note the recommendations and comment on any of the issues arising.

The Chair introduced the final draft of the review group’s report on parking and other travel issues at Kingston Hospital. The following points arising from the review’s recommendations were highlighted:

·        The working group would like to see the Hospital install a pay on exit parking system (making use of available technology).

·        The review recommends that a group be established to explore the possibility of the Hospital building a multi-story car park.

·        There is a need for a champion on the Trust’s Board to highlight parking and travel planning issues.

·        The Hospital’s Healthy Travel Plan is an important document that will need to evolve in order to stay relevant. More regular review dates should be adopted as part of the plan’s monitoring

·        There is a need for more information from patients, visitors and staff to feed into the Travel Plan. Monitoring and feedback suggestions had been put forward in the review report.

Kate Grimes, Chief Executive of Kingston Hospital Trust, advised that she would like to be involved in pushing the recommendations forward. She noted that parking was a big issue for patients and visitors and she would like to resolve the issues involved and reduce any unnecessary worry which might be caused when accessing services at the Hospital. Comments in support of many of the recommendations in the report had also been received from Diane Lee, Head of Facilities for Kingston Hospital Trust, who had been involved as part of the review process.

Councillor David Cunningham advised the Panel of his support for the review and its recommendation for a small working group to explore the case for a new multi-storey car park. He advised that he would be meeting the Trust’s Deputy Chief Executive in relation to this issue and hoped further developments could take place from September.

It was noted that some minor amendments had still to be made to the wording of parts of the report. The report would be finalised, published and an action plan created with review dates. The final version would then be circulated to all the relevant partners and decision-making bodies.

The Panel AGREED that the report be noted.

Report by the Head of Democratic Services and Partnership

Kingston Clinical Assessment Service is the system used for referring patients from GPs to hospitals or places for specialist treatment. The Panel received a scrutiny review report on KCAS at its meeting in May 2007.  The report made recommendations related to the following topics: Publicity, Information Leaflets, Referrals, Public Health, Follow-up procedures, Clinical Governance, General Practitioners and the limitations on GPs Choose and Book.

The Panel considered the results of a survey of patients and clinicians on the impact of the Kingston Clinical Assessment Service. The Panel also questioned Penny Taylor, Director of Performance Kingston NHS, on the Primary Care Trust’s view of how KCAS had been received and how it had operated in practice. During the discussion the following points were made:

·        Since the introduction of KCAS, Kingston had seen an 8% decrease in the number of referrals compared to a 10% rise elsewhere.

·        Patients requiring urgent care are seen outside of the KCAS process. All other (non-urgent) cases are directed through KCAS.

·        Although the overall numbers appeared static, the 18-week target meant that patients were passing through the system quicker and therefore more could be seen.

·        It was believed that cases where a patient might need to be referred from one consultant to another via the KCAS system were the exception rather than the rule.

The Panel AGREED that the survey results and views expressed on KCAS be noted.

Report by the Head of Democratic Services & Partnership 

The Panel discussed potential topics for its provisional work programme for the 2009/10 municipal year, including the establishment of a health scrutiny review. In addition to the list of items included in the report, Members requested that an item also be programmed on Dementia and the Older People’s Mental Health Strategy. It was also noted that standards in care homes might be a suitable issue for the Local Involvement Network.

The Chair proposed that any further views on the provisional work programme, including the choice of topic for the first scrutiny review, be forwarded to Democratic Support. An indicative work programme for the year would then be circulated to Members and health partners.

The Panel AGREED that the provisional work programme for the year be circulated following the receipt of any additional views.

Report by the Head of Democratic Services & Partnership 

The Panel considered a report providing an overview of its work over the past Municipal Year.

Key issues examined by the Panel over the course of the year included:

·        Developments in Commissioning (both Kingston and South West London based).

·        Provision of Services to People with Learning Disabilities: Improvements to Patient Care at Kingston Hospital

·        Joint Overview and Scrutiny Work including Acute Stroke and Major Trauma.

·        Review of Parking and Transport for Patients at Kingston Hospital

·        The Financial Position of Health Partners in Kingston.

·        Changes in local Mental Health Services (Re-provision of Springboard Service through Kingston Eco-op).

Members noted the work that had been carried out over the past year. Councillor Mary Clark noted that there would be an opportunity to comment on the re-provision of Springboard Services at the October meeting.

The Panel AGREED that report be noted.

·        Local Involvement Network: Report from Cllrs Mary Reid and Paul Johnston

·        Winter Pressures Update: Kingston Hospital A&E Performance

·        Health Bulletin 

During the discussion on the information updates, Councillor Steve Mama expressed his concern about the difficulties experienced in establishing the Local Involvement Network for Kingston. The Chair advised that the Panel shared this disappointment and expressed the hope that a positive resolution would be in place by the next meeting of the Panel. 

The Panel AGREED that the following items be noted:

·        Local Involvement Network: Report from Cllrs Mary Reid and Paul Johnston

·        Kingston Hospital: Winter Pressures and A&E Performance

·        Health News Bulletin Items