Minutes for Health Overview and Scrutiny Panel meeting, Jan 27 2010, 7.30PM official page

The Panel received questions from the public between 7.35pm and 8.10pm.

Mr Batson asked why the branch GP surgery in Tudor Drive had not been given permission to open despite the recent ruling of the NHS Co-operation and Competition Panel that it should be allowed to do so. David Smith, Chief Executive of NHS Kingston, explained that the NHS CCP’s ruling represented a recommendation to the Department of Health and NHS London as to the way forward. NHS Kingston was awaiting guidance from the Secretary of State and NHS London on any final decision.

Mr Colin Dance asked questions relating to the establishment of a GP led walk-in clinic in Chessington. These included concerns about the use of the existing Gosbury Hill surgery site, the involvement of Malling Health as a potential third practice and the lack of consultation about recent developments. David Smith agreed to set up a meeting with the existing patients’ participation groups and both practices to work through the issues which had been raised.

Councillors Geoff Austin and David Cunningham asked questions relating to press stories about a possible plan to move Accident & Emergency and Maternity Services away from Kingston Hospital as part of a review of acute hospitals in South West London. The Councillors advised that, at the Hospital Trust’s Board meeting earlier in the day, the Chief Executive and Chairman of the Hospital Trust had not accepted the basis of the story and had expressed concerns about the effect on patients and staff any uncertainty might cause. Councillor Mary Reid advised that she understood that the story about Kingston Hospital had arisen as the local MPs had been informed that it was one of the options being seriously considered by the South West London review but that further details would not be available until after the upcoming General Election.

Copies of a letter sent on behalf of Healthcare for South West London entitled ‘No change is not an option in south west London’s NHS’ were circulated. In the letter the sector chair for NHS South West London stated that there were no ‘secret plans’ but that ‘no change is not an option’. The letter stated that the South West London review was at an early stage and had not considered any specific sites for closure nor numbers of hospitals that will be required to deliver acute services. The review was currently examining the case for change and working to a timetable that would see any proposals published for consultation towards the end of 2010. It was agreed that a special meeting of the Health Overview Panel would be arranged to clarify the issues around the future of services at Kingston Hospital.

RESOLVED that the Minutes of the meeting held on 10 December 2010 be confirmed as a correct record. 

There were no declarations of interest. 

Report by Kingston Hospital Trust 

Maternity Matters is a national policy that will ensure that all pregnant women will be able to choose the type of care that they receive, with better access to services and continuity of midwifery care. The Joint Health Improvement Programme is delivering the choice guarantee in Kingston through the implementation of service redesign and integrated community midwifery teams. The project completed the first phase of its two stage process in December 2009.

The redesign of the service establishes a Core Hospital Team and Integrated Community Midwifery Teams and introduces changes in working practices to provide care across the whole continuum. The same team of midwives will provide antenatal, intrapartum and post natal care to women regardless of setting and choice and place of the delivery. Services will be based around local networks with a strong emphasis on shared care arrangements with GPs and local partnerships with Children’s Centres.

Following a successful recruitment of midwives and maternity support workers, the Unit has rolled out three integrated community midwifery teams in the Kingston area and established a Core Hospital Team. The Unit has worked closely with service users to gather their views on maternity services, contribute to their redesign, review maternity information resources and design a bespoke maternity website.

Phase 2 of the project, to be completed by June 2010, will focus on the roll out of the remaining 6 integrated community midwifery teams, the development of satellite clinics providing routine antenatal care and scanning. This will be followed by an impact assessment of the changes on hospital maternity services.

The Panel heard from the Hospital’s Maternity Services Team that the project would have a very positive impact on maternity in Kingston. 40 new midwives and 30 support workers will have been appointed by the completion of the project to enable the rollout of a number of community teams that will offer improved choice in access, type of antenatal care, place of birth and postnatal care.

Councillor Mary Reid expressed concerns that the ratio of midwives to women remained at 1:34, above the national standard of 1:28. Although it was noted that fewer temporary staff were being used, the overall figure had not improved since June 2009 despite recent recruitment efforts. Lynn Smith, Head of Midwifery & Gynaecology Nursing, advised that there had been an increase in the numbers of women giving birth at Kingston Hospital and that a decision had been taken not to cap numbers or restrict access to the service for local people. There remains a large shortage of midwives at both the national and London level. This was now being addressed locally by a more active rolling recruitment of midwives, looking at internal training and development and exploring recruitment opportunities in Ireland and other countries.

In response to questions from Councillor Paul Johnston about training opportunities, Lynn Smith advised that NHS London had increased the number of higher education places for midwives it funded as university courses had previously several times more applications than places. Training takes time and  ...  view the full minutes text for item 35.

Report by NHS Kingston

NHS Kingston and Kingston Council are working together to improve health and personal care services across the four Royal Borough of Kingston neighbourhoods. This involves developing new 'polysystems' in the Borough.  A polysystem describes a more joined up way of working for care professionals and a more patient-focused way of delivering care, closer to people's homes.

The proposals for Kingston are being developed around two polysystems, one based in the north of the Borough (comprising of the Kingston Town and Maldens and Coombe neighbourhoods) and one in the south (Surbiton and South of the Borough). Proposals for the southern polysystem are based around the redevelopment of the Surbiton Hospital site into a polyclinic and a walk-in GP led health centre in Chessington. The proposals for the northern polysystem are at a less developed stage but will include an urgent care centre to be co-located with Accident and Emergency at Kingston Hospital from July. More discussions were needed between GPs in the north of the borough to determine which model of provision would fit best with the needs of the area.

Public consultation took place between September and November 2009 on “Better care systems and Surbiton Hospital site redevelopment”. The consultation collected initial responses to the key principles behind the polysystem plans. The next steps in the process will be to complete the business case for the Surbiton site whilst also further developing the plans for the north of the borough. It was not thought that the model for the north of the Borough would be based around new buildings.

David Smith, Chief Executive of NHS Kingston advised that further work would be taking place on the model of care for patients who are admitted and discharged from Kingston Hospital, including looking at the number and type of community beds available. It was noted that, in addition to the considerations about the best model of care for patients, there would also be affordability issues in relation to any decision to locate community beds on the new Surbiton site.

David Smith advised that it would be helpful to hold as much of the forthcoming discussions in public where possible. NHS Kingston would be talking to Council officers about the best ways to carry out future consultation, including linking in with the existing neighbourhood structures.

RESOLVED that the update be noted and that the Panel continue to receive updates on the development of polysystem arrangements in Kingston upon Thames on a regular basis.

Report by South West London and St George’s Mental Health Trust. 

Maresa Ness, Chief Operating Officer for South West London and St George’s Mental Health Trust, informed the Panel of proposals drawn up by the Trust for a new service model for mental health care across south west London. The proposed model, which has been developed for discussion at this stage, aims to create a much clearer path of assessment, treatment, support and follow-up than is currently available. It is also intended to ensure that all services are more clearly driven by evidence based practice, whilst also allowing for support to be tailored to a person’s unique requirements. 

Key aims of the service redesign will be to create a system from the perspective of people using services and those close to them that is:

·        Clearer and easier for all to navigate and access

·        Better at sharing knowledge and information with people using services and their loved ones

·        More help in a crisis and better at reducing crises

·        Offering the right support at the right time, throughout the person’s journey through services

·        More consistent across the Trust area and achieving better outcomes for all.

Under the current arrangements, GP referrals are directed to the Community Mental Health Team. Staff are currently expected to be ‘generalists’, providing services for all types of mental health condition. Depending on the expertise of the individuals in the local team, people in Wandsworth can therefore receive a different experience of care than those in Kingston. The proposed service model accepts that encouraging and making best use of individual specialisms across the sector will benefit the patient experience.

Maresa Ness explained the proposed service model and the breakdown of the tiers of care from primary care (Tier 1) to specialist services (Tier 5). A diagram of the proposed model is attached as Annex 1 to these Minutes. The model had been designed to be consistent with current policies and represented the Mental Health Trust’s vision of the way forward for mental health services. The proposed model will:

·        Provide GPs and other community organisations with specialist advice and support they need to help people with mental health conditions whom they serve

·        Provide those people whose needs cannot be met by their GP and primary care psychological therapy services with more effective assessment and earlier access to the treatment and support they need to do the things they want to do and make the most of their lives

·        Ensure those who are most disabled by their mental illness, whether in the short or longer term, have access to the most effective, evidence based services and personalised support.

In response to questions from the Panel, Sue Denby, Service Director for Kingston, advised that the availability of services which enabled carers of mental health users to have breaks, for example day centres, was noted to be a concern for carers. It was noted that there were few mental health day centres operating and further thought would need to be given as to how to work in partnership with the voluntary sector to  ...  view the full minutes text for item 37.

·        Tudor Drive GP/Primary Care Issues

·        Kingston’s Link - Local Involvement Network

·        NHS Car Parking: Consultation on Improving Access for Patients

·        Work Programme

·        Health News Bulletin

RESOLVED that the following information items be noted:

·        Tudor Drive GP/Primary Care Issues

·        Kingston’s Link - Local Involvement Network

·        NHS Car Parking: Consultation on Improving Access for Patients

·        Work Programme

·        Health News Bulletin