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Questions
Members of the public were invited to put forward questions to the Chair and Chief Executive and the Trust’s key presenters:
Robotic Surgery
Ben Eddy, Consultant Urologist, responded to questions raised:
Robotic surgery can be used for procedures including: gynaecology, colorectal, ENT procedures, cardiac surgery. Going forward, the Trust would be looking to develop the use of this equipment into other specialty areas. East Kent Hospitals University NHS Foundation Trust is the first NHS Trust in Kent to have this type of surgery.
As prostate cancer is a slow growing cancer and this is a fairly new procedure worldwide, there was currently no data to ascertain the impact on mortality rates. However, there were huge benefits to patients including reduced risks of complications, quicker recovery periods (reduced length of stay), and minimised scarring. The procedure requires a general anaesthetic but there is no need for epidurals and PCAs, resulting in minimised pain control post operation.
Ben Eddy is currently the only surgeon trained in this type of surgery in the Trust. A second surgeon had commenced training in laparoscopic surgery and a third surgeon will undertake training for kidney cancer.
There are currently 26 robots in the UK and Ireland with approximately 20 surgeons who had undertaken training. The Trust had purchased a training programme (a ‘surgical simulator’) with the Da Vinci Robot. A project had commenced in the Trust to introduce this surgery to medical students. However, accredited training is at fellowship level and takes approximately 15 months.
The Trust purchased the Da Vinci Robot for £1.5m. Currently there is only one company worldwide which holds the patents. Competition in the market place will come eventually to make this equipment more accessible.
Elderly Care Services
Shelagh O’Riordon, Consultant (Healthcare of the Older Person), responded to questions raised:
Currently 70% of hip fracture patients admitted Sunday to Friday were operated on within 36 hours. Patients admitted on a Saturday were waiting slightly longer due to theatre availability. The Trust was working to improve this further by establishing fair access to trauma lists at weekend and orthogeriatrician cover on bank holidays.
The Trust was working with the community to prevent unnecessary admissions from care homes to hospital.
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General Questions
General Questions
Question: Health and Safety Reasons preventing installation of Toasters on Wards
Steven Hams, Deputy Chief Nurse and Head of Quality, advised that the Council of Governors Patient and Staff Experience Committee had discussed this in detail. Total cost to the Trust to make the necessary safety improvements to install toasters on wards equates to £250,000. However, patients are offered toast at breakfast times and can request toast at any time during the day which can be obtained via the restaurant. There was also a whole range of other options available to patients following nil by mouth procedures.
Jocelyn Craig (current Governor Chair of the Patient and Staff Experience Committee) advised that the Committee had been working with the Trust to conduct a nutrition survey and a number of recommendations had been put forward into the Trust’s catering contract.
Question: Maternity Services - Consideration of Royal College of Midwives Birth Rate Plus
Dr Neil Martin, Medical Director, stressed that the Trust had worked with Birth Rate Plus for several years to ensure maternity services meet requirements. The main reasons for the maternity services review was to improve the experience of all patients; improve the ratio of midwives to patients; and to ensure equitable services across East Kent. This was the main aim of the forthcoming maternity consultation.
Question: Can an additional drop off be introduced at KCH Main Hospital entrance?
Liz Shutler, Director of Strategic Development and Capital Planning, confirmed she would review to ensure drop off points were more appropriate and convenient for patients. The Trust was keen to draw attention to the Kent and Canterbury Park and Ride facility. Details can be found on the Trust website.
Question: Were plans for new wards at K&C still in place?
Liz Shutler, Director of Strategic Development and Capital Planning, advised that the Trust was currently reviewing its clinical strategy and the number of beds needed on all sites. The clinical strategy will link closely to the Trust’s estates strategy with the introduction of new wards and/or refurbishment of existing wards as appropriate.
Stuart Bain, Chief Executive, added that the overall ambition of the Trust was to ensure beds and the environment were fit for purpose. The Trust’s capital strategy will be aligned to the clinical strategy. It was anticipated approximately 50% of beds would be single rooms with en suite facilities. The Trust would consider staffing configuration, technology, visual surveillance and lessons learned from other NHS Trusts in terms of patient safety.
Question: How did the Trust visualise the future of summary care records?
Dr Neil Martin, Medical Director, stated it was the Trust’s intention to improve its communication with primary care colleagues and to patients and their families with the aim of further improving patient safety. Nearly 100% of discharge summaries are produced electronically to GPs. It was the intention to roll this out to outpatient letters.
Question: Impact of Government plans to dismantle the NHS National Programme for IT (NPfIT)
Stuart Bain, Chief Executive, provided assurance that the Trust had established an Information Strategy which included the renewal and modernisation of patient information systems. There were a number of elements of the national programme that were successful such as Spine, N3 Network, NHSmail, Choose and book and Picture Archiving and these services will continue.
Question: Impact of Health Bill’s commissioning system ‘any qualified provider’ on the Trust’s financial probity
Jeff Buggle, Director of Finance and Performance Management, reported that the Trust’s Finance and Investment Committee had already started to monitor the financial environment and to establish plans to address challenges that the Trust may face. The Trust had a strong financial platform and positive engagement from staff to generate efficiency ideas.
Question: What is the Trust doing to ensure nutritional needs of elderly patients in hospital are met?
Stuart Bain, Chief Executive, reported that positive reports had been received from the CQC following recent unannounced visits focussing on nutrition and privacy and dignity. However, the Trust recognises that there was further improvement work to be done. Staff on wards work with patients and relatives as part of continuing care arrangements for patients.
Steven Hams, Deputy Chief Nurse and Head of Quality, stressed that nutrition was an important aspect of patient care. The Trust had a number of initiatives in place: Red Tray System to identify patients at risk; work undertaken with relatives as part of continuing care arrangements; establishment of meal time champions through volunteering to provide support (not feeding). The Trust was also looking to reduce the length of time patients are ‘nil by mouth’.
Question: Concern was raised about cancellation of outpatient appointments with appointments being put back a considerable amount of time
Stuart Bain, Chief Executive, stated he would need to see specific examples. New referral to treatment criteria had been introduced by the PCT which ensures patients are appropriately triaged. Evidence shows that patients are being seen in outpatients (first appointment) earlier with more slots available for follow up appointments.
Question: What progress had been made for the Dover Community Hospital?
Stuart Bain, Chief Executive, reported the Trust’s position as follows:
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Following several years of debate about the future of the Buckland Hospital, the Trust agreed with Dover District Council that it would re-provide the Hospital on a site in the mid-town in Maison Dieu Road.
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Indicative design work was undertaken and a provisional cost of c£20m identified.
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In 2009 the Council commissioned a hydrology study which identified 3 separate flood risks – from ground water, surface water and general drainage. The Environment Agency then effectively vetoed the use of the site for hospital use.
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The PCT, supported by the Trust, arranged an independently facilitated stakeholder event in Dover to discuss the way forward in October 2009. This was well attended by statutory bodies, local MP and pressure groups. Five alternative sites were identified for comparative evaluation – the ‘front runners’ being the existing Buckland site and the Whitfield area.
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After detailed evaluation the Trust expressed its preference for the Buckland site.
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Following the General Election in May 2010 the newly elected MP for Dover met with the Chairman and Chief Executive to press for a reconsideration of the Whitfield option. The Trust took time to undertake a further evaluation following this request – but in November 2010 reaffirmed its decision to proceed on the Buckland Hospital site.
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The Board has earmarked capital in its forward development programme published in April 2010 and this was reconfirmed in the Trust’s Annual Plan submission to Monitor in April 2011.
The biggest single unresolved issue surrounds the midwifery unit at Buckland. Its future depends on the outcome of the public consultation about to commence on Maternity Services across East Kent. The specialist nature of this service is such that it is not possible to finalise the brief for the building and begin design work ahead of a decision.
The anticipated timetable is as follows:
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Completion of designs and obtain GMP (Guaranteed Maximum Price), April – October 2012;
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Full business case to Board of Directors, October 2012;
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Construction starts on site, November 2012;
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Completion, Summer 2014.
Stuart Bain, Chief Executive, stressed there had been no change to the Trust’s commitment to the Dover Community Hospital development. The overall aim was to establish a viable local hospital that can meet the ambulatory care needs of the local public. In the short term, the Trust was currently exploring services that could be relocated to Buckland Hospital ahead of the new development to meet commissioning aspirations.
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In Summary
Nicholas Wells, Chairman, thanked all members of the public, staff and representatives of key stakeholder organisations for attending.
He provided assurance that the Board of Directors seeks opportunities to continually develop the services it provides and emphasised that safety and quality of care provision are always the top priority.
September 2011
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