At its June meeting the Programme Board received an update from the hospital care workstream which is focusing as a priority on urgent and emergency, acute medical and elective orthopaedic services in east Kent; and stroke and vascular services across the whole of Kent and Medway.  These services have been assessed as most in need of change to make sure they consistently meet national quality standards.  Kent and Medway currently have some of the worst outcomes for stroke in the country and work continues with focus around proposals to develop hyper acute stroke units to offer more concentrated specialist care in the critical first 72 hours after a stroke.  The work in east Kent continues with the development of a model of care based on Sir Bruce Keogh’s clinical model for urgent and emergency care.  The emerging proposal is to establish a major emergency centre with specialist services; an emergency centre and a medical emergency centre, creating a sustainable model across all three of the main EKHUFT hospital sites.  This proposed model of care, and hurdle criteria to apply to a long list of options, has been discussed widely, including with the South East Clinical Senate.  Patients and the public are being asked for their views on the model of care at a series of listening events in June and July, building on previous discussions and engagement activity.  Hurdle criteria were discussed with patients and the public at a series of events in the Spring of this year.   Next steps are for the proposed service models and hurdle criteria to be taken to CCG Governing Bodies and Trust Boards across Kent and Medway for approval.  They will also be shared formally with Kent Health Overview and Scrutiny Committee and Medway Health and Adult Social Care Overview and Scrutiny Committee, building on earlier discussions and briefings.  Governance structures for consultation are also being put in place (for example, through the creation of CCG joint committees) to facilitate joint decision-making amongst the CCGs on these particular service issues. The Board were also made aware that the Clinical Board has recommended a sub-committee be set up to consider stroke prevention and rehabilitation.

There was a discussion on priority areas to support the smooth-running of the programme, including reviewing governance arrangements, recruitment of a full-time programme office team to support the workstreams and the recruitment of a Director for System Transformation to lead the system transformation workstream.   Leaders in both commissioning and provider organisations across Kent and Medway generally agree there should be a strategic commissioning function for Kent and Medway.  Its role would focus on strategic planning, resource allocation and commissioning those services which serve a large population and operate on a Kent and Medway wide basis. This function would work alongside local commissioning for local populations – through local accountable care systems. The System Transformation workstream has recently been set up to look at this in more detail.

The Board received an update on engagement activity to date, and recommendations from the Patient and Public Advisory Group around engagement, including aligning a PPAG member to each workstream now recruitment of members was complete with more capacity in place to enable this level of support.  It was agreed that engagement around local care was as important as engagement around emerging proposals for hospital care.