On 4 October, the NHS in east Kent announced a series of eight public listening events as part of wider pre-consultation engagement on potential changes to local care and hospital services. This update provides further information ahead of the public events to help people understand the focus of the activities and the scope of services potentially affected.

The proposals are still being developed; led by doctors, nurses and others from the hospital and clinical commissioning groups (CCGs). No final decisions have been made. Clinicians now want to test current thinking and are keen to get feedback from a wide range of people. The aim is to design modern health services that are high quality, meet people’s changing needs and are sustainable for years to come. You can read our case for change here.

The benefits of change would potentially be:

  • higher standards of care, improving outcomes for patients
  • joined-up care for frail people, intervening swiftly if their health takes a downturn
  • consistently high-quality care seven days a week
  • wider range of services from GP surgeries and local health centres
  • fewer operations cancelled
  • shorter stays in hospital
  • shorter waits in A&E and for planned operations
  • better recruitment and retention of staff.

As well as the public meetings, the NHS is gathering views from seldom heard groups and will have an online survey to collect wider views. This feedback will then be considered as part of the full evaluation to confirm a shortlist of options for a formal public consultation in the future.

Which services could change?

At the public meetings, and the wider engagement work happening over the coming months, the NHS will be particularly focusing on explaining the latest clinical design work on two potential options for hospital services in the future.

However, broader plans for improving health and care services in east Kent require a whole system approach. So the meetings will also be looking at local plans for preventing ill health and improving services available in patients’ homes, from GP surgeries and other local settings. Potential locations and opening hours for urgent treatment centres will also be part of the discussion.

Two potential options for hospital services

In November 2017, the NHS announced a “medium list” of two options to improve hospital services for urgent, emergency and acute medical care – having reviewed a longer list against criteria developed with clinicians, patients and the public, and other stakeholders. Both potential options involve significant investment.  You can read the published papers here.

  • Option 1 involves reorganising some specialist services across each of the three hospital sites and using the William Harvey Hospital (Ashford), Kent and Canterbury Hospital (Canterbury) and Queen Elizabeth the Queen Mother Hospital (Margate) in different ways. This would mean consolidating specialist services on one site at the William Harvey Hospital in Ashford, with more day-to-day hospital services provided at Canterbury and Margate.
  • Option 2 was added to the medium list in October 2017 following an offer by a local developer to build the shell of a new hospital in Canterbury as part of a development of 2,000 new homes and gift it to the NHS. It would involve changes at all three sites, including moving some current services provided at the William Harvey and QEQM hospitals to the Kent and Canterbury site.

Developing the options

Since November 2017, clinicians and health leaders in east Kent have been developing both options and looking in detail at how a potential new hospital in the centre of east Kent might work and how it could benefit patients. Clinicians now want to share these ideas and discuss them further with local people.

Specific changes involved in the two options

Accident and emergency services and urgent treatment centres

  • Under option 1, there would be an A&E at William Harvey Hospital as part of the major emergency centre and an A&E at QEQM. This would be supported by 24/7 GP-led care, including an Urgent Treatment Centre treating illnesses and injuries, which are not 999 emergencies, in Canterbury.
  • Under option 2 there would be an A&E for east Kent at the major emergency centre at Canterbury, along with other inpatient services, which must have immediate access to acute emergency teams. This would mean that A&E, acute medical care and complex inpatient surgery, which currently take place at William Harvey and QEQM, would relocate to Canterbury. This would be supported by 24/7 GP led care, including Urgent Treatment Centres treating illnesses and injuries which are not 999 emergencies, in Ashford and Margate.

Under both options, the NHS aims to open further urgent treatment centres in east Kent, as part of a national drive to simplify urgent care. Urgent treatment centres bring together a whole range of services for illnesses and injuries that need urgent care but are not a 999 emergency. The NHS is asking for views on the potential locations and opening hours of the urgent treatment centres.

Specialist inpatient services

Both of the potential options propose bringing together all specialist inpatient services, including trauma, specialist heart services, inpatient treatment for veins and arteries (vascular services) and specialist renal, urology, head and neck services and children’s inpatient services in a major emergency hospital with specialist services. This would be at William Harvey Hospital in option 1 and Kent and Canterbury Hospital in option 2. These services would not then be provided elsewhere in east Kent. They are not currently provided at all hospital sites now; but they are provided at different sites rather than one specialist site.

Maternity services and children’s inpatient services

Consultant-led maternity units and children’s inpatient services are both currently available at William Harvey and QEQM hospitals. Best practice is for these services to be on the same site as an emergency department in case there is a need for additional specialist support.

In option 1 this would mean consultant-led maternity units and children’s inpatient services would continue at William Harvey and QEQM. There would be a range of maternity and children’s outpatient services provided, including clinics and antenatal day care at Kent & Canterbury.

In option 2, all consultant-led maternity units and inpatient children’s services would relocate to Canterbury. There would still be a range of maternity and children’s outpatient services provided at William Harvey and QEQM, including clinics and antenatal day care.  The NHS is also keen to understand and assess whether women would choose to use standalone midwifery led birthing units and views on this will be sought at the events and through other engagement work with local people.

Frail elderly services

Both options give the opportunity to improve services for frail patients recovering from injury and illness by providing joined-up care, support and treatment in hospital from a number of different health and care organisations. These could offer people more intensive support than can be provided at home or in the community. Staff from different organisations would become specialists in the care, mind and body, of people with complex needs or who are frail, helping to minimise the time they spend in hospital. In option 1, consultant-led services for frail older people would be provided at William Harvey Hospital in Ashford and the QEQM in Margate, and in option 2 at the Kent & Canterbury Hospital.

Day surgery and outpatients

Under option 2, it is currently proposed that day surgery and outpatient appointments would also move away from Kent & Canterbury Hospital to other sites.

As part of exploring the developer’s offer to build the shell of a new hospital the NHS has looked at how big the hospital could be; and how many services could be located there. Given the size of the site, the current proposal is to create a major emergency centre with specialist services providing emergency care, complex inpatient care and specialist services. This would mean that day surgery and outpatient appointments would need to be provided elsewhere. This could be by providing more of these services from GP surgeries and other community settings in the Canterbury area such as Estuary View (Whitstable); or from other east Kent locations such as Buckland Hospital (Dover); the William Harvey (Ashford) and QEQM (Margate). The NHS is keen to understand views on this proposal.

We know people will have lots of questions about these proposals. We also have questions we want to ask, to help us shape the best possible services for east Kent. To join us at one of the listening events you can register online at  http://kentandmedwaynhs.eventbrite.com/. Alternatively, you can email info.eastkent@nhs.net or call 01622 211940 to reserve a place.

These events are part of an ongoing conversation the NHS in east Kent has been having with local people about the need to change the way services are currently organised and developing emerging proposals for change.  The proposals are not yet part of a formal public consultation.  It is expected that formal consultation on any proposed changes will take place later next year.

Spaces at listening events (6 November update)

Some of our listening events are now fully booked. Please see here for details.

Online survey

If you would like to share your views on the current proposals we also have a survey open until 9 December 2018 (extended from 25 November) at https://www.smartsurvey.co.uk/s/EastKentNHS2018/