Thank you to all of you who embraced Slido and used it to ask questions during our One Year On conference which was held on 31 October 2017. We’re sorry we couldn’t answer them all on the day. We’ve answered the top 10 most ‘up-voted’ questions below and are working on responses to other questions we received, which we will share as soon as possible.


10 most ‘up voted’ conference questions

How do we ensure all the work put into the STP is not wasted because of restructuring in a few years’ time because of the usual national directives/ changes?

The work going on across Kent and Medway is key.  There is no question that we need to plan and implement changes to improve the health and wellbeing of our population; to improve the quality and clinical sustainability of services; and to use our limited resources in the most effectively way.   Elements of this work have been underway for some time (for example, to improve the quality and clinical sustainability of services such as stroke across Kent and Medway, and acute services in east Kent), or to drive forward ‘prevention’ work.  Other areas we may have been working on at organisation level for some time but are now working on at a health and social care ‘system’ level across Kent and Medway, such as our approach to local care, and to productivity.  We have made significant progress over the past year through taking a ‘system’ approach, which has been facilitated by the STP, but ultimately the relationships, networks and system approach are delivered through individuals working together across organisational boundaries.  We are confident this should and will continue whatever future structures are in place.

Why if the system is about collaboration are the CCGs still keen and actively tendering services?

A challenge for any significant change programme is that we must continue to deliver services for patients and the public in parallel to improving how we work. This means that inevitably CCGs will need to continue to tender for services to ensure there are no gaps in provision until any new working arrangements are in place. Wherever possible new contracts will be drawn up with an eye on the likely future landscape in Kent and Medway.

Great content today, but themes and messages many of us have heard before. What changes will actually have been delivered when we sit here in a years’ time?

By late 2018 we will have rolled out the local care model for frail and elderly people in Kent and Medway. This will be implemented at local level to populations of around 50,000 people. The model for each area will be tailored by local teams to meet the needs of their population. We will have also completed the review of hyper acute stroke services and will – we anticipate – have started to implement  a new and improved approach to delivering hyper acute stroke care for patients in Kent and Medway. The Clinical and Professional Board will have developed the next iteration of the clinical strategy, which will focus on cancer, mental health and children’s services.  We have already started to make progress in terms of productivity gains in the way we procure some goods and services, and we anticipate this area of work strengthening over the next period. The NHS in Kent and Medway is using its collective purchasing power to get a better deal from suppliers, saving an estimated £10million this year.  In terms of our system transformation work – the purpose of which is to have the right infrastructure in place to deliver our plans faster and better – this too should be running in at least shadow form by this time next year.

How can staff and public stay motivated when leaders with great values (Matthew Kershaw) have to leave over what Glenn Douglas stated is only one part of the issue ie performance challenges?

Matthew worked very hard to deliver the best possible services for patients, and was very supportive of his staff. It is as important as ever for all leaders, at every level across our health and social care organisations, to maintain and uphold their values and to continue to work for the good of the people who use our services, the taxpayers who fund them, and the staff who deliver them. However, the important thing here is not to focus on individuals but to recognise what all our health and social care teams need to do to play their part in helping our system work better and to keep focused on our goal to deliver responsive and high-quality services for local people. We have a dual challenge, to deliver in the here and now, whilst planning for and beginning to implement a better future.

In addition, the STP leadership has a collective responsibility to demonstrate to staff, patients and the public how our plans will make things better for staff who deliver services and patients, service users and the public who rely on them. We are committed to doing that.

If we are talking about integration and working together why are there three presentations for the local care model? Shouldn’t there just be one model?

There is a single model for local care in Kent and Medway that has been developed. The work to date on the model for local care describes how people who have the highest health and social care needs will receive joined up care, delivered by multidisciplinary teams of health and social care professionals working in a coordinated and integrated way, to ensure that the holistic needs of the individual are met.

The model has brought together existing work and early thinking from each of the eight CCGs in Kent and Medway, from Kent County Council and Medway Council, and it is right to acknowledge projects and pilots underway whilst drawing the ‘local care’ approach and model together at scale.  We also know there is variation in need across our area and therefore  the exact way in which the model is delivered may also differ across Kent and Medway, in order that it meets the specific needs of the population it serves.

The presentations given at the conference showed the overarching local care model, and then more detail on how it is being implemented by health and social care colleagues in different areas.

What progress so far of the STP would you most like to highlight?

The greatest achievement of the STP is undoubtedly bringing together leaders, and their teams, from across social care, public health, the NHS, patient and public and third sector organisations to work across organisational boundaries and to broadly agree on a single vision for the future of health and care services in Kent and Medway. There is a shared understanding and endorsement of a new way of working that delivers joined up care to people, closer to where they live, designed to keep them as well as possible and to avoid lengthy and unnecessary stays in acute hospitals.

Our next big challenge is to ensure we make this vision a reality, and do so as quickly as possible to ensure we address the three health and care gaps, as outlined in the national NHS Five Year Forward View, we know are impacting on the quality of services we can offer.

Chris Hopson, the Chief Executive of NHS Providers, said some STPs are doing well, some are struggling, others are in the middle. Which group does he think our STP is in?

We asked Chris to answer this question, and he sent the following response:

It’s very difficult for me to judge from the outside. There are clearly some big challenges the STP in Kent and Medway has to address but I was impressed with everything I saw and heard on the day and the fact that you were holding the meeting in the first place. The recent success at Medway has shown that rapid real improvement is possible, so I shall be watching your progress at STP level with interest.

Why are we not moving forward and implementing the new model for stroke services?

We are very much moving forward with the work to change the way we deliver hyper acute stroke services in Kent and Medway, and this is a key priority for the STP. However, reconfiguring services is a complex undertaking and it is essential that we get it right. Making major changes to the way that services are organised and delivered – especially when they are dealing with serious conditions such as stroke – requires detailed analysis of a wide variety of information including thoroughly understanding and building on evidenced clinical best practice, patient numbers, demand for services, staffing levels, travel times, and resourcing and capital requirements. Most importantly, we have also spent significant time engaging with the clinicians who work in these services every day and the patients, carers and families who rely on them, as well as political and public representatives across Kent and Medway.

To make sure we have a robust and accurate evidence base on which to base our proposals, there are several assurance and legal hurdles that we need to go through to ensure that the potential options that we bring out for public consultation are the right ones. We are currently in that phase of the work and over the next period will be discussing and critiquing our work in detail with the South East Clinical Senate (a group of clinical experts from across the south east); a Joint Health Overview and Scrutiny Committee (working across Kent and Medway), and with NHS England at a local, regional and national level.  A joint committee of the eight Kent and Medway CCGs and neighbouring CCGs in Bexley in south east London, and High Weald, Lewes and Haven in East Sussex, has been formed and will make the decision on the options for public consultation.  We expect the formal consultation to begin in the new year.

How are you going to ensure that mental health is seen as important and prioritised alongside physical health?

As Dr Diana Hamilton-Fairley and Helen Greatorex discussed during their presentations, mental health is, and has always been, a priority for the STP.

The new local care model will see greater provision of mental health services alongside physical health care, particularly for those with the greatest health and social care needs. The local care model recognises and addresses the impact of mental wellbeing on physical wellbeing, and vice versa.

In addition, as we move towards more integrated primary, community and social care services, mental health care will be easier to access for everyone, closer to where people live.

We also want to make sure that our prevention work includes a focus on mental health and wellbeing. This was feedback to us at the conference and through the STP Patient and Public Advisory Group.

In terms of our system transformation work, across Kent and Medway we are determined to integrate our approach to physical and mental health and have discussed our preference for our accountable care partnerships to include mental health, rather than to have a ‘stand-alone’ mental health accountable care partnership.

Finally, services for people in crisis, and those with serious mental illness will continue to be improved and developed across Kent and Medway. Helen Greatorex discussed some of the recent developments and future plans in her presentation, including the new perinatal mother and baby unit, the Open Dialogue programme and the reduction of use of out of area acute beds to zero.