This page includes questions and answers about the East Kent NHS proposals for improving hospital services and local care provided from GPs and other community-based services. We will keep adding to the page as the proposals develop towards a full public consultation.
Why can't there be full A&E, specialist and maternity services at all three hospitals?
Some people are calling for a third option to be added for consultation with full A&E and maternity services at all three hospitals, at Canterbury, Ashford and Thanet.
We have recorded this request as part of the feedback on the proposals. However, to avoid any doubt, we cannot put such an option into a public consultation. The possibility of running three full A&E departments has already been considered and ruled out. It would not be consistent with the latest clinical guidance on emergency care, it would not be possible to staff, and it would not be affordable.
Even if the money was available and there were enough specialist staff to run full services on all three sites; it would still not be the right thing to do clinically. National quality guidelines set out the minimum recommended population required to deliver certain specialist services. This is to ensure staff see enough patients with the range of conditions they treat to maintain and build their skills.
The evaluation which ruled out this option was part of the earlier stages of developing our proposals. You can read the evaluation paper. The specific points about three A&E units not being possible are on pages 4-8.
Would Option 1 mean a downgrade to A&E at Queen Elizabeth the Queen Mother
It has been claimed that because in option 1 the William Harvey Hospital is the Major Emergency Centre the A&E department at QEQM hospital will be a downgraded A&E and some emergencies would be taken to William Harvey instead. This is not right.
In option 1, there would be investment to expand and improve the accident and emergency department at Queen Elizabeth the Queen Mother Hospital. It would continue to have emergency surgery and an intensive care unit, and would treat the full range of emergencies that it does now (with the exception of stroke which is subject to change under a Kent and Medway wide review of stroke services).
The William Harvey Hospital would provide other specialist services in addition to Accident and Emergency. This combination of A&E with other specialist services is referred to as a “Major Emergency Centre”. The only specialist services that is currently based at QEQM is gynae-oncology (treating women’s reproductive cancers). In option 1 this would move to William Harvey but it would not reduce the level of treatment provided by the A&E department at QEQM.
Why are there not more options for consultation?
Some people have claimed that the NHS is not following proper consultation processes by removing options before public consultation; and that all options must be presented to full public consultation.
This is wrong in both the suggestion that we are not following the correct process and that the objective of a consultation is for the public to choose one of the options.
The correct process for developing proposals for significant changes to NHS services is to start by looking at a long list of all possible options and use an evaluation process to reduce the number of options down to a shortlist for public consultation. What we are not allowed to do is run a public consultation that includes an option we know cannot be implemented either on grounds of clinical quality or affordability. We can only present options for public consultation that could actually be put in place.
It has also been stated that we must show why some options are not viable. We have done this already. We have been developing these options led by clinicians and health leaders and involving patient and public representatives since 2016. We have looked at numerous potential options including one with all three hospitals offering all services. The reasons some options could not be included in the medium list have already been published in November 2017 when the Joint Committee of Clinical Commissioning Groups announced the medium list. You can read about this in the Medium list options paper. The specific points about three A&E units not being possible are on pages 4-8.
The suggestion that consultations offer the public a choice is misleading and wrong. NHS consultations look to gather views from patients, the public, staff, partner organisations and other stakeholders. Your views will be used to shape the proposals and where they highlight concerns will allow us to consider what can be done to remove or minimise those concerns. But consultation is not a vote. To suggest the process is similar to political democratic processes like elections or referendums is a fundamental misunderstanding of public consultation on plans to change NHS services.
We absolutely want to hear people’s views so we can address concerns raised. However, the feedback from consultation and wider engagement activities will be looked at alongside all the other data and evidence related to the changes when a final decision is made.
Consultation influences the final proposals, but it does not decide the outcome. The four clinical commissioning groups in east Kent are the statutory NHS organisations responsible for making a final decision. Whilst some people may disagree with this, they are wrong to suggest that we are not following the correct process.
Is there evidence that mortality rates could increase when A&E services change?
The campaign group Save Our NHS in Kent is using a study (Closing Five Emergency Departments in England between 2009 and 2011” – Knowles, Nicholl) to claim there is evidence that if changes are made to A&E services “mortality could rise by 2.3% for those with emergency conditions”.
In fact, the paper’s main conclusion is that there was no statistically relevant evidence of increased mortality from the reorganisation of the emergency care services it looked at.
The scientific conclusion section of the report states:
The impact measure that is probably of most importance to the public, health-care providers and policy-makers is mortality. The public, in particular, requires reassurance that the closure or downgrade of an ED does not result in increased death rates within the population. In the five geographical areas studied here, there was no statistically reliable and consistent evidence of an increase in deaths among the population from SECs in the period following the reorganisation of care. This suggests that any negative effects caused by increased journey time to an ED can be offset by other factors; for example, if other new services are introduced and care is more effective than it used to be or if the care received at the now-nearest hospital is more effective than that provided at the hospital where the ED closed.
Given such a major reorganisation of emergency and urgent care, we might expect there to be some changes in emergency and urgent care activity. This was apparent in our study.
Nationally, ambulance service call volumes in England continue to rise. Our study found some evidence of an increase in emergency ambulance incidents on average across the five sites, over and above the increase in the control area. This suggests that the ED closures studied here may have contributed to an additional increase in workload within these areas.
As with ambulance service call volumes, there is also a national trend towards increasing numbers of attendances at EDs and emergency hospital admissions. However, our study found no statistically reliable and consistent evidence of an impact of the ED closures on hospital activity, although the direction of change pointed to a decrease in activity on average.
Is this all about A&E?
Some people are calling our proposals the ‘A&E consultation’ and naming our events as ‘A&E listening events’, This is incorrect.
A&E is a service everyone can relate to, and A&E units are part of the proposals, but only one part. The proposals are looking at all specialist inpatient services and under one of the options other consultant-led services including maternity would see changes. Beyond the hospital services which will be consulted on, our plans are also looking at how to offer as much NHS care as possible as close to people’s homes as possible. We encourage everyone to read the information we have provided about the proposals at https://kentandmedway.nhs.uk/where-you-live/plans-east-kent/.
When will the full public consultation happen?
We have not set a date for the consultation. The proposals are still in development and will need to be reviewed and approved by our national regulator, NHS England, and clinical experts in the South East Clinical Senate (a committee of doctors, nurses and health professionals working across the south east of England) who will test our work to make sure it proposes the best clinical outcomes for patients.
When our formal consultation does happen there will be more public events across east Kent alongside a wide range of other ways for people to give their views.
Will it be safe if people have to travel further for treatment?
Clinicians are leading the development of our options and providing safe high-quality care is the top priority. For serious illness and injuries, the most important thing is to get patients to the right specialist care first time – not necessarily the nearest hospital.
We know travel times are a concern for people. The accessibility of services is our second most important criteria for evaluating the options against. The top priority is the ability to provide acceptable clinical standards on an on-going basis.
As part of finalising the options we will be looking closely at the potential impact on ambulance services and whether they would need additional resources in order to implement and deliver any proposed changes.
Will GPs and community services really offer an alternative to hospital?
Services we have already put in place are helping frail older people and those with multiple long-term conditions. They are reducing the number of unplanned, emergency hospital admissions and helping people get home again faster after hospital treatment.
Other examples now happening in east Kent include; small surgical treatments that used to need a hospital visit are now being done in GP surgeries and other community locations – for example, cataract surgery. Regular appointments to review patients with haemophilia are now happening online with patients using an app to send results to their doctors; avoiding the need to travel to a hospital appointment.
You can read about some of the improvements already happening in the East Kent You Said We Did document
Is this all about cuts and saving money?
This is all about how we can work more effectively as a health system in east Kent, to deliver services in a sustainable way that more consistently meet national quality guidelines within our available resources – staff, equipment, buildings and funding.
The proposals would mean a significant investment in the NHS in east Kent. They would provide higher quality specialist hospital services and more care through GPs and other community services for everyone in east Kent.
Helping people to stay healthy, avoid hospital admissions and get home without delay after hospital treatment would help us to provide better care. After the initial investment to improve services, the new ways of providing care would offer better value for money in the long term.
How are the plans for Hyper Acute Stroke Units affected by these proposals?
The NHS ran a public consultation on Kent and Medway stroke services in 2018. The preferred option includes creating a hyper acute stroke unit at the William Harvey Hospital in Ashford.
Under option 2 a new hospital in Canterbury would become the major emergency centre for east Kent and we would anticipate any hyper acute stroke service would also move with the other specialist services. This was highlighted during the stroke consultation.