Healthcare in Kent

Healthcare in Kent is now mainly the responsibility from 1st April 2020 of the Kent & Medway Clinical Commissioning Group. Certain specialised services are directly commissioned by NHS England, coordinated through the South East integrated regional team. Some NHS England structures are aligned on a Kent & Medway basis, others on a South East basis and there is liaison with London that provides many tertiary (highly specialised) healthcare services to the residents of Kent.

History

From 1947 to 1965 NHS services in Kent were managed by the South-East Metropolitan Regional Hospital Board. In 1974 the boards were abolished and replaced by regional health authorities. The whole of Kent came under the South East Metropolitan RHA. Regions were reorganised in 1996 and Kent came under the South Thames Regional Health Authority. Kent had an area health authority from 1974 until 1982 when it was divided into five district health authorities: Canterbury and Thanet; Dartford and Gravesham; Maidstone; Medway; South East Kent; and Tunbridge Wells. in 1993 these were amalgamated into two - West Kent and East Kent. Regional health authorities were reorganised and renamed strategic health authorities in 2002. Kent was under Kent and Medway SHA. In 2006 regions were again reorganised and Kent came under NHS South East Coast until that was abolished in 2013. There were three primary care trusts for the area: NHS Eastern and Coastal Kent; NHS West Kent; NHS Medway up until April 2013. After this eight clinical commissioning groups were established, being Canterbury and Coastal; Dartford Gravesham and Swanley; Medway; South Kent Coast; Swale; Thanet; West Kent; and Ashford. These were given conditional approval to amalgamate in October 2019 and this progressed with formal approval on 20th March 2020 to the formation of the Kent & Medway Clinical Commissioning Group on 1st April 2020.

Sustainability and transformation plans
Further information: Sustainability and transformation plan

Kent (and Medway) formed a sustainability and transformation plan area in March 2016 with Glenn Douglas, the Chief Executive of Maidstone and Tunbridge Wells NHS Trust as its leader.[1] He was appointed accountable officer for all six CCGs in March 2018, having left the Trust.[2] The subsequent establishment of a Kent & Medway Clinical Commissioning Group in 2020 evolved from this structure.

In February 2018 it was reported that the Encompass project in Whitstable, Faversham & Canterbury had seen a 7.3% reduction in the emergency admissions rate in the area between 2014-15 and the 12 months to September 2017.[3]

A health and social care shared record system, the Kent and Medway Care Record, was launched in the county in December 2020. It includes data feeds from the four acute hospital trusts, three community services providers, two community-based mental health services providers, 225 main GP practices and 85 branch sites, and around 466 social care teams based in local authorities. Patients are able to access their own records. [4]

Commissioning issues

Community services are provided by Kent Community Health NHS Foundation Trust and Medway Community Healthcare. Community services in north Kent were transferred to Virgin Care by Swale CCG and Dartford, Gravesham and Swanley CCG in January 2016 in a contract for £18 million a year for the next seven years from April 2016 with an option to extend by a further three years. [5] Kent Community Health NHS Foundation Trust started proceedings for a judicial review of the decision in February 2016. They claimed that Virgin could not deliver the contract.[6]

West Kent Clinical Commissioning Group cancelled all 1,700 non-emergency operations due before April in February 2017 to save £3.2 million by delaying them until the new financial year.[7]

It appeared in February 2018 that all the eight CCGs in Kent and Medway were contemplating a merger.[8] Financial issues in three of the four East Kent CCGs and all four being placed in special measures resulted in August 2018 of an amalgamation of management functions (some other commissioning functions had been long aligned)[9]

The clinical commissioning groups in Kent were asked in September 2018 to find an extra £2 million a year for the wheelchair service, operated by Millbrook Healthcare, which has a contract worth £6.2 million a year because of the increasing complexity of cases.[10]

Primary and community care

There are 262 GP practices in the county. Out-of-hours services are provided by IC24. In East Kent they were taken over by Primecare in early 2017. The contract envisaged integrating NHS 111 and GP out-of-hours services. Primecare was placed in special measures in August 2017 by the Care Quality Commission after it was rated inadequate – only seven months after it started full operations. It is to hand back the 3 year contract in July 2018.[11]

Whitstable is one of the areas selected to pilot Multispecialty community providers, under the Five Year Forward View. [12] Whitstable Medical Practice, with 53,000 patients, is one of the largest in England and is proposing to build a new community hospital and a “teaching nursing home".[13] The practice already has an ambulance response base, a minor injury clinic, a fracture clinic and acommunity pharmacy. It employs 25 consultants, and the local acute trust also rents space for outpatients.[14] The multispecialty community provider is to develop into a super-practice of 17 practices and 125 GPs, with a population of 160,000 patients.[15]

Palliative care is provided by Demelza Hospice Care for Children and for adults the Pilgrims Hospices in East Kent, and elsewhere in Kent by the Heart of Kent Hospice, Hospice In The Weald, Ellenor Hospice and Wisdom hospice. .

Virgin Care secured a seven year £126 million contract to run services in community hospitals in Dartford, Gravesham, Swanley and Swale in January 2016. These services were formerly provided by Kent Community Health NHS Foundation Trust.[16] The wheelchair service was transferred to Millbrook Healthcare in April 2017.[17]

Dermatology services in North and East Kent are provided by DMC Healthcare.[18] The contract in north Kent was suspended in June 2020 because of concerns about long waiting times for treatment.[19]

Acute care

The main providers of NHS acute hospital care in the county are East Kent Hospitals University NHS Foundation Trust, Medway NHS Foundation Trust, and Maidstone and Tunbridge Wells NHS Trust. In September 2015 the South Kent Coast Clinical Commissioning Group set up a contract with the Centre Hospitalier de Calais for patients to travel to France for general surgery, gynaecology, cataract surgery, pain management and orthopaedics. The French hospital had been arranging English classes for nurses. Patients would have to meet their own travel costs. [20]

Inpatient specialist vascular services in the county are to be centralised, as neither Medway nor East Kent have sufficient staff, activity or facilities on their own.[21] There are plans to consolidate the 6 existing stroke centres offering immediate stroke care to three, and to establish a thrombectomy centre, as at present patients have to be taken by air ambulance to St George’s Hospital, which takes an average of two hours from the decision to transfer.[22] Campaigners against the plan lost their judicial review in February 2020. [23]

Patient transport services in the county are provided by G4S at a cost of £15 million a year. They have not been able to meet the specified targets because although 14% fewer car journeys than expected were required, 4% more ambulance journeys were required and 9% more patients needing an escort.[24]

Mental health

NHS Mental Health services are provided by Oxleas NHS Foundation Trust and Kent and Medway NHS and Social Care Partnership Trust. Services for children and adolescents are provided by North East London NHS Foundation Trust, who took over from Sussex Partnership NHS Foundation Trust in 2017.[25] 76 children and young people out of 793 who had waited longer than the 18 week target time for treatment were put at risk by long delays in 2018/9. The trust does not expect to meet the 18 week target until October 2020.[26]

In December the CCGs, the NHS Trusts, the police and the local councils signed up to the Kent and Medway Mental Health Crisis Concordat whereby they all agreed to: *make early interventions to prevent people reaching crisis point.

  • ensure a multi-agency response for people in crisis so needs are met appropriately in a healthcare setting.
  • provide a plan that supports the recovery and prevents reoccurrence for those for people who have experienced a crisis.[27]

HealthWatch

Healthwatch Kent is an organisation set up under the Health and Social Care Act 2012 to act as a voice for patients.

See also

References
  1. "The leaders chosen for 41 of England's STPs". Health Service Journal. 30 March 2016. Retrieved 18 April 2016.
  2. "Former acute trust boss to lead six CCGs". Health Service Journal. 12 March 2018. Retrieved 11 May 2018.
  3. "Best and worst performing vanguards". Health Service Journal. 26 February 2018. Retrieved 5 April 2018.
  4. "Kent and Medway mobilise integrated health and social care record". Building Better Healthcare. 7 December 2020. Retrieved 31 January 2021.
  5. "Virgin Care takes over Sheppey and Sittingbourne hospitals". Kent on line. 13 January 2016. Retrieved 14 January 2016.
  6. "Legal challenge launched against £126m Virgin Care contract". Health Service Journal. 24 February 2016. Retrieved 22 March 2016.
  7. "West Kent Clinical Commissioning Group cancels all non-emergency operations". Kent on line. 3 February 2017. Retrieved 6 February 2017.
  8. "Eight CCGs contemplate merger". Health Service Journal. 5 February 2018. Retrieved 2 April 2018.
  9. "Four cash-strapped Kent CCGs placed into special measures". National Health Executive. 7 August 2018. Retrieved 2 April 2020.
  10. "CCGs asked to pump extra £2m into wheelchair contract". Health Service Journal. 18 September 2018. Retrieved 20 October 2018.
  11. "'Inadequate' private provider to hand back troubled contract early". Health Service Journal. 21 September 2017. Retrieved 13 October 2017.
  12. "NHS chief unveils 29 'vanguard' areas in his new reforms". Independent. 10 March 2015. Retrieved 11 March 2015.
  13. "New hospital and Aldi planned for Whitstable business park". Canterbury Times. 6 October 2014. Retrieved 12 March 2015.
  14. "GP 'super-practice' care model will 'break commissioning barriers'". Health Service Journal. 17 February 2015. Retrieved 12 March 2015.
  15. "33. Dr John Ribchester". Pulse. 2 September 2015. Retrieved 13 September 2015.
  16. "Seven year contract to run community hospitals in Dartford, Gravesham, Swanley and Swale awarded to Richard Branson's Virgin Care". Kent on line. 13 January 2016. Retrieved 6 May 2016.
  17. "How do you get a wheelchair in Kent? Contract has been won by private firm Millbrook Healthcare and it starts on April 1". Kent News. 27 March 2017. Retrieved 23 April 2017.
  18. "Private provider's contract suspended pending safety review". Health Service Journal. 24 June 2020. Retrieved 2 August 2020.
  19. "Private provider's contract suspended pending safety review". Health Service Journal. 24 June 2020. Retrieved 18 August 2020.
  20. "Kent NHS 'to offer patients surgery in France'". BBC News. 8 September 2015. Retrieved 18 September 2015.
  21. "Kent vascular services likely to be centralised". Health Service Journal. 26 April 2016. Retrieved 2 July 2016.
  22. "County leaders plan major stroke service shake-up". Health Service Journal. 22 November 2017. Retrieved 30 December 2017.
  23. "Campaigners lose legal battle against major reconfiguration". Health Service Journal. 21 February 2020. Retrieved 29 March 2020.
  24. "Commissioners up spending on struggling transport service". Health Service Journal. 30 April 2018. Retrieved 26 June 2018.
  25. "Harm assessments after 160 children wait more than a year for mental health treatment". Health Service Journal. 13 June 2018. Retrieved 31 August 2018.
  26. "Young people put at risk by delays for treatment". Health Service Journal. 25 February 2020. Retrieved 29 March 2020.
  27. "South Kent Coast - care for people in mental health crisis". Dover Express. 8 December 2014. Retrieved 21 December 2014.
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