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Consulation over plans for improved services


By Dennis Fowle


LOCAL NHS health services, from GPs to hospitals and much more, are set for major changes and pub- lic consultations have now started. The first Kent andMedway public meeting under the national plan to transform health and social carewas held at the Gallagher Stadium, Maidstone, by theGP-ledNHSWest Kent Clinical Commissioning Group. Now group chairman Dr Bob


Bowes says the plan must be writ- ten.


Outlining the key problems, he


said the Kent and Medway popula- tion will increase by 24% in the next 20 years, with many more over75s. With medical advances come greater expectations (and costs). One in three live with long-term illnesses, 18% smoke, 27% do not get enough exercise, 10% are obese and one in four have mental health problems. About one in three (total 1,000) in hospital no longer need acute hospi- tal treatment at a time when there is a severe shortage of nurses, doctors and other staff. The area’s health and


Pressure’s on


AFTER a long period of missing A&E targets the local hospital trust recently hit the 95% four-hour tar- get for two successive days “show- ing excellent collaborative working over the winter period.” There has also been an improve- ment in enabling hospital dis- charges. However, the cancer diagnosis figure has fallen, and pressure on the NHS111 phone line service has meant some patients have been asked to call back during peak pe- riods.  Dr Bob Bowes, chairman of the West Kent Clinical Commis- sioning Group, said there was real pressure on the system and their job was to help providers achieve the best they could under difficult circum- stances and


avoid blaming individual organi- sations.


High A&E use THE Shepway area of Maidstone has been highlighted for its high hospital A&E usage. West Kent Clinical Commission- ing Group says it is the highest area of deprivation in its area and has a high single doctor list at its GP practice.


social care budget is overspent by £110m this year and that could grow to £486m by 2020/21. The current review is widespread.


The spotlight will certainly fall on: GP services The county needs an- other 245 GPs and the shortages are starting to hit hard. A practice of five GPs at Iwade (Swale) now has none. Some patients cannot register with a practice; others cannot book timely appointments. In West Kent, practices are now grouped in clusters to increase effi- ciency and support each other. These could develop in to much closer relationships. The future could be based on a practice in Whit- stable with many GPs, five man- agers and support staff and specialist services in one building.


 Hospital services A review is under way of services in Maidstone, Tunbridge Wells and Medway hos- pitals and changes are set to improve quality and cost-effectiveness. All three have stroke units but with a shortage of specialist consult- ants and staff, this service is likely to be concentrated in one place. As pa- tient journeys of more than an hour will not be permitted, Maidstone could become the central point. Maidstone is seen as a vital oncol- ogy centre and is likely to continue. The meeting heard that many services were centralised in Maid- stone and Tunbridge Wells NHS Trust area when Pembury hospital opened, well ahead of the review. No statements have been made yet about the A&E departments. They are known to be under growing pa- tient pressure, partly linked to the shortage of GPs. There are plans to improve efficiency, but there ap- pears to be no public appetite for a reduction in the A&E offer. Dr Bowes warned: “There are great challenges ahead. We must look at all options.”


Trust ‘will miss targets’


THE growing challenges facing the GP-led NHS West Kent Clinical Commissioning Group mean that it is unlikely to be lifted by NHS Eng- land from its “requires improve- ment” status.


Up to 2015/16 the group was rated as good, and last year it agreed to take a range of actions to restore its position. These included:  Four-hour A&E access – achieve 94.5%.  62-day cancer diagnosis and treatment – achieve 85.1%.  Dementia diagnosis rate – achieve 66.67%.  Direct access diagnostics – re- turn to 99% or better.


But the group now expects to miss three of these four targets.


In addition the group says


achievement of timely urgent care pathways continue to challenge. And despite a 5% fall in A&E at- tendances compared to December, an increasing number require ad- mission to a bed. Delayed transfers to care out of hospital (bed blocking) are signifi- cantly higher than the national av- erage, and this resulted in 6.7% of all occupied bed days in January being due to patients who would be better cared for outside hospital. This in turn put pressure on A&E admissions.


In addition, urgent ambulance re- sponse times continue below the required standard, although the 19- minute call time has improved.


Death rates cause concern


THE local hospital trust is being in- vestigated now latest figures show mortality has risen above nationally anticipated figures. The GP-led West Kent Clinical Commissioning Group is discussing causes with Maidstone and Tun- bridge NHS Trust. It wants to understand these causes “and be assured effective ac- tions are in place.


“There is a need to keep a close


eye on this and to be careful, ensur- ing the safety of our population.”


One of the GP commissioners has called for a “deep dive” investiga- tion.


The trust has halted relatively new procedures to correct tongue tie following two infant deaths (one locally and one in London). The problem relates to a strip of skin connecting the tongue to the floor of the mouth being shorter than usual. This can cause breast feeding difficulties.


Another infant died after surgery to remove an extra digit.


Health | News


£26m injection KENT will receive a much-needed £26m cash injection from the gov- ernment to help meet the growing cost of caring for the elderly. The financial assistance, an- nounced in the Chancellor’s spring budget, will be paid in this April. The county council’s leader Paul Carter said it was clear the money will help, with the cost of adult so- cial care accounting for about 40% of the council’s overall expenditure. However, he said, the gap in fund- ing would remain a challenge. He welcomed a government Green Paper to explore new sustain- able funding streams for social care, which will cost KCC about £364m.


Cancer access FASTER cancer investigation and treatment are planned for local pa- tients by NHS West Kent Clinical Commissioning Group. A new Direct Access Pathway means GPs will be able to to send patients for a scan or an X-ray, rather than refer them to a consultant. Most patients are sent to Maid- stone Hospital on 4-6 weeks path- ways with a 62-day target to begin the first definitive treatment. The local hospital trust achieved only 78% of this target in December. But the two-week wait achievement in December at 95.1% was above the national standard.


Cost to coeliacs GLUTEN-free products, used by


many with coeliac problems, may no longer be free on prescription. The decision will be made by NHS West Kent Clinical Commis- sioning Group as part of its finan- cial recovery plan following a wide public consultation process. This showed 54% favoured the proposal with 46% against. A key objection was that it would be un- fair on lower income groups, re- moving an effective treatment option from a group of people with a life-long auto-immune disease, which has no cure.


Gluten-free products/recipes are now widely available in supermar- kets.


999 plans fail THE local NHS ambulance service


is still missing targets, especially for reaching patients in most ur- gent need. After it was rated inadequate and put in special measures by the Care Quality Commission, SECAmb worked on two remedial plans. But the area’s West Kent Clinical Commissioning Groups now say “insufficent assurance has been provided”.


So now SECAmb has been issued with a quality contract notice ex- ception report, outlining the areas of continued concern and the detail required to evidence improve- ments.


Maidstone May 2017 31


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