Health commissioners holding public events to discuss potential options for future hospital services in east Kent have revealed more details of their proposals which could include moving many services, including accident & emergency, to a new build hospital in Canterbury.
At the events, between October 30 and November 20, doctors and other leaders from east Kent’s clinical commissioning groups (CCGs), which plan and pay for local health services, will talk about ideas for changes to urgent, emergency and acute medical care (including A&E departments), specialist care, and planned inpatient orthopaedic care (such as hip and knee operations).
New details reveal that as part of looking at two options for urgent, emergency and acute medical services in east Kent, commissioners are also discussing whether to move maternity and children’s inpatient services to a new hospital in Canterbury and options for moving specialist services to either Canterbury or Ashford. There are also plans for new urgent care centres.
Currently the three main hospitals – at Ashford, Canterbury and Margate – each provide different services, with A&E departments at Margate and Ashford and an Urgent Care Centre at Canterbury. A range of specialist services are at different hospitals, such as the trauma unit at William Harvey Hospital and inpatient kidney services at the Kent and Canterbury Hospital.
NHS professions and the East Kent Hospitals University Foundation Trust (EKHUFT) say there is a body of evidence that shows specialist services, such as stroke, trauma, vascular and specialist heart services need to be centralised and located together.
There are two options for urgent, emergency and acute medical care
Option 1 – A&E at Ashford and Margate
Reorganising some specialist services across each of the three hospital sites and using the William Harvey Hospital (Ashford), Kent & 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.
Under option 1 there would be an A&E at William Harvey Hospital as part of the major emergency centre and an A&E Department 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.
Option 2 – A&E at a new Canterbury hospital
Added to the medium options list in October 2017 following an offer by Quinn Estates to build the shell of a new hospital in Canterbury as part of a development of 2,000 new homes. It would involve changes at all three sites, including moving some services currently provided at the William Harvey and QEQM hospitals.
Under option 2 there would be an A&E department for east Kent at the major emergency centre at Canterbury. 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.
Urgent treatment centres
Under both options, the NHS aims to open further urgent treatment centres in east Kent by December 2019, 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 & Canterbury Hospital in option 2. These services would not then be provided elsewhere in east Kent. They are not 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. The Kent and Medway NHS say 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 Hospital.
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
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 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.
‘Modern health services’
Caroline Selkirk, Managing Director of East Kent Clinical Commissioning Groups, said: “We want to test with the public our emerging proposals which are still being developed, led by doctors, nurses and others from the hospital and clinical commissioning groups.
“This will help us understand people’s views, and take onboard their ideas and concerns. It is a vital part of the process we need to go through as we identify options to take to formal public consultation next year.
“Our aim is to design modern health services that are high quality, meet people’s changing needs and are sustainable for years to come.”
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.
A spokesman from campaign group Save Our NHS in Kent spokesperson said: “People were shouted down at listening events earlier this year when they said that the loss of a stroke unit might lead to further losses such as A&E and maternity. Now we have proposals popping up that could mean QEQM is left with a midwifery-led maternity unit and a GP-led ‘A&E’.
“This appears to be an ongoing drive to remove QEQM’s specialist consultants, leading to a downgraded hospital. As a result of these plans, there’s a possibility that all acute care will ultimately go to another hospital. Acute care means treatment of severe injury or illness that requires rapid intervention to avoid death or disability – so this could mean an awful lot of ambulances, or even all ambulances going to another hospital in future.
“Canterbury has been left without consultant-led maternity care for some time now and it means that pregnant women in Canterbury are in fear that if something goes wrong during childbirth, they face a delay in treatment and a journey in an ambulance. Midwife-led childbirth is not suitable for everyone.
“This reduction in service now threatens Thanet and Ashford populations as it has in Canterbury. Again, Kent’s NHS executives are engineering a situation in which locations are expected to fight each other for the best health care. SONIK say that all three hospitals deserve consultant-led maternity care, and all three hospitals deserve acute care on site.”
“Save Our NHS in Kent recommends to everyone in east Kent that they keep a close eye on these developments and attend the listening events coming up in October and November. Details of events and news updates can be followed on our facebook page and website.”
Labour’s parliamentary candidate for South Thanet, Rebecca Gordon Nesbitt, said the options present a lose-lose situation for Thanet.
She said: “The two options for hospital reconfiguration in East Kent represent a lose–lose situation for Thanet.
“Under option 1, we lose a whole raft of services; under option 2, we lose our A&E. It seems our worst fears are being realised, with services being stripped out of QEQM and moved to Ashford or Canterbury. The stroke unit is just the start. The people of Thanet can ill afford this.
“As I’ve said several times before, Thanet has high levels of deprivation, meaning that our people are more likely than people in other parts of the county to suffer from strokes, heart and cardiovascular disease. Moving the relevant services further away from the people who need them is a failure of the statutory duty of health commissioners.
“I’d like to echo the view of SONiK, of which I’m a member, that East Kent hospitals shouldn’t have to compete with each other for excellent services. If the Government funded the NHS properly and the Department of Health took responsibility for commissioning services, we wouldn’t be in this mess.”
Conservative MP Craig Mackinlay said: “I always listen carefully to the recommendations of the doctors, nurses and others from our various NHS Trusts and organisations, but these proposals are at a very early stage of development.
“You can be assured that, given Thanet’s geographical position and population, I support QEQM maintaining as broad a spectrum as possible of full range services – including a full A&E – into the future.”
MP Sir Roger Gale has been asked for comment.
Public NHS listening events in Thanet
Tuesday 13 November: Ravenscliffe Suite, Pegwell Bay Hotel, 81 Pegwell Road, Ramsgate CT11 0NJ
6.30pm to 9.30pm (registration from 6.15pm)
Tuesday 20 November: The Lido, Ethelbert Terrace, Margate CT9 1RX
10am to 1pm (registration from 9.45am
For more information visit https://kentandmedway.nhs.uk/eastkent.