Two options for a huge overhaul to hospital services in east Kent, including moving accident and emergency to a new build in Canterbury, have been confirmed as the options that will be then be reviewed by NHS England and NHS Improvement, and the South East Clinical Senate.
The pre-consultation business case from east Kent NHS bosses proposes major changes to the way Canterbury, Ashford and Margate hospitals operate.
Caroline Selkirk, managing director of the four east Kent clinical commissioning groups, said: “We want the NHS to provide excellent healthcare for everyone in east Kent. To achieve that, it has to change.
“Our proposals include major improvements to hospital care and local care in east Kent, with significant new investment to deliver high quality hospital services including emergency services, bringing together specialist inpatient services into one hospital, and separating planned and emergency orthopaedic surgery.
“To be included on the shortlist, both options were assessed against five detailed criteria, developed with clinicians and tested with the public. The criteria have been designed to ensure the options being proposed can deliver improvements in patient care, are accessible for patients, are deliverable within the timeframe needed, sustainable for the future, and affordable within the money available.”
As well as changes to urgent, emergency and acute medical services in east Kent, commissioners have discussed 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.
The two options are:
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
The possibility of a new site was added to the 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.
East Kent NHS says this option would be less than half the cost of building a new single site hospital on green belt land, which was ruled out because there isn’t enough national funding to pay for the estimated £700-800m cost and it would take too long to build.
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.
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.
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).
County councillor Karen Constantine said she was ‘dismayed’ by the proposals. She added: “This comes at a time where we are awaiting the outcome of a community led legal challenge to NHS managers. The current plan to relocate the stroke service from QEQM to the William Harvey Hospital in Ashford is subject to a Judicial Review, we are expecting the outcome very soon. But clearly the NHS intend Ashford to be the home for stroke service and other significant clinical provision. Meaning longer journey times and greater expense for Thanet residents.
“The key issues in this proposal is the phrase “affordable within the money available.” What we actually need to do is to boost health locally, and increase access. We need to match provision with need.
“Everyday I am contacted by people who are struggling to get access to basic health care on the Isle of Thanet. The thought of future complex rearranging of services, including maternity, leaves me with a sense of dread. The Conservatives promised to look after our NHS, Improve funding and staffing. However these decisions are being strongly driven by financial considerations.
“As a member of the Kent Health Overview and Scrutiny Committee I will be scrutinising and challenging these decisions very carefully indeed. Making changes based on clinical evidence is usually a good thing, and improves patient outcomes. Making changes based on budget constraints is undoubtedly going to compromise patient safety.
“Our hardworking NHS staff also need to be fully considered and consulted. Changes on this scale, if not handled with the upmost care could be demoralising, lead to increased stress and attrition rates, recruitment and retention difficulties and long term vacancies in key areas. ”
A draft pre-consultation business case is now being assessed by NHS England and NHS Improvement’s South East team and the South East Clinical Senate -an independent group of clinicians. Their feedback will be incorporated into a final version.
Because both options require significant capital funding from central NHS budgets, the final pre-consultation business case must be approved by NHS England and NHS Improvement’s national team before consultation can begin.
The timing of a public consultation depends on the business case review and approval process and will be published as soon as dates are confirmed.
No final decision will be taken until after commissioners have run and considered feedback from a formal public consultation, alongside all other evidence.
You can read more about the two options here.