A boy born in Cliftonville West typically has a lifespan ten years shorter than the national average. This is a scandal in this day and age in the UK with a national health service.
Come and join us in a big conversation from 10:30am to 3pm on Saturday 27 January at Queens Road Baptist Church, Broadstairs, CT10 1NU
Rebecca Gordon-Nesbitt has provided us with this overview.
It can’t have escaped anyone’s notice that health and social care is on the verge of collapse. With inadequate funding coming into the system, dramatic changes to hospitals and GP surgeries are being contemplated in East Kent. Thanet Trades Union Council and Save Our NHS Kent have organised a conference to discuss the NHS crisis in East Kent. Here’s a little background to our current predicament.
The Health and Social Care Act of 2012 signalled devolution of health and social care provision from central Government to NHS England. Among other things, the Act legislated for the creation of 210 clinical commissioning groups (CCGs) across England, which included health and social care experts and assumed responsibility for commissioning the majority of services. In 2014, NHS England published a vision for the future of the health service, entitled the Five Year Forward View (5YFV), placing an emphasis on better public health and prevention. In 2016, England was divided into 44 ‘footprints’, each of which was invited to devise an ambitious plan outlining how they would implement 5YFV. These became known as Sustainability and Transformation Plans (STPs).
The Kent and Medway STP includes eight CCGs and covers a population of 1.8 million people which continues to grow. The STP forecasts a deficit of £486m by 2020/21 and outlines ways of reducing this to £29m. Making little reference to 5YFV, the STP proposes better integration of health and social care, a shift from acute hospital care to the community and a keener focus on prevention. 5YFV outlined an urgent need to tackle health inequalities, and the STP recognises a 22-year gap in life expectancy between different wards in Thanet. (A boy born in Cliftonville West typically has a lifespan ten years shorter than the national average.) The STP also identifies a shortage of skilled staff. (A proposal for a new medical training centre at Canterbury is currently being considered by the Secretary of State for Education.) A critical review of the draft STP found scant detail on health and social care integration, stakeholder communication and engagement, timings and costings. Significantly, the rate of population growth was thought to have been underestimated, and analysis of local need was found wanting.
In 2017, NHS England published Next Steps on the Five Year Forward View, which identified as priorities the upgrade of urgent and emergency care, the better regulation of flow into and out of hospitals and greater access to GPs. There are three main hospitals in East Kent – at Ashford, Margate and Canterbury – with 24/7 A&E services at the first two and an urgent care centre at the latter. £190m of the ‘efficiencies’ the STP proposes relate to hospitals, with two main options on the table:
1) Ashford as a major emergency centre with 24/7 A&E and specialist services; Margate with 24/7 A&E; and Canterbury with a 24/7 GP-led urgent treatment centre. As a prelude to this, stroke services have begun moving from Margate to Ashford.
2) Accepting an offer of land and the shell of a hospital from Quinn Estates in exchange for planning permission to build 2,000 new homes. This would lead to the creation of a single major emergency hospital for East Kent at Canterbury and the loss of A&Es at Ashford and Margate. East Kent Hospitals NHS Trust seems unwilling or unable to consider a third option – the retention of specialist services as they currently are.
At the same time, a series of extended practices or ‘hubs’ – involving GPs, nurses, therapists, social care workers, mental health staff and urgent care staff – has been proposed. In Thanet, it has been reported anecdotally that the three hubs planned for the area will replace at least some of the 17 current GP practices, which would mean worse patient access to GPs and job losses for trained medical staff. It’s hard to see how the proposals for primary and acute care fit with the priorities of 5YFV or its successor.
It’s difficult to have a mature conversation about health and social care when the NHS is on its knees. The Labour Party has committed to investing in a modern, well-resourced health service, to overturning the Health and Social Care Act and to reversing privatisation of the NHS. Only then will we be able to think about the best way forward for health and social care in East Kent and beyond.