Healthcare in Kent

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Healthcare in Kent has, from 1 July 2022, been mainly the responsibility of the Kent & Medway Integrated Care Board. 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 and Medway basis, others on a South East basis and there is liaison with London to provide many tertiary (highly specialised) healthcare services.

Contents

Local authority areas covered by NHS Kent and Medway Integrated Care Board: 1) Sevenoaks 2) Dartford 3) Gravesham 4) Tonbridge and Malling 5) Medway (single tier in yellow) 6) Maidstone 7) Tunbridge Wells 8) Swale 9) Ashford 10) City of Canterbury 11) Folkestone and Hythe 12) Thanet 13) Dover Kent numbered districts.svg
Local authority areas covered by NHS Kent and Medway Integrated Care Board:
1)   Sevenoaks
2)   Dartford
3)   Gravesham
4)   Tonbridge and Malling
5)   Medway (single tier in yellow)
6)   Maidstone
7)   Tunbridge Wells
8)   Swale
9)   Ashford
10)  City of Canterbury
11)  Folkestone and Hythe
12)  Thanet
13)  Dover

History

From 1947 to 1965 NHS services in Kent were managed by the South-East Metropolitan Regional Hospital Board (RHB). In 1974 the boards were abolished and replaced by regional health authorities (RHA). 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 (AHA) from 1974 until 1982 when it was divided into five district health authorities (DHA): 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 (SHA) 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 (PCTs) for the area: NHS Eastern and Coastal Kent; NHS West Kent; NHS Medway up until April 2013. After this eight clinical commissioning groups (CCGs) 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 20 March 2020 to the formation of the Kent & Medway Clinical Commissioning Group (CCG) on 1 April 2020. This contributed to the Kent & Medway Integrated Care System (ICS) until the creation in 1 July 2022 of the Integrated Care Board (ICB) by the Health and Care Act 2022.

Sustainability and transformation plans

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 were 262 GP practices in the county in 2017 but a process of consolidation and reorganisation is current. 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 a community 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 in East Kent by the Pilgrims Hospices in Ashford, Canterbury and Margate, founded by Ann Robertson, 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. From December 2021, after a take over, it was renamed HCRG Care Group. 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]

The practice at Sheppey Community Hospital was run by DMC Healthcare from 2009 on an alternative provider medical services contract which was terminated in 2021. The company's contract to run practices in Chatham was terminated in 2020. [20]

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, Maidstone and Tunbridge Wells NHS Trust and Dartford and Gravesham 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. [21]

Inpatient specialist vascular services in the county were centralised to the Kent & Canterbury Hospital, as neither Medway nor East Kent had sufficient staff, activity or facilities on their own for safe services. [22] There are plans to consolidate the six 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. [23] Campaigners against the plan lost their judicial review in February 2020. [24]

Patient transport services in the county are provided by G4S at a cost of £15 million a year. In 2018, they were unable 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 needed an escort. [25]

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. [26] 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 did not expect to meet the 18 week target until October 2020. [27]

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.

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

Related Research Articles

<span class="mw-page-title-main">Monitor (NHS)</span>

Monitor was an executive non-departmental public body of the Department of Health, responsible between 2004 and 2016 for ensuring healthcare provision in NHS England was financially effective. It was the sector regulator for health services in England. Its chief executive was Ian Dalton and it was chaired by Dido Harding. Monitor was merged with the NHS Trust Development Authority to form NHS Improvement on 1 April 2016.

The Dartford and Gravesham NHS Trust is an NHS Trust with an annual budget of about £121 million, and employs 1,900 staff. It manages Darent Valley Hospital in Dartford, Queen Mary's Hospital in Sidcup, Erith and District Hospital and Elm Court.

Medway NHS Trust is an NHS foundation trust based in Kent which runs Medway Maritime Hospital.

<span class="mw-page-title-main">Virgin Care</span>

Virgin Care was a private provider of community health and social services in parts of the UK, commissioned by the National Health Service and by local authorities in England. From 2010 the company was known as Virgin Care and was part of Virgin Group. In December 2021, it was acquired by Twenty20 Capital and rebranded as HCRG Care Group.

The Five Year Forward View was produced by NHS England in October 2014 under the leadership of Simon Stevens as a planning document.

Healthcare in Dorset was primarily the responsibility of Dorset Clinical Commissioning Group until July 2022. Dorset County Council is leading in the development of an electronic health record, to be called the Dorset Care Record, provided by Orion Health. It is intended to enable all health and social care providers to share records.

Healthcare in Devon was the responsibility of two clinical commissioning groups until July 2022, one covering Northern, Eastern and Western Devon, and one covering South Devon and Torbay. It was announced in November 2018 that the two were to merge.

Healthcare in Bedfordshire is the responsibility of Bedfordshire and Luton Integrated Care Systems.

Healthcare in Somerset, England was the responsibility of three clinical commissioning groups (CCGs) until July 2022. These covered the ceremonial county of Somerset, which comprises the areas governed by the three unitary authorities of Somerset, North Somerset and Bath and North East Somerset.

Healthcare in Sussex was the responsibility of seven Clinical Commissioning Groups covering: Brighton and Hove; Coastal West Sussex; Horsham and Mid Sussex; Crawley; Eastbourne Hailsham and Seaford; Hastings and Rother; High Weald; and Lewes-Havens from 2013 to 2020. From April 2020 they were merged into three covering East Sussex, West Sussex, and Brighton and Hove. In 2021 the three Sussex CCGs were merged into one, Sussex CCG. In 2022 Sussex CCG transitioned into an Integrated Care Board or ICB.

Healthcare in Staffordshire was the responsibility of six clinical commissioning groups until July 2022, covering Stafford & Surrounds, North Staffordshire, South East Staffordshire and Seisdon Peninsula, East Staffordshire, Cannock Chase, and Stoke-on-Trent.

Healthcare in Cornwall was until July 2022 the responsibility of Kernow clinical commissioning group, a National Health Service (NHS) organisation set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in England. As far as the NHS is concerned, Cornwall includes the Isles of Scilly.

Kent Community Health NHS Foundation Trust is an NHS provider of community services in Kent, East Sussex and Newham. It was awarded Foundation Trust status in March 2015.

Healthcare in the West Midlands was, until July 2022, the responsibility of five integrated care groups: Birmingham and Solihull, Sandwell and West Birmingham, Dudley, Wolverhampton, and Walsall.

Healthcare in Surrey, England was the responsibility of five Clinical Commissioning Groups: East Surrey, North West Surrey, Surrey Downs, Guildford and Waverley, and Surrey Heath from 2013 to 2020 when East Surrey, North West Surrey, Surrey Downs, Guildford and Waverley merged to form Surrey Heartlands CCG. The new organisation started with a £62 million deficit.

Healthcare in Cambridgeshire was the responsibility of NHS Cambridgeshire and Peterborough Clinical Commissioning Group until July 2022. This was one of the largest in the United Kingdom.

Healthcare in Essex is now the responsibility of six clinical commissioning groups: Basildon and Brentwood, Mid Essex, North East Essex, Southend, Thurrock and West Essex.

Healthcare in Wiltshire, England, is the responsibility of the integrated care board (ICB) for Bath and North East Somerset, Swindon and Wiltshire.

Healthcare in Lancashire in 2015 was the responsibility of seven clinical commissioning groups covering Blackpool, Chorley and South Ribble, East Lancashire, Fylde and Wyre, Greater Preston, Lancaster North and West Lancashire. In 1 April 2017 32 GP practices from Cumbria Clinical Commissioning Group merged with Lancashire North CCG to form Morecambe Bay CCG which was abolished in July 2022 when integrated care systems were introduced.

Healthcare in Norfolk was the responsibility of five clinical commissioning groups: Great Yarmouth and Waveney CCG, Norwich CCG, North Norfolk CCG, West Norfolk CCG and South Norfolk CCG, they merged in April 2020 becoming the Norfolk and Waveney CCG until they were replaced by an integrated care system in July 2022. Social Care is the responsibility of Norfolk County Council.

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. Archived from the original on 9 May 2022. 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. ↑ "CCG closes private firm's GP practice in remote area". Health Service Journal. 10 September 2021. Retrieved 16 October 2021.
  21. ↑ "Kent NHS 'to offer patients surgery in France'". BBC News. 8 September 2015. Retrieved 18 September 2015.
  22. ↑ "Kent vascular services likely to be centralised". Health Service Journal. 26 April 2016. Retrieved 2 July 2016.
  23. ↑ "County leaders plan major stroke service shake-up". Health Service Journal. 22 November 2017. Retrieved 30 December 2017.
  24. ↑ "Campaigners lose legal battle against major reconfiguration". Health Service Journal. 21 February 2020. Retrieved 29 March 2020.
  25. ↑ "Commissioners up spending on struggling transport service". Health Service Journal. 30 April 2018. Retrieved 26 June 2018.
  26. ↑ "Harm assessments after 160 children wait more than a year for mental health treatment". Health Service Journal. 13 June 2018. Retrieved 31 August 2018.
  27. ↑ "Young people put at risk by delays for treatment". Health Service Journal. 25 February 2020. Retrieved 29 March 2020.
  28. ↑ "South Kent Coast - care for people in mental health crisis". Dover Express. 8 December 2014. Retrieved 21 December 2014.
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