ACUTE CARE: Emergency services at the Kent and Canterbury Hospital could be downgraded because of concerns that trainee doctors being left to cope with potentially seriously ill surgical patients.
The site, run by East Kent Hospitals University Foundation Trust and the main hospital in Canterbury, could be left with just a just a primary care urgent care centre, dealing with minor illnesses and injuries, and an acute admissions unit. Patients with abdominal pain, alcohol intoxication or a primary mental health would be taken to William Harvey Hospital in Ashford or Queen Elizabeth the Queen Mother Hospital in Margate.
The proposals, which will be examined by councillors on the local NHS scrutiny committee this week, were prompted by the threat of the hospital losing all its medical trainees unless changes are put in place.
Health Education Kent, Surrey and Sussex has asked for the changes after a review team raised concerns. These included:
trainees were unhappy at managing patients presenting with acute general surgical problems, as there are no general surgeons available;
a medical on-call team was covering both the existing emergency care centre and the rest of the hospital out-of-hours;
when paediatric and obstetric patients attended emergency cardiovascular care medical trainees felt vulnerable when seeing and transferring them; and
juniors felt the unit was operating as an accident and emergency department but without A&E doctors.
Since the concerns were raised, the trust has put in interim arrangements with consultant physicians covering 12 hours a day; senior surgical review 8am-6pm, Monday to Friday; and advice available out of hours.
However, it says these arrangements are fragile and reliant on the use of locums and overtime. It is already working with the ambulance service to divert potential surgical, drunk and mental health cases to other hospitals. “The trust is doing everything possible to continue to address the issues raised by HEKSS and to provide all of the trainees with a quality experience,” it said.
However, it says there is a risk that its current work will not be enough and medical trainees could be withdrawn from the site, which would close the emergency care centre and mean almost all medical in-patients would need to be taken elsewhere.
It hopes the proposed urgent care centre and acute medical admissions could be established by the end of June.
Hospital services in Canterbury were bitterly fought over 15 years ago when some were centralised at the trust’s other sites. The A&E was downgraded then and a midwife led unit – now closed – replaced a full maternity service.
David Shortt, who led the campaign against the downgrading and then went on to be lead governor, said the latest developments were “deeply depressing”. He said: “It defies logic because Canterbury is in the middle [of the trust’s catchment area] and you would think the facility in the middle would be upgraded.”
Council papers and HSJ research
25 January 2016