on location Kent and Medway

Published: 01/07/2004, Volume II3, No. 5912 Page 12 13

Many people may picture the garden of England as a rosy place to live.

With rolling green hills and a sizeable coastline, it takes in the seaside town of Margate, idyllic Whitstable and the historic town of Canterbury.

Yet when it comes to the local health economy, things in Kent have been far from rosy for several years. There have been 'six years of paralysis' across Kent and Medway SHA, says its chief executive Candy Morris.

One of the main headaches centres on the reconfiguration of health services in east Kent. The various health economy stakeholders, Kent county council and the population have until recently been unable to agree on an appropriate plan to reconfigure services away from the traditional acute trust formula in the shape of East Kent Hospitals trust.

The central idea is simple: to restructure services so that accident and emergency capacity is reduced and more investment is concentrated in primary care through primary care trusts.

However, there has been stiff resistance. Downgrading A&E services at Kent and Canterbury Hospital to a local emergency centre - which will be used as 'the front door' to a range of health services - was one of the main sticking points.

According to Ms Morris, a lack of movement over the changes to east Kent's health economy has contributed to the trust's£11m financial overspend for 2002/03.Across the health economy, trusts were£19.6m in debt, overspending on a budget of£1.3bn.

The strategic health authority was awarded£17m this year in the form of a special assistance grant from the NHS Bank, largely to bail out East Kent Hospitals trust.

Because of this, the trust has now achieved financial balance, and has also managed to get the show on the road with reconfiguration.

Ms Morris explains: 'We were the first area in the country visited by the Department of Health's independent reconfiguration panel, which helped us plan the reconfiguration across the region.

'We were desperate to get some certainty to be able to make changes that have been holding up financial recovery'.

But the other big acute trust in Kent and Medway is Maidstone and Tunbridge Wells Hospitals trust, which last year posted a£9.7m deficit.

At its most recent board meeting, chair James Lee admitted that the trust was 'really up against it' but said that a robust financial plan had been put in place which meant the trust would achieve financial balance by 2006.

Chief executive Rose Gibb joined the trust in November following an inquiry which had highlighted waiting-list irregularities last year. She says that this year's deficit includes£4m from the last financial year.

'We need to build sustainability into the system, we need to release resources over the next two-year period and to do so we must invest'.

One initiative is a new cardiac centre which will initially be on the site of the Maidstone Hospital before transferring to the£250m private finance initiative Pembury Hospital once it opens in 2008-09.

East Kent Coastal Teaching PCT chief executive Darren Grayson chairs the region's cardiac network board, newly set up to work on a project to build new cardiac centres across the region.

Much of the Kent and Medway population have to travel to London for cardiac treatment, though according to Mr Grayson the scheme should see '90 per cent of [heart] patients treated in Kent and Medway by 2008-09'.

Mr Grayson says this will mean 'a very significant change for the region, not least because of the workforce and the kit involved'.

The network has managed to secure£14m in capital investment from the national heart team and is confident that putting this kind of investment back into the local health economy will reduce the overall financial deficit.

Mental health services in the region are also currently subject to a review. East Kent NHS and Social Care Partnership trust is considering reducing inpatient capacity and has recently introduced a new crisis management team which provides services to patients in their communities.

Trust chief executive David Parr denies that this is a cost-cutting measure.

'If the crisis assessment team works well it will prevent the need for admission to inpatient units... The evidence shows that this could lead to a 30 per cent reduction in the number of inpatients'.

Over the next few years Kent is also set to face a significant swell in its population as part of deputy prime minister John Prescott's housing plan for the South East.

According to Ms Morris this is likely to pose even more challenges for local health services, especially in increasing the services provided to children and the elderly people.

Ms Morris says the SHA has at last succeeded in reaching agreement with the Department of Health on a 'future funding allocation for the increase in population [for 2006-07] rather than funding being retrospective, as at present.'

However, an exact budget has yet to be decided.

'The population of Ashford will grow by 37 per cent in coming years, which is hugely significant.

However, we already have a team in place across the SHA who are planning and preparing for this', she says.