The departing chief executive of a hospital trust has called for an increase in the pace of change in health services in the area.

Lesley Dwyer, who will return to Australia in November after leading Medway Foundation Trust in Kent, said: “We have been part of an STP for a couple of years and we really need to pick up the pace and say we are going to do things to improve health. We are still all in our own little fiefdoms.

“People have had bad experiences in the past when they have tried to do things. If you have been around the system for a long time then there is a reticence to do things.

“We need to reduce overheads in the system – if someone can do things better, I don’t need to do it as well.”

She welcomed some of the changes being implemented such as around commissioning – Kent and Medway now have a single strategic commissioner and joint accountable officer for its eight clinical commissioning groups. “We don’t have to do it several times with different people…I hope it will move on at pace,” she said.

Ms Dwyer also suggested small DGHs such as Medway needed to focus on what they did best and what only they could do as the route to sustainability. Partnership was crucial to this – and acute leaders needed to help strengthen social care. The fragility of primary care in Medway was also a concern, and she said that the trust was trying to reach out to primary care which it might have been reticent to do in the past. “individually we will both fail but together probably we can create the level of support that gives resilience.”

Medway has recently been reinspected by the Care Quality Commission and is likely to remain as requires improvement. Ms Dwyer said the inspectors had seen “an organisation under pressure” in the busy period around Easter. But she stressed that the organisation was still improving. “I would be very disappointed if the CQC felt otherwise but we also acknowledge that there is still more to do,” she said.

She said that during her remaining time at Medway the trust would continue to pick up the pace. Although the future configuration of stroke services across Kent and Medway has still to be decided, she said the trust had decided some time ago to “establish stroke standards at the level they needed to be. I am not going to wait for them (the countywide changes) to be implemented.”

Ms Dwyer’s deputy chief executive James Devine – whom she described as having “shared ambition and shared values” – will take over as interim chief executive when she leaves.

The chief executive of the Kent and Medway Sustainability and Transformation Partnership defended the partnership.

Glenn Douglas, who has been in post since September 2017 when he left Maidstone and Tunbridge Wells Trust said: ”A large and successful part of the work of the STP in Kent and Medway since its inception has been about bringing 19 NHS and local authority organisations together, agreeing a common vision for health and care services in our area, and aligning the way we work to deliver shared goals.

”As in many other areas the challenges are complex, but we have certainly made progress and transformation of health and care in Kent and Medway is actually well underway.

“We are also working hard to prepare for a public consultation on health services in east Kent, looking at the many complex factors involved in potentially using the east Kent hospitals in different ways. This includes how services could be delivered, what that would mean for patients and the health and care workforce, what estate would be needed, and the financial and capital implications to enable us to make any changes. It is very clear that no change is not an option and a lot of detailed work is underway to develop proposals for creating improved and sustainable services for people in east Kent into the long term.”

He said the STP had secured £19.5m in capital funding, reduced by 200 the number of adult mental health inpatients treated out of area and was working on a joined-up electronic patient record for the county, working with social care. A new medical school in Kent and Medway was also approved earlier this year.