FAO Caroline Selkirk, Managing Director, East Kent CCGs
East Kent NHS Proposals Pre-Consultation Engagement – Patients Public and Staff
4th December 2018
Pre-consultation feedback from Save Our NHS in Kent (Please accept this as a response to the consultation) We urge the east Kent CCGs to take these concerns and suggestions on board and make the necessary changes to ensure a fair consultation next year:
a). It is essential that the consultation for east Kent hospital reconfiguration plans be conducted separately from the consultation on primary care. The topic is too large and not manageable for public discussion in its current form. Consulting the public on, and opening up the discussion to all primary care and all hospital care means that little time gets devoted to any one aspect. The presentations we have seen so far, and the discussions had at the pre-consultation stage have been very low on facts and details. This will only continue into the public consultation if you continue to attempt covering such a broad remit in one process. In particular, there should be separate public meetings for the hospital part of the plans.
b). Consultation options. A third option must be added to the consultation choices which includes full A&E and full maternity at all 3 district general hospitals in east Kent (the William Harvey in Ashford; the QEQM in Margate and the Kent & Canterbury in Canterbury). This view is supported by a large number of Kent residents, and we have gathered nearly 4,000 signatures in a short time calling on you to include this third option so that the public can scrutinise the details and compare it with the other options being put forward. Details and copies of this petition will be submitted to you by mail. We will not accept that the few pages dedicated to this matter in your ‘Medium List’ paper is sufficient to dismiss the option for three full A&Es given the population growth expected in all 4 CCG areas and the lack of conclusive evidence that the longer journey times will be safe. A full counter-argument to the position that you are currently taking on this matter is to follow in a separate document.
c). An option must be included that allows respondents to say that none of the options are acceptable, allowing respondents to reject all the options provided if they wish. There must be a genuine choice, not an illusion of choice. What has been on offer so far, ie the 2 options presented during the pre-consultation, is a Hobson’s choice.
d). You must provide a clear, concise and comprehensive list of the all negative impacts of each of the hospital proposals and include it in all consultation materials, ie what will be lost from each hospital in terms of staff, equipment, beds and services under each proposal. This should be given due prominence in consultation materials. The same must be done with the primary care proposals.
e). A clear concise explanation of how many ambulances will be going to each hospital under each proposal and most crucially where bluelighted ambulances will be going. What proportion of bluelighted ambulances will be going to each hospital under each option must be made very clear. This should be a thorough breakdown. This should be given due prominence and be included in all consultation materials.
f). You must provide a clear breakdown of how many specialist staff, consultants, doctors and nurses at each band there are in each of the three hospitals at present, and what that distribution will be under each of the proposals. This should be given due prominence and be included in all consultation materials.
g). There must be an independent impact assessment and also input from the Kent Public Health Observatory in the form of an Evidence Review. We have enquired about this matter via email on 16th, 28th and 30th of November.
h). The A&E consultants, doctors and nurses from the hospitals affected, particularly QEQM, should be present at the meetings and be allowed to freely give their views.
i). Opinions from all current A&E staff in east Kent should be sought (anonymously / by a third party) and published as part of the consultation materials, rather than afterwards, as happened with the stroke consultation. The reason for this is that the insights and opinions of staff could be very useful to the public in forming their opinion. We are aware that selected medical staff are on the panel at meetings, but they always back the proposals 100% and do not give any differing views, therefore there is no balance. By providing all the views from all the most relevant staff during the consultation, consultees will be given a broader perspective of opinions.
j). A SECAmb representative must be on the panel at the meetings to answer questions from the public about ambulance provision. k). Meeting Venues: Public meetings must be held in accessible venues that are close to public transport links. The majority of the pre-consultation meetings were held in locations only accessible by car, and you studiously avoided more deprived areas and favoured affluent areas. This has to stop. The evening events were much better attended than the daytime ones, which you had to pad out with your own staff. The use of Eventbrite ticketing puts attendees off and is unnecessary. We request that you organise meetings with the aim of getting as many attendees as possible, therefore we suggest that you hold them in town centres near public transport on evenings and on Saturday mornings; choose larger venues that can hold 100-200 people; publicise them well; and don’t use online ticketing. This is not difficult; there are many venues in each town that suit these criteria.
QUESTIONS: We hope that these questions will be answered as soon as is possible in order to compensate for the lack of available information provided thus far.
Apologies if any of these questions listed overlap with the 5 questions we asked by email on July 16th, but we were unsure if any answer was ever going to come after a wait of over 4 months. We still hope that all questions will be answered.
The amount of questions below comes to over 20 due to the fact that the pre-consultation exercise gave precious few details and the materials provided also told the public very little about the proposals.
We are hoping to get some factual information to create a clearer picture. [questions 1 -5 were sent by email on July 16th].
6. We need a clear explanation of what will happen to women who experience sudden onset of foetal distress or any other sudden complication that requires a consultant for patients that are in an MLU without access to consultants. What are the likely impacts for Ashford and Thanet patients if Option 2 goes ahead? Please provide a worst case scenario as a part of your answer.
7. We need a clear explanation of the impact on inpatients at QEQM who experience sudden illness or injury that requires an acute care/emergency medicine consultant. What is the likely impact in these scenarios for Ashford and Thanet patients if Option 2 goes ahead? Please provide a worst case scenario as a part of your answer.
8. What exactly are the differences between the proposed 'better' A&E/Medical Emergencies Centre and what A&Es in east Kent are offering now, aside from building work? Will there be better equipment, and if so, what will it be? Please list all improvements that will be made.
9. What will happen to the equipment in A&Es that close or are downgraded?
10. Who will be chairing the Senate (South East Coast Clinical Senate), and who will the members of the senate be for the purposes of this proposal?
11. Can the meeting of the Senate (the meeting that happens prior to the public consultation) be held in public, and can it also be webcast?
12. Where else in the country has this type of acute/emergency hospital reconfiguration proposed happened already? We are aware of Northumbria, and Susan Acott mentioned Cheltenham and Gloucester at the Hythe meeting when asked about it. Could we have a full list of all areas where this has been implemented, the date of implementation, and the names of the hospitals impacted by the change.
13. How will the changes affect Intensive Care? If QEQM's A&E closes and there is only a GP-led UCC there, will any consultants, beds or equipment be lost from ICU?
14. Under Option 1, and under option 2, what specialisms will stay at QEQM?
15. We have learned that 150 Urgent Care Centres nationally have already been approved. Has approval already been granted for the number of Urgent Care Centres in Kent and Medway?
16. How much additional money and resource will go to the ambulance service for the hospital changes proposed? Will it be an annual amount or a one off; will the amount be in addition to yearly increases and to the amount allocated due to the stroke changes (£1m p/a)?
17. Currently WHH, QEQM and K&C are all acute hospitals. Under option 1 and option 2, which hospitals will keep their ‘acute’ status?
18. Please state the total number of A&E and Acute beds now for each of the 3 hospitals, and how many there will be under each of the two options.
19. Can you provide a guarantee that the loss of yet more acute care and specialisms at QEQM won’t result in losses of further units at the hospital over time?
20. The loss of acute care and specialisms at QEQM is likely to result in QEQM being unable to recruit the right staff to the hospital in future; do you deny this?
21. Can you provide assurances/ guarantee that the care delivered in people’s homes as part of this plan will be free at the point of use, and not be means tested? Will this be the case over time?
22. The changes proposed will result in much more care in the home; what percentage increase do you anticipate? What proportion of this will be means tested? 22. What is the total difference in running costs between urgent care centres and accident and emergency departments?
23. Will the running of the UCCs be tendered out? What will the tariffs be for urgent care centres?
24. Please provide estimates for the total running costs of the ambulance service that will be required to adequately support each option in this plan, and provide a comparison with the current running costs of that service for the region affected.
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