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Judicial Review – full steam ahead!

SONiK JR fund for web copy

SONIK’s Judicial Review with regard to the plans to close stroke units at QEQM, Medway and Pembury – it’s full steam ahead!

Thursday 18th April 2019

On Monday 15th April, SONIK (Save Our NHS in Kent) sent a legal letter to the Kent and Medway Stroke review CCGs which starts the firing gun for our judicial review which will challenge the decision to close QEQM’s stroke unit and result in all of Kent and Medway having just 3 acute stroke units where there are currently six. The NHS commissioners (known as ‘the JCCCG’ or the ‘CCGs’) will now have to respond to us by April 29th with their response. If they do not agree to rethink the plans or reconsult, then SONIK will proceed with the application for Judicial Review (which must be submitted prior to May 14th).

Save Our NHS in Kent have been working towards a judicial review for nearly a year and a half. We have always intended to take this step, and we have always made that clear. Preparations have been lengthy and detailed. To prevent stroke unit closures, our first line of defence is to campaign for KCC to ‘Refer It Back’, as it involves no legal costs and has achieved good results in other areas; but we will not lose our stroke unit, and we knew that a referral back to government and a JR might well be necessary in parallel. This has been discussed at numerous meetings, in social media posts and news articles.

As we have had nearly a year and a half to prepare, and researchers working on the review for the same length of time, this means we have a very strong position in terms of our grounds and our understanding of the full documentation base, as follows:

  1. SONIK have studied and made analyses of the SSNAP data, PCBC and DMBC, impact assessments and the clinical studies used to claim that centralisation of stroke services will save lives. This information is currently with our solicitors, Leigh Day, who are specialists in Judicial Review cases, and won the Lewisham case.

  2. We have also made hundreds of enquiries to the Kent & Medway STP throughout 2018 and 2019, resulting in a lengthy paper trail of responses that give far more detail than is available in the consultation documents. The SONIK members who have been immersed in this for a year and three months have been giving their full attention to this matter alone. That focus means that masses of relevant information has been acquired and is at the forefront of their minds; they know where the info is (amongst the vast amount of data produced by the STP) and how to use it.

  3. SONIK took initial steps toward a judicial review in 2018 (on the basis of a failure to adequately consult the public) which resulted in the STP being more compliant with information requests for a period of time. SONIK made full use of that and are in receipt of letters from the STP in which they have admitted inaccuracies in their listening event presentations.

  1. Members of SONIK attended and recorded 6 of the stroke ‘listening event’ public meetings plus the initial ‘meeting in public’ JCCCG meeting in January, which again has provided exceptionally useful information in relation to the review.

  2. SONIK have counter arguments prepared for all of the CCGs’ lines of argument. SONIK has successfully rebutted each of the STP’s justifications for having only three HASUs in Kent and Medway and their justifications for closing QEQM’s stroke unit.

  3. SONIK have strong relationships with NHS campaign groups across the country that have provided us with advice and support and will continue to do so. They will help us with fundraising as will Keep Our NHS Public and Health Campaigns Together, which SONIK is affiliated to. They are large national campaigns with a lot of reach. HCT organised the large NHS marches in London in recent years (in conjunction with the People’s Assembly).

  4. SONIK have 2k followers on facebook and a 3k mailing list plus the support and goodwill of the community, who know us very well from our frequent TV appearances and our bi-weekly street stalls which have been held throughout Thanet for almost 2 years.

It may well be that there are three Judicial Reviews in regard to the stroke decision, reflective of the strength of feeling against the plans; Medway Council announced their intention some time ago. Our solicitors (Leigh Day) have invited the law firms representing both Thanet Stroke Campaign and Medway Council to work collaboratively in order to avoid duplication; this will rest on how different or similar the grounds for each case are. Filing one review as a combined whole may be more sensible, or it might be that grounds are sufficiently different that it is sensible to file more than one in order to cover all potential bases.

SONIK’s priority has always been to ensure high quality healthcare for all of Kent. Three hyper acute units are not enough, and QEQM needs a stroke unit, for geographic and demographic reasons. We will continue to push for four or more units, and we will continue to represent the people of Thanet to the best of our ability.

Save Our NHS in Kent

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SONiK Published the case AGAINST stroke cuts

Save Our NHS in Kent has now published our document laying out the case against the plans to re-organise Stroke Services in Kent that would see some communities left with no local service. You can read it here:

The case AGAINST changes to Stroke Services

 

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SONiK writes to CCG boss – 4 Dec 18

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.
Kind Regards,
The Committee of Save Our NHS in Kent.

csj.carly@gmail.com / saveournhskent@gmail.com / http://www.saveournhskent.org.uk
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Medics defend SONiK campaign

Last week, SONIK were branded ‘inaccurate’ and ‘irresponsible’ for voicing concerns that the stroke plans could lead to additional deaths for Thanet residents. Here is our response in full. [Please note that some publications have chosen to edit our response, this is why we want it to be clear that this is the full, unedited version].
—–
Save Our NHS in Kent would like to respond to the letter from 4 Kent doctors on behalf of Kent NHS Managers (October 11th 2018), firstly by pointing out that ‘time is brain’; this is a maxim used by neurologists to refer to the rapid loss of brain cells when a stroke is left untreated.

Every minute in which a large vessel ischemic stroke is untreated, the average patient loses 1.9 million neurons, 13.8 billion synapses, and 12 km (7 miles) of axonal fibers. Each hour in which treatment fails to occur, the brain loses as many neurons as it does in almost 3.6 years of normal ageing. Thanet’s 141,000 residents will be one hour away from crucial stroke care once these plans are implemented, with possible ambulance response times of 40 minutes for some patients. We are confident that our concerns are justified.

They say that their ‘guiding principle’ is ‘first do no harm’, and stress that the project is clinically led, but the fact is that the project in Kent is led by high-salaried managers with a business mindset, plus a few clinicians. The STP’s main duty is to drive through national reforms to scale back services so that far fewer hospitals in the country provide acute care (the treatment of sudden, urgent or emergency injury and illness that can lead to death or disability without rapid intervention). It is the Kent & Medway STP’s role to ensure that these plans are rolled out in Kent. This is no secret, it is revealed in the STP’s own reports. Sadly, the duty to ‘do no harm’ is contradicted by the legal duty of the commissioning groups to eradicate their large financial deficits. Were NHS funding more in line with 1948-2010 levels, these deficits would not be as crippling as they are.

We stand by our assertion that it is an experiment on the people of Kent, as no other area in the country has such a high percentage of the population outside 45 mins journey time. We challenge the executives at the STP to disprove this. If they are unable to do so, it would be appropriate for them to retract the accusation that SONIK are behaving irresponsibly, halt the plans as they stand, and opt for a 4 HASU solution instead.

All of the studies being used to back up the stroke review plans are flawed in some way or not applicable to this area. We are working currently on a document that summarises the numerous ways in which the NHS managers are using data inappropriately, and in particular the misleading claim that death and disability outcomes will improve – there is no such evidence. They are also aware that studies exist that prove there are disbenefits to moving acute care further away, but they have consistently chosen not to mention that. They have also ignored their own impact assessment that was carried out independently in December 2017; it shows that negative consequences are likely.

Signed Dr Coral Jones, Dr Tim Winch, Dr Paul Hobday, Carly Jeffrey, Helen Whitehead

On behalf of Save Our NHS in Kent (SONIK)
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This decision must be challenged

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We MUST fight this proposal

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Thanet GP Hubs: Q & A with head of CCG

Save Our NHS in Kent
QUESTIONS & ANSWERS – THANET GP HUBS
Emails between C Jeffrey (SONIK) and Dr Tony Martin (Chair, Thanet CCG) on the topic of changes to Thanet GP surgeries (aka ‘supersurgeries’)

—-

On 29 March 2018 at 12:07, C Jeffrey wrote: Hello Tony,

I hope you are well.
I have a few questions regarding the new GP superhubs plan for Thanet, and I’m hoping that you can provide answers as you are a spokesperson for this proposed change to services and also you are head of Thanet Clinical Commissioning Group.

  1. Would you say that this is overall an increase in services and amenities, a reduction, or will the services and amenities stay the same?
  2. Will there be a public consultation on they change, and if so, when?
  3. Will the change result in fewer GPs or other medical staff in the short or long term?
  4. Will the any of the existing GP surgeries be closed, merged, or left to wither on thevine? Will there be continued and adequate funding for the existing surgeries? Arethey likely to lose staff to the new units, and therefore have to close?
  5. Will the ‘extra’ NHS spend allocated for this proposal be spent entirely onconstruction work? Is it possible to provide a breakdown of where that spend will go?
  6. We are concerned that the infirm, elderly and people without cars will be forced to outof town locations for primary care; we would like to see guarantees that people in those categories will be able to continue receiving primary care within close proximity in the short and long term. Will this be possible?

Many Thanks, Carly Jeffrey

—-

On 30 Mar 2018, at 15:02, C Jeffrey wrote: Three more questions I’m afraid!

  • 7. is there an estimate for how many GPs in Thanet are likely to retire in the next 5 years?
  • 8. What is the current GP FTE to patient ratio in Thanet, and how does that compare to the UK average and to ten years ago?
  • 9. Will the number of GPs in Thanet increase or decrease in the next 5 years? Many Thanks,Carly Jeffrey —-On 30 March 2018 at 19:02, MARTIN, Tony (BETHESDA MEDICAL CENTRE – G82105) wrote:

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Good evening
Here is an attempt to answer your questions

1. Are we looking at spend, staff numbers, experience or other?
Spend should be stable after the injection of build capital.
Staff numbers probably increase but with change in mix to reflect modern working methods. So multidisciplinary and working “at the top of your license” are concepts I am sure you are aware of.
Patient experience has been greatly improved ( from survey results) for services that are currently provided in the community rather than hospital ( migraine, epilepsy and Ophthalmology to name a few).

2. The entire look at local care in Thanet will be the subject of an open meeting in the next couple of months following on from the one last week at Canterbury cricket club. We want to give residents the opportunity to look at some models and help shape the future.

There are changes that have to be consulted on and of course we will.
I would be rather driven by wanting to develop a system of care that does what I would want “for me and mine” rather than limiting our consultation scope to the legal must.
Surgeries moving or merging must engage with their registered population and submit that consultation to the CCG Primary Care Commissioning Committee with their formal application for change.

  1. As we have discussed at stroke meeting, the traditional model of primary care Is becoming ever more difficult. As an aside a recent survey of newly qualified GPs showed that on average they wish to work 5.5 sessions a week ( for clarity 10 is full time). We are having to change our working pattern to use more non-doctor clinical staff, paramedics, advanced nurse practitioners, physicians associates and others. There is no directive that we must it is the reality of supply that is driving these changes yet one has to say that some of the change is overdue. I don’t need to see coughs and colds and feel my time is best spent having longer to see more complex patients.
  2. Plans beyond Cliftonville are too early for me to try to presume a detailed answer. Our survey of premises last year did highlight a number of surgeries which even with large sums invested would not come upto current requirements for new premises. With regard to the development currently out to planning it will mean the merger of the two practices and relocation of services from Northdown, there has already been communication with those patient groups and more will follow as they move forward . There will have to be consideration as further applications are received of how the surgeries will propose to both improve quality of care and not disadvantage any group.
  3. I probably need you to help me understand what other areas you are concerned about. Of course we have architects, quantity surveyors, planning designers etc as well as the builders but the spend is entirely on delivering the project.
  4. This one will be the subject of the discussions with the patients in the individual projects. As I have said the PCCC will require to be convinced, and it has a lay majority with only two GPs on it.
  5. No precise figure. They are independent contractors so we can only work on averages. The average GP currently retires at 58 or 59. I don’t have the age spread graph with me at home but there is if a remember it right a bulge coming up rather than a linear distribution.
  1. This one will have to wait until next week when I can get the workforce analysis, we have it by practice but that is less useful as it can vary greatly depending on use of non-medical clinicians and locums.
  2. We should see an increase this year with recruitment from outside UK. The new medical school starts its intake in two years and will take another ten to produce GPs. My own view is that we will not see significant increase within 5 years.

I appreciate that these answers may spark more questions and there is a lot that we cannot give set answers on, however our aim is to develop services across Thanet to address our commissioning aims of reducing health inequalities. We have another piece of work that you would be interested in, pulling together the public sector provision of health and well being and looking at how we can collaborate more closely to maximise our impact. This involves TDC, KCC, health and police, the agencies are formulating ideas of how this might be most effective.

Kind regards Tony

Apologies for brevity, sent mobile —-

From: C Jeffrey
Date: Monday, 9 April 2018 at 18:14
To: “MARTIN, Tony (BETHESDA MEDICAL CENTRE – G82105)”
Subject: Re: A question regarding the new GP Superhubs

Hello again Tony,

Many thanks for your answers.

Could you reply to these questions too?

  1. Will there be receptionist triage?
  2. You mention that you ‘don’t need to see coughs’ – what if they appear to be simplecoughs, but are not coughs, and get missed as the patient has been seen bysomeone without full GP training?
  3. Who will be seeing these minor cases, if not GPs, and what level of training all theyhave?
  4. The ‘change in mix’ – so is it fair to say that this will this result in more, but lessqualified staff?
  5. Will there be a formal consultation?

Many thanks, Carly

—-

11 April

MARTIN, Tony (BETHESDA MEDICAL CENTRE – G82105)

Dear Carly,
Looking to your questions, we of course work within the recommendations of our professional bodies and require all our staff to work within their professional competencies.

We also have the additional control and needing to ensure that medical indemnity organisations are happy with the range of services an individual is undertaking as they will only cover staff and doctors undertaking care that falls within an expected style of care.
For example a nurse who has satisfactorily completed the independent prescribers course can then issue prescriptions for medication themselves as long as it is within an area of care that they have relevant training. So a nurse who has done the prescribers course and an asthma course can then issue prescriptions for asthma medication.
Our receptionists ask for details of problems and put them on the appointments page and may escalate a problem but not de-escalate. So if a patient rings in with chest pain and asks for an appointment they will ask whether the patient needs an ambulance rather than waiting and will contact a doctor if in doubt.
Across Thanet there are physios, nurse practitioners, paramedics undertaking frontend care roles with physicians associates in training. So there are more staff, I would not like to say a paramedic is less qualified than a doctor but is qualified in a subset of GP work and to be honest has training in some areas I don’t.
As you heard last night there are to be listening events called “design by dialogue” relating to health services in Thanet. Individual practices will want to engage with their populations about these changes which I believe are good news for local people. I do not think there will need to be statutory consultation.

Regards, Tony Martin

——-

11th April Carly JeffreyDear Tony,

Thank you for the information.
Do you know when the Thanet ‘Design By Dialogue’ event will be?

I would suggest that a better title for these meetings would be something that people can understand, such as ‘Future of GP Services in East Kent’, or ‘Consultation meeting on Primary Care and Health services in Kent’ – currently people have no idea what he meetings are for, if they know of their existence at all.

Is there a page online where we can look out for details of Thanet and other ‘Design by Dialogue’ meetings, or can we subscribe for an alert of some kind?

Many Thanks, Carly

—-

12 April
MARTIN, Tony (BETHESDA MEDICAL CENTRE – G82105)Morning Carly

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Thanks for your comments, I will forward to the event planners, we don’t want this work to be “white middle class”.
They will be posted on the CCG web site and we usually notify members of Thanet health network, I’ll let you google it if you aren’t a member already,

Kind regards—

12 April

Hello Tony,
I’m not sure what you mean by ‘we don’t want this work to be “white middle class”.’ Can you explain?
Carly
—-

12th April
MARTIN, Tony (BETHESDA MEDICAL CENTRE – G82105)
Only that,
We really want to get the views of a good cross section of the population and suggestions about matters such as event title can be really helpful in engaging
Regards

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Report from Broadstairs Listening Event

Broadstairs Listening Event (public consultation meeting), Stroke Review report:

24.03.2018 (week 7 of the 10 week consultation)

The venue was full, with all 110 seats full, and some people being turned away as they hadn’t booked. Ten members of SONIK were present in the audience (we had requested a place on the panel to provide some balance, but had been refused). Also present in the
audience were councillors Iris Johnson, Paul Messenger, Lesley Game, and Karen Constantine, and prospective parliamentary candidates for Labour Raushan Ara, Rebecca Gordon Nesbitt and Helen Whitehead, as well as ex Councillor and CCG member Clive Hart. Neither of our local MPs were present.

The panel: Dr Tony Martin, Dr David Hargroves, Patricia Davies, Caroline Selkirk and Susan Acott.

At the beginning of the meeting, Candy Gregory handed over a formal letter from SONIK stating that the consultation process has been inadequate and requesting that the committee withdraw their plan or reconsult. Copies of this letter were also given out to the audience. Patricia Davies responded that the letter will be ‘logged’, and Carly Jeffrey of SONIK stated that is must be read and responded to before it is logged.

What was different about this meeting to preceding ones? Our questions were answered directly without intervention from the chairperson, who at previous meetings had rephrased people’s questions and in some cases bundled numerous questions together. This time, there was no attempt to do so. Also,the chair stated that any unasked questions could be written on cards, handed in, and said they would be answered on the Kent & Medway STP website. At previous meetings, they said they’d ‘feed the questions back’, meaning that nothing would be done with them until after the consultation had ended.

The audience, yet again, were pretty well informed, and asked very pertinent questions around ambulance journey times and ambulance response times, they asked why there is no national approach to stroke recruitment and staffing, and it was commented that this needs to be established before regional areas move to the HASU model.

Also raised were: funding for specialist training, travel difficulties to Ashford, family accommodations, the fact that Thanet healthcare is struggling already, and they asked why QEQM hospital isn’t on the table forthis consultation. One audience member asked for a show of hands, and the response was almost universal for keeping services at QEQM hospital.

An ex- Speech and Language therapist talked of her experience of trying to get back into the role, specifically with the high costs of training. SONIK members asked about the effect on hospitals left behind, the inadequate evidence on death and disability outcomes, inequality of care, and acute bed numbers.

Dr Tim Winch made some very good evidence based points; the audience were very interested in what he had to say, and he got a big cheer from the crowd. He ended by telling the panel that they should ‘hang their heads in shame’.

The two voices from the audience that were in agreement with the panel are both known to the panel – GP Sarah Philips, who quoted the now discredited death and disability evidence from London, and Patricia Funnell, ward manager of QEQM’s stroke unit. Patricia has been at every Thanet meeting so far; this time stood up and said that all who work in the QEQM stroke unit are behind the plan.

SONIK do not believe this to be true, but it is not something that can be proved one way or the other when staff are scared to speak out for fear of the workplace bullying that is known to happen to whistleblowers in the NHS. Dr David Hargroves is Ms Funnell’s direct line manager.

There are 5 new videos from Saturday up on the FB page – please take a look to see what happened at the meeting:

https://www.facebook.com/pg/SaveOurNHSKent/videos/?ref=page_internal

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What has happened to CAMHS?

If you attempted to telephone your local Child and Adolescent Mental Health Service (CAMHS) in the first weeks of September, in Broadstairs or Canterbury, or anywhere else in Kent or Medway, you will have been greeted by a monotonous tone signalling that the telephone line had been disconnected.

No-one was warned about this; not the patients, families, GPs or other professionals, or even the staff who work in these clinics. The reason the phones were disconnected was because the management of Kent CAMHS services migrated from its former provider, Sussex Partnership Foundation Trust (SPFT) to the new provider, North East London Foundation Trust (NELFT) on 1st September 2017.

As well as the telephone lines being disconnected, the electronic patient record system shut down, pending referrals were closed, and staff email accounts were disbanded. CAMHS, as you know it, was effectively cut off.

SPFT had been responsible for Kent CAMHS services for the past four years since they successfully won the tender from East Kent Hospitals Trust (EKHT). One can only assume that the tender, like any other, was won on a ‘provide more for less’ basis. SPFT’s head offices are in Swandean and Arundel; hours away from the Kent services they were commissioned to provide. The tender brought uncertainty for clinical and admin staff including restructuring, redundancies and reapplications for jobs with obvious implications for patients and families – all at financial cost to the NHS.

It also meant a massive rebranding of everything from letter heads to the signage outside every single clinic. There were new mobile and desktop telephones, laptops and ipads for all staff as well as new paper and electronic patient record systems.  As well as new contracts for buildings maintenance, IT support, heating, lighting, telephones, even alarms – all at a financial cost to the NHS. The initial tender was for three years and so from about 18 months in, senior and middle managers became embroiled in writing a new tender bid, travelling by car, with expenses paid in addition to their salaries, to meetings in Sussex; a tender they ultimately lost –  all at financial cost to the NHS.

There was also a cost to staff and to patients and families who moved further and further down on managers’ lists of priorities as the deadline for tender grew closer.

On 1st September, NHS Clinical Commissioning Groups (CCGs) and Kent Local Authorities awarded the new tender to NELFT. Staff were issued with brand new mobile and desktop telephones as well as desktop and laptop computers – a further financial cost to the NHS.

There was another new electronic patient record system to be trained in; two days’ worth of training for every clinical and admin staff member, as well as additional training in health and safety and the obligatory Meet and Greet with lunch provided – a further financial cost to the NHS.  NELFT’s mission is to deliver an ‘easily accessible, emotional wellbeing and mental health service to children and young people’*. CAMHS tier 2 and tier 3 services in Kent and Medway no longer exist. Let’s be clear here; they no longer exist.

In Kent the new service is Children and Young People Mental Health Service (CYPMHS) while in Medway it is the Young People’s Wellbeing Service (YPWS). NELFT were also chosen to develop and deliver an all-age eating disorders service (AAEDS) across Kent and Medway. Again, a tender won, one assumes, on a promise to provide more for less.

These new services are currently in a period of consultation. Uncertainty around what they will look like in reality is set to continue until this period ends on 1st April 2018. The consultation period has been billed as ‘business as usual’ by managers but anyone trying to access the services or work within them will know that this is not the case at all. Chaos and confusion reign. Staff and union representatives have been provided with the consultation document which reiterates that NELFT ‘are not consulting on what will be delivered as this is pre-determined’*.

In January 2018 staff began the process of re-applying for jobs; either their own or a de-banding because, in reality, there aren’t enough clinical or admin roles to go round. There are no receptionist roles at all. Staff will face a choice between agreeing to relocate anywhere across the county, accept a demotion or resign. Many are opting for the latter in a bid to avoid going down with the sinking ship.

One of the criticisms of CAMHS, as it was, was high referral criteria and long waiting lists. NELFT’s response to this is Single Point of Access (SPA). There is a Kent SPA based in Maidstone and a Medway SPA in Chatham that take referrals from anyone, including self-referrals from patients aged 0 – 19 years and their families.

SPA is commissioned to receive, screen and direct referrals as well as provide advice, information, consultation and support to referrers and other services; that’s a big ask. The idea behind the model is to ‘allow more children and young people to obtain better help and support sooner’*. The previous CAMHS service, which was under-staffed and under-funded, failed to meet the mental health needs of young people in Kent.

The new service promises to do much more for much less. It’s not working; SPA currently has a backlog of almost 500 referrals waiting to be triaged in East Kent. Once triaged, these patients will enter the system and be signposted out or sit on internal waiting lists for treatment.

The new service will consist of five care pathways*. These are:

  • Early help pathway
  • Behavioural and conduct pathway
  • Neurodevelopmental and learning disability pathway
  • Mood and anxiety pathway
  • Complex pathway

The specialist learning disabilities and challenging behaviour (LDCB) and children in care (CiC) teams that sat within CAMHS will be disbanded. To reiterate, tier 2 and tier 3 CAMHS no longer exist. The five care pathways will be led by band 7 clinicians, who will act like (but not be remunerated as) managers. The care pathway services will be provided by multi-disciplinary pathway workers employed at band 6 and mental health workers employed at band 5. To bastardise an old adage; you pay peanuts; you get CYPMHS.

Name and address withheld

*Quotes and CYPMHS structure taken from the Consultation document

*Proposed posts

Position Band Canterbury full time equivalent Thanet full time equivalent 
Consultant Psychiatrist Consultant 1.20 2.00
Trainee Doctor CT2 0 1.00
Senior Clinical Psychologist or Psychotherapist 8b 1.00 1.00
Integrated Team Manager 8a 1.00 1.00
Clinical Psychologist/ Family Therapist/ Psychotherapist 8a 1.20 1.80
Pathways leads 7 5.00 5.00
Youth Offending Worker 6 1.00 1.00
Multi-disciplinary Pathway Worker 6 5.50 6.50
Mental Health Worker 5 1.00 1.50
Medical Secretary 4 0.50 1.50
Assistant Psychologist 4 2.50 3.00
Administrator 3 2.50 3.00
Total full time equivalent staff 22.4 28.3

 

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