Enormous gaps in staffing, availability of capital and revenue funding seem set to stymie long term plans set out in the Kent and Medway ‘Strategy Delivery Plan’ published this month in board papers for the troubled East Kent Hospitals FT.

Since the Trust has not even made it onto the “long list” of 21 given seed funding to plan for new hospitals in five years’ time, it is astounding that the plan admits to including a “suite of projects” (“ranging from £500,000 to £363 million”) requiring a total of £821 million (p72).

The HSJ now reports that these figures include huge increased estimates for the cost of rebuilding the William Harvey Hospital in Ashford – from £160m in November 2017 to £351m now: and the projected cost of an alternative scheme for a new hospital in Canterbury (which seemed to have won support from Boris Johnson in an unguarded remark at last year’s Conservative conference, later denied) has risen from £250m to £363m.

Seriously unstable, concludes audit of NHS finances

But the new hospital is just one element of a mid/long term plan for substantial investment adding up to a hefty £637m:

  • Stroke services Reconfiguration – £27.7m
  • East Kent Acute Redesign – Option 1 = £351m, Option 2 =£363m
  • Acute bids – £224m (excluding the EK Redesign)
  • Local Care including primary care £211m
  • Mental Health – £31m

Back in 2016 most of the 44 Sustainability and Transformation Plans were characterised by huge and unrealistic requirements for capital investment, totalling £14.3 billion, when it was widely recognised that nothing like that amount would be available.

Now Kent and Medway, which included no capital requirement in their STP, have set out their demands, which if replicated in all 42 areas responding to the Long Term Plan could stack up to well over £34 billion.

However, there are other worrying aspects of the K&M plan. It admits (p75) to dire workforce shortages in primary care (among the most severe in the country, with 25% of GPs and 55% of general practice nurses approaching possible retirement) in mental health (with a required total growth in the mental health practitioner workforce of 1577 FTE by 2024  – an increase of 50%, including psychiatrists and nurses) and in the cancer workforce (90 additional FTE).

The acute trusts do not have a sufficient stroke workforce to provide hyper acute stroke services on the current sites – or to deliver the proposed reconfigured services on the preferred sites, which will require “an estimated additional 135.5 FTE to 264 FTE staff, including the filling of a range of new and enhanced roles.”

Meanwhile, one certainty is a fast-growing population following the large housing growth which will occur over the next 10 years within Kent and Medway “resulting in an additional c. 400,000 or c.23% increase in population by 2031” (p86).

Facing a current forecast net deficit of £135m in 2019/20 (p69), K&M health bosses are following the herd in a desperate quest for savings, claiming significant opportunities for productivity and efficiency across Kent and Medway, “for example, in pathology, back-office functions and our use of temporary staffing.

Inquiry into chronic system failures at East Kent Trust

In primary care, with “some of the lowest GP to patient ratios in England, currently 1:2520 in Thanet” (compared with 1:1724 in England), the economy drive seems set to make it the exception for patients to see a GP. The aim is for GPs to focus

“on the patients that need their expertise – between 20-30% of daily demand. The other 70% channel shifting to administration support, social prescribing, practice pharmacists and nursing staff.” (p83).

Will the people of East Kent revive the great tradition of the 1381 Peasants Revolt, or will they happily accept the policies of a government most of them have just voted for?

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