Gale's View - East Kent Hospitals
August 19th 2015
That the East Kent Hospitals University Foundation trust is considerably “in the red” should be of concern to all of us. Monitor, the health `watchdog` has put the Trust on notice and improvements have, clearly, to be made in the manner in which finances are managed if the Trust that controls the QEQM, Margate, the Kent and Canterbury Hospital and the William Harvey, Ashford, is not to have to go cap-in-hand to the Department of Health for `distress funding`.
We are assured by the Trust`s Interim Chief Executive that patient services will not deteriorate as a result of the £37 million deficit but we are also informed that `planned investments in new services` will not, for the moment at least, go ahead. That is bad news because there are services that do need improvement or enhancement. This is the first time that the Trust has been in a deficit of this kind and simply saying that “operating services over three sites is complex” is not an answer. The geography of East Kent dictates that each of those three sites is, in its own way, essential and the regurgitated idea that a super-hospital on one site would provide the solution to all ills is neither practicable nor affordable. Those who, for partisan political reasons seek to blame “the cuts” are also very wide of the mark; with a £550 million turnover the Trust is, compared with similar enterprises, not badly funded.
Chris Bown, the Interim Chief Executive, has identified, rightly, a number of reasons for the overspend. First, there is the huge and excessive sum spent hiring agency staff because of an inability to fill permanent medical and nursing posts. There is, certainly, a national shortage of consultants and qualified nurses and were it not for the use of overseas skilled personnel the service would collapse. As it is, we are fishing in a small pond and an unhelpful and in my view unfairly critical report by the Care Quality commission a year ago has not enhanced our prospects. I said at the time, locally and to the then Chairman of the CQC, that the nett result of the report would be to damage our chances of recruitment and to make matters worse, not better. That has proved to be correct and I hope that the recent CQC inspection will generate a rather more measured and constructive assessment of what is, fundamentally, an excellent service than their last effort.
One of the more accurate but ill-targeted of the CQC`s criticisms was of the stresses on our A&E services. A friend who is a consultant told me recently, after a weekend stint in A&E (not their normal specialty) that in a clinically qualified opinion only about half of the patients in the QEQM actually needed to be in hospital at all. The fact is that, faced with over-long waiting times for primary healthcare appointments and a significant transient population that is not registered with a GP at all, there are far too many who simply use A&E as an alternative to a visit to the Doctor or to a pharmacist who could very probably help but would, of course, charge for over-the-counter medicaments that a hospital may well dispense “free”.
We have to address this issue if A&E services are not to continue to be overwhelmed and it is time, I think, to seriously consider and progress the establishment of a GP surgery with the A&E hospital grounds. I suggested this some time ago but the idea fell on the stony ground of “not thought of here”. Perhaps, faced with stark reality, our Care Commissioning Groups across East Kent will either address this issue or come up with a better alternative that IU have yet to hear.
And finally we might, perhaps, consider investment in treating more patients locally and “in House” rather than sending people to London Teaching Hospitals for treatment that can and should be provided at less cost, more conveniently for friends and relatives, and locally. I accept that there is a chicken-and-egg situation that has to be faced and with debts already too high to suggest that still more money should be spent on better-qualified staff and facilities might not seem, at first, an option. If we are to break out of the vicious downward spiral, though, then just spending still more money is not the answer. All of the taxpayer`s cash that is being spent has to be used to provide long-term, cost-effective and local solutions to our needs and it is up to those of us who are elected to, or employed in, public office, at every level, to impress that fact upon the Secretary of State and upon Monitor.