When CHEK was established in January 1999, the principal raison d'etre was to fight a major re-configuration which appeared largely unnecessary. The health service in East Kent was running relatively smoothly. The hospitals (or two of them - K&CH and WHH at least) were above average in comparison to national performance indicators, the merging of the three Trusts was to go smoother than some had predicted, and apart from a big black cloud on the horizon - called 'Tomorrow's Healthcare', there seemed to be no major problems.
It was a case of 'If it ain't broke don't fix it', because that's how the situation was perceived at that time.

Sadly that is not the situation now. By virtually every meaningful criterion, healthcare delivery has deteriorated over the last 18 months. Deteriorated to a point where there are anything up to100 patients on trolleys in A&E corridors waiting for beds, sometimes for as long as two/three days; where waiting lists and waiting times have lengthened; where operations are frequently cancelled; where staff morale is at an incredibly low ebb and where standards of hygiene and cleanliness are appalling and infections such as MRSA are rife. Headlines, such as that in the Daily Mail on Nov 14th 2000 describing conditions as 'third world' have become increasingly frequent.

Why has the situation deteriorated to such an extent and so quickly? There is one issue, more than any other, which seems to have been the catalyst - and that was the decision to close Nunnery Fields (a geriatric stroke unit close to K&CH) several years earlier than was originally planned. There was only one reason for that decision and that was money. Everyone accepts that the Nunnery Fields building was in poor condition and inappropriate for its use, and that it should have closed years ago. But to attempt to squeeze its facilities into the K&CH before adequate room had been vacated for them has proved to be desperately ill advised.

There are only 72 HCOOP beds at the K&CH when there were 93 at Nunnery Fields; although extra beds have been created at WHH and QEQMH, the move has resulted in the loss of acute beds at K&CH at a time when there is a desperate and proven on-going shortage of acute beds. In the light of the proposed Nunnery Fields Acute bed capacity become the bete noir.

At about this time, a motion was passed by the Medical Staff Committee (the association which includes every doctor in the Trust) begging the Trust to create more capacity; *2 senior anaesthetists begged the Trust to create more capacity; a deputation of 15 senior consultants begged the Trust to postpone the closure and create more capacity, 128 junior doctors wrote a letter begging the Trust to postpone the closure; Most of the surgical residents wrote to the Trust begging them to postpone the closure and create more capacity. All their pleas were ignored in the face of 'financial necessity'.

The Trust constantly overstate East Kent's acute bed capacity by including non-acute capacity. We are not sure of their motive for doing this. For example, in the adjournment debate on October 30th 2001, the Health Minister Ms Hazel Blears quoted the Trust's figures that there were 1642 acute beds in East Kent whereas the 'Situation Report' of 20th May states that there are actually only ±1,300 - and this was a month before the NFH closure.

In Nov 2000 the Trust commissioned a Risk Assessment from Healthcare Risk Resources International. The Report was delivered in December. The report was generally less than flattering, but about emergency services it was absolutely damning (Appendix 4). It was not until CHEK was leaked a copy in March that the Trust acknowledged the existence of the report and asked senior staff to prepare a plan to counter the problems identified. A remedial plan was presented at the April board meeting, with strict instructions that progress was to be closely monitored. That was the last we heard of it and little has changed.

There have various other major initiatives by the Trust to tackle the crisis of under-capacity and emergency pressures (though EKHA's figures actually show that A&E attendances were 20% lower in 2001 than in 2000). It is our opinion that managers are highly adept at producing documents and theorising about solutions, excellent at presenting them at meetings, but woefully incapable of implementing them.

Communication between management and staff has been virtually non-existent until recently. For example a group of junior doctors from one of the A&Es who we spoke to had never even heard the name of their Care Group Director, let alone met her. In fact they had never knowingly seen any member of the board apart from the Chairman and one NED.