The new Clinical Director for Anaesthetics for East Kent, Dr John Rampton made an invited visit to the Theatres in Canterbury the other day to address the staff and to inform them of his vision of the future. His visit was not a complete success. (That would be the understatement of the millennium). There were one or two very contentious points that he made.
1] The first was that the Accident and Emergency department in Canterbury should close as it was not very busy. This was completely in contradiction to the first hand knowledge of the staff in Canterbury's theatres, as they know how busy theatres are as a consequence of the activity of the A & E unit. They are also well aware of the ICU activity which 'spills over' into the recovery area when the ICU is busy.
2] The second point of contention, was his statement that no patients' surgery had been postponed over the very busy Christmas and New Year period.
This he stated demonstrated that the pressure on beds must be very low indeed. This he gave as another reason for the closure of the theatres and indeed the whole hospital. Dr John Rampton is well known for getting his facts and figure correct. The question that needs asking is why would he get his facts so very wrong? Canterbury has probably the greatest pressure on beds in East Kent given the average length of stay for acute medical admissions is the shortest in East Kent, and the surgical department is the most efficient in Southern England. Many of the theatre staff have worked in all three hospitals and know first hand that Canterbury is busy not only in the theatres but also in the whole hospital. The press statement from the 'press officer' Alison Pemberton seemed to confirm Dr Rampton's comments that no operations were cancelled at the Kent and Canterbury hospital, whereas the reverse is true. This blatant distortion of the truth is broadcast to mislead the general public, and is despicable and unlawful.
It would seem that this degree of misinformation is coming from the very highest levels in order to 'prove the case' that Canterbury can close, as the amount of work going on is very small! The staff in the William Harvey and the Queen Elizabeth the Queen Mother Hospital need to watch activity levels very carefully as they might get a very nasty shock if they have to work at the continual intensity of the theatre staff in Canterbury! Dr John Rampton will of course get the actual figures soon and may realise that he has quite a task on his hands fitting the work Canterbury does into Ashford and Thanet.
The appointment of a replacement to the previous Pain doctor, Dr Tai in Thanet is proving interesting. The Medical Director Dr Noel Padley has been informed of concerns about the suitability of one of the applicants from a number of sources including a previous employer of the applicant. Why then does the Trust carry on with the appointment with this knowledge?
Is this just another example of 'any' doctor will do - never mind the quality or the views of the other clinicians who will have to work with this person? We will have to wait and see who is appointed to this very important role.
The link 'The Case for Keeping Cancer Care in East Kent' or where it is repeated below, to view the document prepared in 1997 outlining the case for keeping a cancer centre in East Kent - please keep an eye on what is happening in the hospitals to see if a Cancer Care Centre is going to remain in East Kent ,or if it will be lost forever to London or Maidstone or Tunbridge Wells. The Webmaster has also obtained a draft document that outlines the standards that South East London Cancer Target Group are hoping to introduce to their hospitals for the management. Again the download time is quite long so please be patient. But it is well worth a read as you will see that East Kent is doing everything totally wrong for the management of patients with Cancer - and remember one in three of us will develop Cancer in our lifetimes - It could be you.
Cancer Care in East Kent
Cancer Care seems to be in deep trouble following the re-organisation of West Kent. Maidstone and Tunbridge Wells hospitals are to merge to form one trust. The current Chief Executive of Maidstone has lost his job and will be replaced by a new appointee. There is a real possibility that the new person will not be able to expend the necessary time and effort on the management of Cancer Care in West Kent - never mind East Kent. We could all be left out as second class citizens.
Where does that leave Cancer Services which are currently based at Canterbury and Maidstone? The answer is possibly nowhere - If Maidstone is to lose many services to Tunbridge Wells- which given that Maidstone is only 20 miles from Ashford would seem on the face of it logical. Quite what the population of Maidstone would have to say about that is another question. Cancer Service delivery requires the full services of a proper hospital, something that EKHA were told time and time again and chose to ignore. We hope that West Kent does not choose to make the same error. We hear that EKHA have only just consulted their West Kent colleagues on the possible increased role of their Cancer Care Unit, so there has been no financial allowance for a larger unit, or indeed any new space allotment. That is about par for the course - so far.
If many hospital service have to move to any redevelopment on the Tunbridge Wells site then the future of cancer services in Kent looks very bleak. It would be quite possible that Cancer Services would need to be completely relocated either in London or at one of the 'new' hospital sites which would be very expensive (one linear accelerator costs around �1,000,000) and is very disruptive during the building. Patients would ultimately suffer. This would hardly seem to be the aim of 'Tomorrow's Healthcare' to improve health care for the residents of East Kent.
The Case for keeping Cancer Care in East Kent 1998
Prepared in April 1997 by the Old Kent and Canterbury Hospitals NHS Trust-Summary
Cancer is now the leading cause of death in the United Kingdom. One in three people get the disease, and one in four die from it. Preventing and treating cancer is one of the major challenges facing the NHS. The importance of providing high quality cancer services is recognised by the NHS Executive.
The Chief Medical Officers commissioned a team of experts to advise on the provision of cancer services in England and Wales. Their report, the Calman (or Calman Hine) Report was accepted by the NHS Executive, by the medical Royal Colleges, and by the medical profession as a whole. One of the main recommendations of the report was that there should be Cancer Centres and Cancer Units provided with good access to patient populations.
In order to decide how cancer services would best be provided within Kent, the East Kent Health Authority and West Kent Health Authority commissioned Dr J Bullimore to produce a report on the organisation and distribution of services in Kent. The Bullimore report (1996) recommended the formation of the Kent Cancer Centre, a single organisational and managerial structure but based on two sites, at Maidstone and Canterbury.
The report stated 'if all the equipment were at Mid Kent, this would result in an unacceptable reduction in access to radiotherapy and chemotherapy services for the people of East Kent and would undoubtedly lead to many patients being denied proper treatment'. The recommendations contained in the Bullimore report were accepted by the East Kent and West Kent Health Authorities, and the Regional Office of the NHS Executive in 1997.
East Kent Health Authority recently reviewed the provision of acute services in East Kent and published proposals for changes. One option, their favoured one, is to down-grade services at the Kent and Canterbury Hospital with loss of acute medical and surgical facilities. This would mean that the Cancer Centre could no longer be sited at Canterbury and would need to move to Maidstone.
The loss of the Cancer Centre from Canterbury will have a major impact on the provision of cancer services in East Kent. It will result in patients having to travel further to receive radiotherapy and the more complex types of chemotherapy. Basing consultant oncologists at Maidstone will increase travel, giving less time for clinical care of patients and for professional contacts with others providing cancer services. The quality of service provided will be reduced. There will also be adverse effects on recruitment of staff in East Kent.
There will be considerable costs in moving the Cancer Centre from Canterbury to Maidstone. Capital costs are estimated at �12-14 million, plus �1.5 - 2.5 million per year additional revenue costs based on current prices.
There will be additional costs for transport. Some of these will fall directly on patients with cancer. In a single year, over 10,000 radiotherapy treatment visits will require travelling an additional 46 miles or more. Over 9,500 radiotherapy treatment visits will incur an additional 56 minutes or more of travelling time.
Patients with cancer need services provided as near to their home as possible. Not only are they dealing with an extremely disturbing experience, they are often very debilitated by their disease and its treatment, and in some cases are in pain.
There are no advantages to the people of East Kent from losing the Cancer Centre. There are considerable medical, social and financial costs associated with its loss. This loss can be avoided by maintaining acute services at the Kent and Canterbury Hospital.
Introduction
These specialities comprise Maxillo-Facial surgery, ENT and Ophthalmology [Eye surgery] If these departments are moved to Ashford, would you like your child with a quinsy or bleeding tonsil to travel more than 30 miles along winding country roads. Quite a journey for relatives and friends. Worse still- trauma cases with fractures that separate the face from the skull [so-called Le Forte fractures] will have to face the same journey. These are not uncommon in severe car and motor bike crashes.
Access from the Isle of Thanet would not be as good as if the unit were to remain in its central site in Canterbury Thus despite the 'outreach' service that will be offered (and is currently offered). the level of service and access to that service will not be the same for the deprived population of Thanet.
Maxillo-Facial Surgery
This speciality has developed, enlarged and improved dramatically over the past 10 years. from the position in 1988 when we had 2 consultant surgeons, one consultant orthodontist, one associate specialist and 2 SHOs we now have:
3 maxillo-facial consultants
2 orthodontic consultants
2 associate specialists
2 specialist registrars
1 overseas `registrar.`
5 SHOs
10 clinical assistant sessions
Some 5 years ago, before the concept of 'Tomorrow's Healthcare' our 3rd consultant maxillo-facial� consultant was appointed. This coincided with the extension to our customised out patient facility in Canterbury at a cost of �500,000. The completed department was one of the largest and best equipped in the country outside a teaching hospital. Our whole service was, at the time, held up by East Kent Health Authority as an example of sensible rationalisation.
Our catchment of 600,000 was basically served on a single central unit which maximised available facilities and met all the junior doctors 'New Deal' requirements. The arrangements impressed the SAC (Specialist Advisory Committee) and an SpR training post was approved. EKHA banged on to everyone about the effectiveness of a 'hub and spokes' model running from a centrally located site.
Assuming the changes that have been approved by our unenlightened politicians, progress to their illogical end, the maxillo-facial service will relocate to Ashford. It is difficult to see how the same quality of care can be maintained from what geographically will be a peripheral outpost...there will be a very long spoke to the Isle of Thanet. To provide a unit of similar quality to the existing Canterbury unit will involve a capital spend of approximately �1.5million. There may well be difficulties in relation to satisfying College requirements about supervision of trainees.
The maxillo-facial specialty provides the only microvascular reconstructive service in East Kent which cannot exist without an intensive care unit. There is therefore no argument that Max-fac could stand alone without full support facilities. Initial proposals for this specialty were to move the inpatients to the William Harvey Hospital as soon as possible but keep the purpose built outpatient facility in Canterbury. This demonstrated how little the planners (EKHA) knew about this specialty. The patients in hospital (inpatients) need immediate access to the doctors that are looking after them. If the outpatient facility were to remain in Canterbury they would be at least 30 minutes away by car - this would hardly be an increase in quality.
There is no difficulty in the concept of bringing ophthalmology, ENT and Max-Fac together under the single heading of Head and Neck...and we welcome the appointment of the first Clinical Director, Norman Bradley. It does seem crass that such an amalgamation will perforce have to be centered at one extreme end of the East Kent parish.
Ophthalmic Surgery
This is the one speciality which relies almost entirely on one to one contact between patient and doctor. This is regardless of whether they are in an outpatients or in the operating theatre. Thus the site of the department is of less importance to the doctor. However since the patients are almost all young children or the very elderly they are also the most dependent on other people.
Here travelling times are crucial and a twenty minute consultation with the surgeon may take all day for patients from Thanet and rural areas around Canterbury dependent on public transport. Imagine this same effect on surgical patients who would normally receive day case surgery. They will have to be kept overnight regardless of their clinical condition. This will put an even greater strain on a hospital which at present cannot cope with its own burgeoning population.
ENT Surgery
The story is the same here as with ophthalmic surgery. A single outpatient appointment can take a whole day travelling to and from a distant hospital, especially for the deprived who are reliant on public transport. The surgical treatments rarely require more than an over night stay. However the real concern is for the post-operative complications such as a bleeding tonsil, and for A & E emergencies such as a swallowed fish bone or other foreign bodies. The subsequent care after a seemingly short and simple operation is paramount, and without expert care can be lethal. To have these facilities in some cases up to nearly forty miles from the most deprived areas seems a crass proposal.
The hospital in which people will now have their babies will be determined not on patient preference but on Post Code - This may put a premium on certain post codes! Try and answer these questions:
a] Are there any differences in the service delivered by any of the three obstetric units and if so how will the individual departments bring them all up to the same standard? [K & C H]
b]Where is the highest caesarian section rate? [K & C H]
c]Who has the greatest use of epidurals? [K & C H]
d] Which hospitals manage to run a separate Obstetric operating theatre for their patients? [K & C H]
These issues and other quality related issues will need to be tackled by the managers to ensure that quality does not drop as any moving takes place.
NB. It seems strange that the proposal to downgrade the K & C Hospitals to a Midwifery Led Unit for low risk maternity in the light of the statement by 'Tomorrow's Health Care' that Thanet has the highest concentration of the elderly. Lord Winston would have a field day with the old ladies of Thanet! There is no such entity as a low risk Maternity Unit.
Ask any Midwife or Obstetrician!
Where will elective cases such as hip and knee replacements be done if trauma is taken from Canterbury? What will happen to patients with fractures in Canterbury outside office hours. Where will the fracture clinics be held? The Trust wish to move Trauma out of Canterbury as soon as possible.
There are a number of problems with doing this. There is a dedicated Trauma theatre every day of the week in Canterbury, with work spilling over into the weekends, when much of the operating performed is orthopaedic in nature. How are Margate and Ashford going to cope with this additional workload when they are already very busy themselves?
Is there spare theatre capacity? - Answer no
Are there spare support staff ?- Answer no
Can you run and accident and emergency service without the backup of orthopaedic surgeons and on-site orthopaedic cover? - Answer no
The group of patients who are most vulnerable are of course the elderly who all too often fall and break their legs. They will have to be transferred to Margate or Ashford to have their operations. The care of the elderly doctors insist that rehabilitation following the surgery required is best performed on the site where the surgery is performed so that the speed of rehabilitation is quick.
This will put an enormous load onto Ashford and Margate who already have quite enough to do already. The alternative is to transfer this group of elderly and frail patients back to Canterbury when they are 'fit' for rehabilitation.
This however slows the whole process down and is one of the reasons that rehabilitation needs to be carried out on a 'main' hospital site. This is one very good example of a second rate service that is planned for the elderly patients in and around Canterbury.
The 'Life for Laura' NICU is to move to Ashford
The Webmaster has not heard of any plans to replace this unit nor of the cost of these plans - we will try and find out some information and keep you updated. The Webmaster has heard that there are plans to relocate the 'Life for Laura' in Ashford. The Estates Director has found accommodation for the unit to move into.
However, despite the size of premature babies they do need quite a lot of facilities and rooms in which their care can be managed. Currently in Canterbury the 'Life for Laura' unit enjoys spacious facilities with excellent facilities for the medical staff such as rooms to rest in at night, rooms for the parents of the children in the unit, rooms for teaching, offices for the consultants and rest areas for the nursing staff. The current unit is complemented by the 'Three Bears House' which is a very relaxing area for the mums and dads to go away from the unit but still be within the hospital.
The Estates Manager assumed that a very small room would be needed to accommodate the Unit in Ashford "the patients are only very small" was heard at one meeting. How this proposal sits with EKHA saying that there will be improved healthcare for the population of East Kent is difficult to fathom.
Building a unit to the standard currently enjoyed in East Kent will be expensive - a cost that EKHA has never built into the costings. The Webmaster has also heard a rumour that the baby doctors in Thanet have now floated an idea of them having 'one' Neonatal Intensive Care cot because they will be so far away from Ashford! How will they staff it.? The concept of one bed is totally ridiculous - the quality of care will never be a good as a unit with five or six beds, and the efficiency of that one bed will be extremely low.
The other issue of distance is also one that has been pointed out on numerous occasions, but ignored. Distance is something that clinicians and managers, as well as the poor patients, are going to have to get used to!
Good news in radiology! The MRI scanner, much needed in Ashford, will now be built using money raised from the lottery. Sadly the Trust has not allowed for any revenue to run the scanner so there is no clarity as to who will pay for this. Not only has the Trust not allocated the running expenses, estimated at �250,000 per annum, it has stated that the three MRI scanners will do the same work as the current scanner at Canterbury and the visiting scanners at Ashford and Thanet.
With the waiting list of one year for a routine scan this represents a disgrace to the population of East Kent and a waste of precious resources. This is on the background of a potential overspend of �9 million for next financial year - and they are closing the most cost efficient site! The Trust is to be congratulated on the appointment of a Nuclear Medicine Specialist for the Queen Elizabeth the Queen Mother hospital site. This appointment follows the blunders of the previous appointment when the previous Trust management allowed the appointment of an untrained doctor who was appointed and sent away for training -she never did turn up and do any clinical work despite being paid by the Margate hospital during her 'training'.
She also never did pass the relevant exams. What is going on with radiology services in Ashford? The webmaster has heard that interventional radiology is a problem in Ashford. This highly complex area has been deficient in Ashford since the previous expert left to work in Tunbridge Wells.
They have not been able to recruit to this post - could that have anything to do with vascular services moving to Thanet? Ashford are now proposing to let a nurse perform some of the less complex procedures - fine you might think - however the only centre in the UK that allows nurses to perform these procedures is St Georges in London where there is excellent 'backup' from trained specialists in interventional radiology. Ashford does not have this. Does this move have anything to do with private practice? How does the hospital cope with other procedures that need the intervention of highly trained radiologists?
Surely patients are not being put at risk with poorly qualified doctors performing tasks outside their normal remit of activities?
Has not Canterbury offered its support and this support declined? Is this just one example of the new 'high quality' service that the trust intends to offer all the patients in East Kent.
These are all questions that the new management may have to answer.
Renal medicine is to move to Thanet along with vascular services. This is a service to the whole of Kent and not just to East Kent.
To place any East Kent service based in Thanet would seem daft enough, but to place a Kent based service in Thanet is truly stupid. The expert called by EKHA could only think that there must be a political motive to move the already successful unit to Thanet.
There certainly was no clinical reason for moving the unit otherwise. Moving the Unit to Medway or Maidstone was not considered despite their central position in the County. Within the Trust there is considerable doubt that moving the service to Thanet will actually work. Ashford have plans for a complex cardiac unit to be built serving that whole of East, and perhaps some of West Kent.
This is widely regarded as a very sensible move that would enhance patient care, provide much needed expertise closer to patients, and be cheaper to run. Renal Medicine is a desirable component that would enhance such a facility. Talks are already going on to establish the link between cardiac services and renal services so that the move to Thanet can be put 'on hold' until the outcome of these talks is known. This site will of course keep you updated as this story unfolds.
Vascular surgery is to move to Thanet despite there being no service there at the present time and no expertise amongst the staff currently employed there. How any East Kent service can be place on the end of a peninsular is a mystery to most people!
It would be quicker to go to London from Ashford than to go to Thanet. If sited in Thanet most of the clinicians involved have stated that the service will eventually fail. An interim vascular service was proposed by all the clinicians involved in the delivery of care based in Canterbury which all agreed would work.
Sadly the politicians involved would not tolerate this idea despite the fact that it would deliver a high quality service with a team of competent and up-to-date clinicians.
The commonest cause of sudden death in sixty year old males is a ruptured Aortic Aneurism. Heaven help the older male who collapses in Ashford High Street. Since the time of writing this there has been appointment of a fully trained vascular surgeon to Thanet who is regarded as an excellent clinician and an excellent appointment for East Kent as a whole. He is well know to the surgeons in Canterbury and they are delighted that he is in post.
The latest on Vascular Surgery
There has been a suggestion made that the whole of Kent should get together and provide a single Vascular unit serving Medway, Maidstone, Ashford, Canterbury and Thanet. The person who put this idea forward has no desire what-so-ever to go to Thanet. Needless to say there is no way that such a unit could be in Thanet. Ashford or Medway would be the best geographical locations.
There is always the possibility of a dual site option of Medway and Ashford which would make even more sense. The Ashford option would work very well alongside the Cardiac Unit being planned. It is hoped that a major cardiac facility with Coronary Angiograms, Angioplasties, and the eventual placement of a Cardiac surgical unit could be made on the William Harvey site in Ashford.
The concept of a major cardiac unit and vascular unit on the same site is very exciting and would be an excellent facility for the population of East Kent were it to actually happen. Of course the one 'specialty' lacking from this is the Renal Unit which is planned to go to Thanet. Both the Cardiac and the Vascular units would need Renal support. Maybe the time has come for the clinicians who actually know about this to sit down and discuss the eventual placement of the Renal Unit.