Posted by Amanda Crawford at 30/05/2014 16:23:32
It is now just over a year since NHS West Kent Clinical Commissioning Group took over responsibility for planning and paying for most of the healthcare for people in Tunbridge Wells, Tonbridge and Malling, Maidstone and Sevenoaks district (except Swanley).
I have been considering what we have achieved this year and thinking about the challenges that lie ahead.
With 62 member GP practices, a population of 463,000 and a budget of £481 million for 2014/15, we are almost twice as big as the average clinical commissioning group (CCG) across the country.
That gives us some real advantages – for instance, we have 12 GPs on the governing body, each of whom has an in-depth understanding of how local health services work and ideas about how they can be improved.
This has enabled us to introduce some initiatives which are already making a clear difference.
For instance, we have commissioned an Enhanced Rapid Response team, including geriatricians, senior nurses, physiotherapists and occupational therapists, from Kent Community Health NHS Trust.
They assess and treat patients in their own homes within two hours of referral, seven-days-a-week, 24-hours-a-day. The focus is on people over 75 and the team is supporting people to avoid hospital admission where possible, and to help with early hospital discharge.
With Kent County Council, we are also funding Romney Ward at Maidstone Hospital for patients who still need nursing care but no longer require oversight from a consultant. They are cared for by Kent Community Health NHS Trust nurses and therapists until they are ready to go home or to a care home.
These initiatives – along with the hard work of A&E and other hospital staff, GPs, minor injuries units staff and others involved in urgent care – have helped Maidstone and Tunbridge Wells NHS Trust (MTW) achieve its best performance in years on the four-hour waiting target.
This is at a time when A&Es across the country have been struggling to see and treat or discharge patients within four hours and when, locally, numbers attending A&E have reached a ten-year high.
In Steve Beaumont, we also have an energetic and dedicated Chief Nurse, who focuses intensely on ensuring quality care for patients.
In the autumn, he led a conference on reducing healthcare acquired infections, including MRSA and Clostridium difficile. Staff from the hospital, community services and GPs shared their determination to further reduce infections by careful monitoring and reduced use of antibiotics.
I believe it is no coincidence that the rate of MRSA infections in this area is now among the best in the country and the number of C. diff cases has plummeted in hospital and in the community.
We at the CCG have also focused on working closely with local people to develop our future plans. A group of 160 members of the public – including 120 picked because they are a representative sample of the population of west Kent – examined our proposals in detail and helped us firm up plans for the next five years.
These will be challenging years, because the rising needs of our population cannot be met within the budgets we expect to receive unless we rearrange services to maintain high quality responsive care.
To meet this challenge, we will need to make dramatic improvements to the care available outside hospital for people, particularly elderly and frail people, with long-term conditions. We need to detect and treat illness in them early, and provide really intensive support in their own homes or care homes when needed, so a hospital admission for illness related to pre-existing conditions becomes the exception rather than the rule.
This will require shifting money into community teams, and new ways of working by health and social care professionals working in the community, including GPs, district nurses, mental health nurses, physiotherapists and other staff.
We are still looking at the detail of how this will work. We just know that we – like the rest of the NHS across the country – need to do it. And we will need your support to make it happen.
If you have a story about local healthcare services you would like to share, you can email@example.com or write to me, Dr Bob Bowes, at NHS West Kent Clinical Commissioning Group, Wharf House, Medway Wharf Road, Tonbridge TN9 1RE.