HAVE YOUR SAY 9 DECEMBER 2013 TO 9 MARCH 2014

Consultation on OUTPATIENT SERVICES IN EAST

Making improvements to your outpatient services

East Kent Hospitals University NHS Foundation Trust I NHS and Coastal Clinical Commissioning Group 6 WHAT WE ARE 8 WHY WE NEED TO 13 19 23 24 CONSULTING YOU ABOUT CHANGE WHAT HAPPENS NOW WHAT WE WANT TO DO BENEFITS OF THESE PROPOSALS DECIDING A WAY FORWARD GIVE US YOUR VIEWS INTRODUCTION We want to improve patients’ experience of outpatient clinics in east Kent and are keen to hear what local people think, before making decisions about the best way forward. PULL-OUT

East Kent Hospitals University NHS Foundation Trust In doing this, the Trust is proposing to consolidate A few years ago, Eastern and Coastal Kent Primary Care SURVEY (the Trust) knows most people’s experience of its outpatient clinics onto six sites around east Kent Trust (PCT) consulted the public on “The Project hospital care starts in an outpatient department and – its five hospitals in Ashford, Canterbury, Margate, – Your Say” and the effect it would have on services INCLUDED it is vital that this provides accessible, attractive, Dover and and a centre to serve people provided in Dover, Deal and the surrounding areas. As friendly and efficient access to their care journey. It living along the north Kent coast. a result, the Trust is investing £23 million to rebuild the is our aim to develop this through taking your views facilities at Dover to provide up-to-date, modern into consideration throughout this consultation. facilities for the south Kent coast population. Dover’s The Trust has looked at four possibilities for the Who is the Trust? outpatient centre on the north Kent coast and new hospital will open in 2015. Having spoken to staff and patients, the Trust has compared the facilities each of them offers. East Kent Hospitals University NHS developed ideas about how it could improve patient Having considered the pros and cons of each site, In summary, over the next few years the Trust aims to Foundation Trust has earned a care and experience, which it believes will mean: the Trust would prefer to base the sixth centre at save patients a number of journeys to clinics using new reputation for safe and effective care technology to work smarter by developing a one-stop by continually searching for • Less travelling for more people when attending Estuary View Medical Centre in . approach for people who currently have to make several improvement and better results for outpatient appointments (83 per cent within a trips in preparation for an operation. patients. 20-minute drive, a significant improvement from The proposals are part of the Trust’s clinical strategy the current 70 per cent) for outpatient services. The strategy also includes Please take the time to tell us what you think, either The Trust strives to achieve the best for • Wider choice of appointment times, including plans to make its outpatient appointment booking online, by using the survey, by letter or phone, or in people in east Kent and, while it early mornings, evenings and Saturdays systems more efficient to cut down on cancellations person. Details for doing so are on page 25. recognises that staff work extremely • Modernised facilities, with improved, more and numbers of patients who do not turn up for hard to deliver a safe and high quality welcoming surroundings and all the necessary their appointments. What you tell us will influence our decisions. service, it knows there is always room equipment for further improvements. • A greater range of specialities offered in each The Trust wants to invest in improving the outpatient clinic centre outpatient departments at the William Harvey Dr Anne Greenhalgh Although it achieves good outcomes • Where appropriate in some cases fewer Hospital, Ashford, the Kent and Canterbury Medical Director, Clinical Support Division East Kent for patients, the Trust is clear that face-to-face appointments will be needed as Hospital at Canterbury, and the Queen Elizabeth Hospitals University NHS Foundation Trust improved treatments require improved the use of technology is expanded over the The Queen Mother Hospital at Margate, and has facilities. It also knows that it needs next few years, and already made improvements at the Royal Victoria to make the best use of the resources • More one-stop sessions combining assessment, Hospital in Folkestone, to enable the Trust to pro- that it has. tests and treatment planning all on the same vide one-stop services in an up-to-date, pleasant day phased in over coming years. environment.

2 I Outpatient Services in East Kent Outpatient Services in East Kent I 3 It would be ideal if I could see everyone (chiropodist, Paula Carr eye scan, consultant, and dietician) all“ on the same day as I work away. FOLKESTONE OUTPATIENT

YOUR VIEWS ARE IMPORTANT TO US

Outpatient services are those where patients The four NHS Clinical Commissioning Groups attend a hospital or clinic but do not stay (CCGs) that between them cover east Kent overnight. These services may include a are: consultation with a healthcare professional, tests • Ashford and images (such as X-rays or scans) being taken, • Canterbury and Coastal a treatment plan being agreed, or treatment being • South Kent Coast given. • Thanet

Margate The four NHS Clinical Commissioning Groups that NHS Thanet CCG oversee healthcare in east Kent buy outpatient services for local people from a number of Canterbury organisations. Some of these are local to the area NHS Canterbury and Coastal CCG and others – which may offer the patient more choice or more specialist care – are further afield, such as in . East Kent Hospital University NHS Foundation Trust is the largest provider in east Kent, seeing 700,000 people a year. NHS South Kent Coast CCG Dover NHS Ashford CCG

NHS Canterbury and Coastal clinical commissioning group consists of 22 practices across Canterbury, , Whitstable, , Sandwich, Ash and the surrounding rural areas. As commissioners they recognise the impact of the proposals on their area, they want to improve services, and they are very interested in hearing local people’s opinion on the outpatient proposals. So NHS Canterbury and Coastal CCG has agreed to partner the Trust in the consultation NHS Canterbury and Coastal CCG is undertaking a process within their area, to hear your views. Their review of community based services to ensure they ambition is to secure the best value and highest offer the best value for local people and make the quality from local services, at a time when health most effective use of resources. Local people and services are seeing more people every year and the partners such as local councils, social care and national ‘call to action’ is challenging health and providers of community based services will be social care to think differently to secure the future integral to creating a shared, sustainable plan for of the NHS. the future of health and social care. At a time when many public services are planning a future The Trust has engaged with all the CCGs in east with less funding, how services make best use of Kent over the last two years. Ashford, Thanet and what already exists will be crucial. South Kent Coast CCGs have decided that they will be consulted by the Trust about the outpatient proposals.

Outpatient Services in East Kent I 5 Evening or weekend appointments would be preferable as I am not always available during working hours. “ THANET OUTPATIENT WHAT WE ARE CONSULTING YOU ABOUT

East Kent Hospitals University NHS Foundation LOOKING AHEAD Trust (the Trust) provides the majority of outpatient services to people in east Kent – and it is these The Trust is piloting advanced technology to services, currently provided from 15 places, that we improve patient experience. Some patients can are consulting you about. have their condition monitored in their own home by a clinician in the hospital, who liaises with them The Trust believes it can improve patients’ about their treatment. New technology also enables experiences of the outpatient services it offers a GP in their own surgery to speak about a patient’s providing more convenient appointments in condition with a specialist hospital clinician via a modern clinical premises. This consultation is video link. seeking your views on the Trust’s proposals to reduce the number of places where it offers The use of this type of technology is growing slowly outpatient clinics to east Kent residents, from across the country and the Trust intends to develop 15 to six. a comprehensive choice of technology in east Kent over the coming years. This kind of approach is This is in order to: especially good for patients with long-term conditions. • Improve access by making a wider range of outpatient services available on six sites in east In the future, patients may even be able to use their Kent, so that more people will be able to have home television or computer to take advantage appointments within a 20-minute drive of home. of opportunities to speak to clinicians. This means • Improve patient experience by offering out- there will be less necessity to visit a hospital – and patient clinics where a better range of facilities is people will get better support in their own homes. available (for tests, X-rays, and scans) to help doctors diagnose patients’ conditions faster, assisting development of the one stop approach.

What we are not consulting you about The proposed changes set out in this • Nurse-led neurology clinics. consultation document will not affect: • Renal services; We are not planning any changes to these While we were doing this work, NHS Swale this consultation. This is a commissioned service • Children’s community services; services, so we are not consulting you about Clinical Commissioning Group asked us to development and so is included here for • Vascular screening services; them. Also this consultation does not include provide a one-stop outpatient centre in the information. It does not form part of the • Midwifery-led community-based our inpatient services, or services supplied by area for their patients. We are consultation. ante-natal and post-natal services, and other health service providers. examining possible locations for this alongside

6 I Outpatient Services in East Kent The waiting area looks a bit tired, Figure 1: The 15 sites where the Trust currently delivers outpatient clinics. but does not reflect on the good service.

2013 SURVEYAshford Walk-in Centre CCG “ Gillingham 14 Staines Walton Community 3 Herne Bay Margate Hospital Swale CCG Whitstable 11 Dartford, 7 Weybridge and CCG 8 Thanet CCG North West Walk-in Centre 15 Surrey CCG 10 Frimley Park Epsom Sittingbourne Hospital Surrey Heath St Peters 9 CCG Hospital Faversham 1 Canterbury Leatherhead Woking Canterbury and Walk-in Centre Farnham Coastal CCG 6 East Surrey Deal CCG Royal Surrey County Hospital CCG Guildford Surrey West Kent Downs Guildford and CCG South Kent Waverly CCG Tunbridge Wells 2 Coast CCG 5 Ashford Dover Haslemere MIU Crawley WHY WE NEED TO Ashford CCG 4 Horsham Hospital CCG 12 Folkestone Hythe Horsham Uck eld

Horsham and Godalming 13 Mid Sussex CCG CHANGE WHAT HAPPENS NOW High Weald, Lewes and Havens The Trust offers more than 700,000 outpatientappointments per CCG Rye Hastings and year – around 240,000 new appointments and 460,000 follow-ups. Rother CCG

Hastings Coastal West Sussex CCG Eastbourne, Hailsham Sites from where the hospitals trust and and Seaford CCG Bexhill currently provides services Hove CCG Bognor Regis Chichester Brighton At present, the Trust provides some outpatient 11. Spencer Wing at QEQM Hospital,War Memorial Margate Hospital services from all the sites shown in Figure 1. 12. St. Saviours HospitalSt, RichardsHythe Hospital They are: 13. New Romney Clinic, New Romney Eastbourne 14. Sheppey Hospital, Sheppey Figure 2: The six sites proposed for a full range of outpatient services in future. 1. Kent and Canterbury Hospital, Canterbury 15. Sittingbourne Memorial Hospital, 2. William Harvey Hospital, Ashford Sittingbourne Ashford 3. Queen Elizabeth The Queen Mother Walk-in Centre Dartford Medway CCG

Hospital, Margate In the past, the Trust held clinics at some other Gillingham Staines 3 4. Royal Victoria Hospital, Folkestone sites, bringing the total to 22. This has reduced Walton Community Margate Hospital Whitstable Dartford, Gravesham Swale CCG 5. Buckland Hospital, Dover to 15 over the last few years for various reasons. Weybridge and Swanley CCG 10 Thanet CCG North West Walk-in Centre Surrey CCG 6. Queen Victoria Hospital, Deal Demand for services droppedFrimley Park significantly on a Hospital Surrey Heath St Peters 7. Queen Victoria Memorial Hospital, number of sites, so that they wereCCG no longerHospital 1 Canterbury Herne Bay viable. Leatherhead Woking Sevenoaks Canterbury and 8. Whitstable and Tankerton Hospital, Walk-in Centre Redhill Maidstone Farnham Coastal CCG East Surrey Whitstable The full list of which specialtiesCCG now provideRoyal Surrey County Hospital CCG 9. Faversham Health Centre, Faversham clinics in each of the current 15 locations is onGuildford Surrey West Kent Downs Guildford and CCG 10. Estuary View Medical Centre, Whitstable page 21: in Table 3. South Kent Waverly CCG Tunbridge Coast CCG Wells 2 5 Ashford Dover Haslemere MIU Ashford CCG 4 Folkestone

Horsham Uck eld

The Trust proposes that the outpatient services in east Kent need to Horsham and Godalming Mid Sussex CCG improve to take account of: High Weald, Lewes and Havens • The equipment required to provide care is CCG Rye • Patients’ views Hastings and not always available Rother CCG • The travelling involved • The outdated facilities used in some places • The time it takes to gather all necessary Hastings Coastal West Sussex CCG • The availability of appointment times Proposed sites where a full range of information for diagnosis Eastbourne, Hailsham outside normal working hours Brighton and and Seaford CCG Bexhill outpatient services will be provided Hove CCG Chichester Bognor Regis War Memorial Hospital St Richards Hospital 8 I Outpatient Services in East Kent Eastbourne Outpatient Services in East Kent I 9 We think this needs to improve. We also know that, as only a I sometimes have to wait for over an few specialities are offered from some of the 15 sites, many hour, it would be great if I could have patients have to travel to other sites for their clinic appointment. easy access to refreshments. “ Time taken to gather all necessary information for diagnosis: Currently, when outpatient consultations happen, clinicians are able to ask patients about their symptoms and carry out a physical examination but then have to ask them to HERE, WE EXPLORE THOSE ISSUES IN MORE DETAIL go on a separate occasion to one of the few places where the tests and images can be done. Patients’ views: Surveys of east Kent outpatient occasions the clinics run late and patients have to services were carried out in February 2011 and in wait for their appointment. The patient then has to return another day to discuss the May 2013, when 75 per cent of patients indicated results once they are known. This can take several weeks and they would be prepared to travel to another of the In a separate survey in September 2013, the full range of consultations and investigations can often Trust’s hospitals if they could have their tests on the outpatients were asked for the top three stretch over a month or more. Patients end up spending many same day as their appointment. Full details of the improvements they would make to the service. more weeks than necessary waiting for each of these survey results are available on www.ekhuft.nhs.uk Common themes in the responses included: appointments. Alan’s story • reducing waiting time for appointments Alan is nearly 50 and lives in Whitstable, The results of both surveys showed that: • improving the timing of clinics Some patients may also have to come back to an outpatient about eight miles from the Kent and • 80 per cent of patients who responded attended • having adequate seating site for a further follow-up appointment or because they need Canterbury Hospital. He was referred to their outpatient appointments by car • better parking some diagnostic tests such as an X-ray or blood tests. Others the neurology Consultant because of his • 70 per cent said they would be prepared to • tea/coffee facilities. have to return for pre-operative assessments. This means there persistent headaches. The only clinic was travel to one of the Trust’s other hospitals if they are a large number of patients who, at present, have to make at the William Harvey Hospital in could have their tests on the same day as their This survey also showed that more than 90 per cent numerous journeys as part of their outpatient care. Ashford, a round trip of 42 miles. clinic appointment with the clinician of the patients who responded were in favour of • more than 34 per cent would prefer to have having their assessment, diagnostic tests and Equipment required: Very few of the 15 clinics where Knowing the traffic is sometimes their appointments before or after the normal treatment plans on the same day and 80 per cent outpatient services are currently provided have the full range difficult, he arrived early for his nine o’clock appointment, to find there was a working day were in favour of extended outpatient clinic hours, of equipment to help clinical staff diagnose people’s illnesses – delay because the consultant was stuck • 75 per cent would like a Saturday in mornings, evenings and weekends. or the space for modern one-stop clinics. on a train – not her fault, these things appointment. happen. After about half an hour, a Travel times: The Trust mapped where patients are The Trust would like to develop a one-stop approach to its nurse came and explained the delay, As a result of these surveys, the Trust also knows travelling from for their outpatient appointments. outpatient services so that, over the next few years, apologised profusely and made that many people want their outpatient Currently a total of 215,469 patients travel more increasing numbers of patients can have all their appointments everyone a cup of tea. appointments to involve less time waiting to be than 20 minutes drive time for their clinic on a single day – but it can only achieve this if outpatient seen and a much wider choice of clinic appointment and often have to visit several appointments are held on the sites that have enough space An elderly lady arrived on a trolley with appointment times, including early mornings, different sites for their assessment and treatment. and the right equipment to provide a full range of services. a care worker for one of the other two evenings and weekends. It also recognises that on clinics using the same waiting area. The obvious solution was to wheel her Outdated facilities: A number of the outpatient locations into the consultant first, but when they that the Trust is using need modernising so that they can asked the man waiting for his 9am provide a welcoming environment for patients and relatives appointment if he minded her going and, importantly, support the proposed new ways of first, he said yes. She was seen after months after that appointment, Margaret’s story delivering outpatient care and treatment. staff intervened. involving a second round trip of Margaret is a grandmother who about 50 miles. lives in Headcorn and sees an eye The Trust knows that some of the outpatient facilities it owns Alan said: “It all seemed a bit chaotic, consultant at the William Harvey really. There was a lot of coming and go- But the good news is that she is and others that it is using (but which belong to other NHS Hospital in Ashford. She has ing as people went off for tests and the being saved a third trip because she providers) are below the best standard. This can result in clinic developed a dark mole on the lower clinic could do with a little modernising. is being given her pre-assessment waiting areas being too small for the number of patients being lid of her eye and went to discuss it I think the staff could be more discreet check in a booked phone call that seen, as well as meaning clinicians do not have all the modern with the consultant and they agreed in their conversations, especially about the hospital will make to Margaret equipment or technology they need to care for patients. it should be removed. other staff and departments. The doctor at her home three weeks before her when we saw her was lovely and very operation. The operation is being done two Certainly, most of these facilities are not equipped with the thorough, really good. I have a repeat kind of technology required for modern healthcare and they appointment in three months, which lack the capacity to provide the one-stop outpatient clinics. came through within four days.”

10 I Outpatient Services in East Kent It would be good if I could just turn up and have everything done on one day and stop having to use my holiday for “ two or three appointments.

WHAT WE WANT TO DO

Over the past two years, the Trust has taken • Improve patient access by providing outpatient account of the survey findings and discussed its appointments early in the morning, later in the outpatient services with a wide range of people evening and on Saturday mornings and groups, who have said how they think these • Make sure outpatient facilities are fit for services need to be improved. purpose and meet patients’ needs and the requirements of the Equalities Act The Trust has used this feedback to develop the • Make better use of technology to reduce proposed improvements. In essence, the ideas are the number of clinics patients have to attend to: for face-to-face appointments, and • Improve the booking system to allow the Trust • Reduce the number of trips patients have to to make more use of facilities and offer a greater make by developing one-stop outpatient clinics, range of outpatient appointments and services where patients receive their assessment, diagnostic from each site tests and treatment plan on the same day.

THE PROPOSAL IS THAT:

East Kent’s outpatient services are • Have sufficient space to accommodate the consolidated in six co-ordinated outpatient clinics and the extended range of equipment clinics, instead of the current 15 sites, and needed to inform clinicians’ diagnosis and athat these centres will: patients’ treatment decisions • Mean substantially more patients receive their • Facilitate an increase in the use of technology outpatient care within a 20-minute drive of home over the next few years, and • Offer an extended working day • Enable the Trust to increase over the next few • Be fit-for-purpose, modern and welcoming to years the number of patients who can attend a people of all abilities one-stop clinic on a single day instead of having to visit several places spread over several weeks.

I want to be able to have a seat while What do you think? I am waiting for an appointment, too What do you think about these ideas? often there is not enough room. Are there any other ways we could improve patients’ experience of outpatient services? “SURVEY 2013 Outpatient Services in East Kent I 13 Table 1: Summary of the option appraisal by the Trust 14 February 2013 The proposed clinic centres are based in • Queen Elizabeth The Queen Mother Hospital, places that are all able to fulfil the Margate SITE Faversham Whitstable & Estuary View QVMH requirements set out in section a) on the • Buckland Hospital, Dover (developing more fully Health Centre Tankerton Medical Centre Herne Bay previous page. when the new hospital opens in 2015) X-ray and Unavailable Unavailable Available Limited availability b • Royal Victoria Hospital, Folkestone (except MRI) ultrasound tests (4 days only) • Site on north Kent coast • William Harvey Hospital, Ashford Pathology Limited availability Unavailable Available 5 days a Available 5 days a • Kent and Canterbury Hospital, Canterbury services including week week blood tests Facilities for MRI Unavailable Unavailable Available Unavailable scanner (portable unit) What do you think? Availability of Limited availability Available Available Unavailable What are your thoughts on the proposal to have six outpatient clinics? Ophthalmology clinic equipment Bariatric facilities Unavailable Unavailable Unavailable Available The Trust has looked carefully at four • Queen Victoria Memorial Hospital, Herne Bay (for very obese locations from where it currently delivers (QVMH) patients) some outpatient services in the north Decontamination Unavailable Unavailable Available Unavailable c Kent coastal area, to see if one of them The Trust proposes that the sixth clinic centre of endoscopes could accommodate an outpatient centre. should be located on the north Kent coast at Related services GPs, MIU, None GPs, theatre, Podiatry theatre These are: Estuary View Medical Centre. in the same place pharmacy pharmacy and MIU • Faversham Health Centre (FHC) Technology links Feasible Feasible Feasible Feasible • Whitstable and Tankerton Hospital (W&T) In an option appraisal the Trust compared 17 for Telemedicine aspects of the facilities the four places currently • Estuary View Medical Centre in Whitstable Percentage of 57.4% 74.8% 100% 74.8% (EVMC) and offer and considered what investment would be needed to make them suitable (see Table 1). patients in north coast within 20 minutes drive by car What do you think? Dedicated car Next to pay & dis- Approximately 15 Approximately 135 Approximately 45 parking play 100+ spaces spaces spaces spaces What do you think about the points the Trust has compared between these sites? Are there any other aspects of the facilities that you think should be considered? Public transport Good Good Some bus routes Good and improvements planned Suitable clinical Limited availability Limited availability Available Available The Trust concludes that: • Whitstable and Tankerton Hospital does not rooms • Faversham Health Centre does not have enough have enough space to provide a one-stop Adequate waiting Yes Yes Yes Yes space to provide a one-stop outpatient centre outpatient centre with the range of equipment area that meets with the range of equipment and specialties that and specialties that would make it work well for disability would make it work well for patients and patients and clinicians, and requirements clinicians • Estuary View Medical Centre is a purpose built modern facility, offering a wide range of existing Building fabric Poor Poor Excellent Good • Queen Victoria Memorial Hospital at Herne Bay and facilities would require significant investment to install facilities which is well located to serve patients Disability and Limited None compliant Compliant Compliant modern diagnostic facilities and does not have as on the north coast and is therefore the Trust’s Discrimination compliance many other related services on the same site as preferred option for the sixth outpatient Act compliance the medical centre clinic centre. Buildings that are Design unsuitable Design unsuitable Yes Yes fit for purpose Able to provide No, due to lack of No, due to lack of Yes - able to Limited diagnostics What do you think? one-stop clinics diagnostics and diagnostics and provide one-stop and availability of What are your thoughts on the preferred option for the north Kent coast? with diagnostics lack of rooms lack of rooms with diagnostics rooms Full details of the option appraisal are available from www.ekhuft.nhs.uk

14 I Outpatient Services in East Kent Outpatient Services in East Kent I 15 It would be nice to have my appointments The Trust wants to develop the use of professionals. This is currently used around the new technology. country and is beneficial for GPs who can at one hospital. contact hospital clinicians via a computer and “ speak to each other via a video link. d • Digital First is a Department of Health initiative • Telehealth is a way of treating patients in a that aims to reduce unnecessary face-to-face separate location from the clinicians. This is contact between patients and healthcare remote patient monitoring. The Trust is piloting professionals by using technology. The Trust is some telehealth initiatives and demonstrating committed to exploring and using these that patients can benefit from not having to initiatives and over time will increase the use of return to hospital for blood pressure checks or this modern technology to improve the patients’ other types of monitoring. experience by reducing travel and visits to • Telemedicine can improve access to healthcare by hospital sites. using remote consultations between health

What do you think? What do you think about these ideas to use more technology to work smarter?

With the Trust’s six site model, the Trust • all relevant diagnostic tests (X-rays, scans, blood will be able to develop the one-stop and/or urine tests) approach. • a proposed treatment package based on the test e results, which you discuss with the doctor The one-stop clinic model offers - on the same day: leading your care • your first appointment at a Consultant’s clinic, • the choice of a mutually convenient date for where you talk to the clinician about your your treatment or operation condition • any pre-assessment tests needed for that treatment or operation

What do you think? What do you think of the one-stop approach for outpatient clinics? Do you support the proposal to expand the one-stop shop approach?

Parking and transport by introducing ‘Pay on Foot’ to the car parks. Patients only pay for the time they use. A ticket is given on Patients have indicated that two important issues for entry to the car park and you pay for the time you them are parking and public transport. have used at a machine just before you leave. Previously patients had to guess the length of time Patients have also said they would like to see they would need for their visit and buy a ticket to improvements in public transport to hospitals. In cover it. This led in some cases to patients paying too response discussions have been taking place with much to make sure they were covered, but for those transport providers to introduce seven new routes whose time ran out, it could end in a parking ticket. across east Kent and to increase the frequency of services on other routes. In the autumn a significant improvement was made Outpatient Services in East Kent I 17 My carer works in a school, so evenings and weekend “ would be better.

BENEFITS OF THESE PROPOSALS The proposals offer a range of benefits to patients.

1. Less travelling for more people: The Trust The results are shown in Table 2, with significant checked the travel times for patients around east increases in the numbers of patients within a 20 Kent and worked out how they would improve if minute drive of one of the proposed outpatient the proposals in this document are put in place. clinic centres.

Table 2: Travel times for patients in each of East Kent’s Clinical Commissioning Group areas Clinical Percentage of Percentage of Number of Number of Commissioning patients patients within 20 patients currently patients within Groups currently within minutes drive in within 20 20 minutes in the 20 minutes drive the future minutes drive future for the proposed six sites Canterbury and 69% 90% 127,924 167,418 Coastal Thanet 84% 97% 135,297 156,652 Ashford 83% 94% 101,361 113,905 South Kent 53% 62% 111,302 129,019 Coast TOTAL 70.1% 83.5% 475,884 566,994

The travel times analysis also found that: choice of clinic times on offer. Both the Trust and • more than 91,000 additional people will be the CCG agree it is too restrictive and know a within 20 minutes drive of their appointments number of patients would appreciate a more • 71,000 people will have their journeys flexible and extended range of available reduced to some extent even if their drive is appointment times. more than 20 minutes • About 25,000 appointments (3.6 per cent) In the Trust’s outpatient surveys in February 2011 would involve people travelling further than and May 2013, people were asked which they do currently. appointment times they would prefer: • Early morning 2. Wider choice of appointment times: The • Daytime Trust looked at patients’ comments about the • Evening

Outpatient Services in East Kent I 19 Table 3: Summary of where the Trust proposes services will be provided from in the future.

Results were broadly the same for each survey: 3. A greater range of specialities offered in

each site: The extended range of specialties that • Around 25 per cent people who responded would be available in the proposed six outpatient

would prefer early morning appointments • Around 60 per cent would prefer daytime sites is shown in Table 3. appointments and • About 13 per cent would prefer evening 4. More opportunities for one-stop clinics: appointments. The Trust has already begun to deliver some of its Service improvements Service improvements follow ups to reduce One stop work increasing as appropriate Hospital Whitstable & Tankerton William Harvey Hospital Queen Elizabeth The Queen Mother Queen Victoria Hospital Deal Estuary View Medical Centre Faversham Health Centre New Romney Clinic Sheppey Hospital Sittingbourne Memorial Hospital St Saviours Hospital Hythe Spencer Wing at QEQM Margate Royal Victoria Hospital Folkestone Dover Buckland Hospital Queen Victoria Memorial Hospital Herne Bay Telemedicine improvements improvements Telemedicine expected outpatient services through one-stop models of SPECIALITY Kent & Canterbury Hospital People were also asked about whether they would care, for example in Urology and Breast Surgery Breast surgery  like Friday evening, or Saturday appointments. outpatient services. The Trust is expecting the Cardiology   number of patients able to take advantage of these Cardiothoracic • A little over 50 per cent would be prepared to improvements to grow over the next three years. surgery attend a clinic on Friday evening Clinical haematology • Around 75 per cent would be happy with a All of this Clinical oncology Saturday clinic • on a single day Colorectal surgery   • in a single place Dermatology The Trust plans to extend the working day for  • only about 20 minutes car drive from home for Endocrinology outpatient clinics. Most specialties will offer three  most people. sessions Monday – Thursday, with only the first two Ear Nose Throat  on Fridays: Gastroenterology  5. Fewer face-to-face appointments as General medicine  • Early (7.30am – 11.00am) the use of new technology expands: General surgery  • Day (11.30am – 3.00pm) Telemedicine and telehealth are growing initiatives Geriatric medicine   • Late (3.30pm – 7.00pm) across the NHS and Trust clinicians have been Gynaecology looking at opportunities to use them for some Haematology The Trust also proposes to run outpatient clinics on time. Saturday mornings with appointments between Haemophilia 9am – 11.30am. Nephrology  Neurology  Nuclear medicine Obstetrics Ophthalmology Jenny’s story and an ultrasound – and I had seen Oral surgery  the consultant again and got my Jenny, who is in her 60s, found a Orthodontics  results. lump in her breast. She was very Orthopaedics  anxious because her family has a “Everyone was really kind and Paediatrics bad history with breast cancer, so gentle and they were all so efficient Pain management she mentioned to her GP that she at the same time. I really hadn’t Restorative dentistry  has private health insurance because expected to have such a good her late husband wanted to be sure Rheumatology   experience, so I had to write and say she could get prompt treatment if Thoracic medicine   thank you to all concerned.” she ever needed it. Trauma Jenny lives in Stelling Minnis, so Urology  Her GP, who had herself had breast she is about 10 minutes from the Vascular surgery cancer, persuaded Jenny to give Kent and Canterbury Hospital, with Hand therapy the NHS a chance with the Trust’s William Harvey Hospital about 20 one-stop breast clinic. (All suspected Neuro physiology Jenny chose to cancer patients are seen within two minutes away. Occupational therapy drive for just under an hour to the weeks.) Orthotics clinic at Queen Elizabeth the Queen Physiotherapy Mother Hospital in Margate as this “I was extremely impressed,” Jenny was the earliest offered appoint- Pre-assessment said. “My appointment was at ment. “Peace of mind is the most Speech and language 9.50am and by 11.50am I had seen important thing,” she said. therapy the consultant, had a mammogram Activity increase Activity will increase at this site No change There will be no change to the current service New service A new service will be provided at this site The service is currently not provided at this site No future service The service will no longer be delivered at this site 20 I Outpatient Services in East Kent Outpatient Services in East Kent I 21 6. Fit-for-purpose facilities: In addition to opening the new Dover hospital in 2015, the Trust plans to improve the outpatient facilities at its other sites over the next few years. Over £5 million is to be spent on improving these facilities at the Queen Elizabeth The Queen Mother Hospital in Margate, Kent and Canterbury Hospital, Canterbury and the William Harvey Hospital in Ashford.

7. Value for money: The proposals have financial benefits for patients and the Trust with the potential for savings for commissioners in the medium/long-term. • Patients will save on travelling and the time taken for the current system involving several different appointments. • The CCGs will realise long-term savings on the numbers of outpatient appointments they need to fund, which can be reinvested in other services. • The Trust will realise savings on the travel expenses of its staff running isolated clinics in a wide range of locations, and on Helen’s story the rent it pays for the rooms in which those clinics are held. Helen is a nurse living and working in Folkestone. She was sent for an MRI scan by her GP when he referred her to the 8. Other benefits: The Trust also aims to improve patients’ Ear, Nose and Throat Consultant for experience by streamlining arrangements for making problems with her nose and sinuses. appointments, increasing car parking and investing in public transport to all proposed six sites. She went to William Harvey Hospital, Ashford, for the scan before Christmas In future, for all new patients we aim to contact the patient 2012, a 27-mile round trip. Her clinic directly to arrange a mutually convenient date for them to appointment in February was at the Royal attend. If the patient’s next appointment is within eight weeks, Victoria Hospital, Folkestone, first thing a convenient time will be agreed. If the next appointment is one afternoon, where the Consultant more than eight weeks in the future, the patient’s name will be decided to use an endoscope to examine her. registered and eight weeks before their appointment is due the booking clerk will telephone the patient to arrange a suitably He saw her again at the end of the clinic convenient time so that cancelled clinics can be avoided and to discuss putting her on the waiting list the number of patients who do not attend their appointment for an operation. is reduced. This will also allow the Trust to establish any special requirements an individual patient may have. She had to take most of the afternoon off for her pre-assessment checks at Kent DECIDING THE WAY FORWARD and Canterbury Hospital in June, a week WORKFORCE IMPLICATIONS before the surgery. The timing of this The Trust expects it would take two or three years to put all the was important because the Consultant changes outlined in this document in place. All the feedback received in the consultation will be • Choice – Patients should have as much choice as wanted her to get antibiotics at the same collated and independently analysed by the possible about appointment times and time. The journey was 34 miles. The Trust has not yet discussed with the staff involved how they University of Kent. This analysis will be presented to arrangements, such as one-stop clinics and the This fragmented process disrupted three would work or how individual jobs might be affected because the Board of the Trust and the governing body of use of new technology. work days, took more than six months – it does not want to pre-empt the outcome of the consultation. NHS Canterbury and Coastal CCG. • Sustainability – the changes must link with all the anxiety of not knowing what Changes that impact on staff will be implemented through best effectively with CCG plans to secure better care would happen or when – and involved practice and in accordance with the Trust’s policies and national They will consider it in relation to: for patients with long-term conditions, take three trips to different hospitals totalling terms and conditions. • Equity and equality – every patient should account of integrated urgent care, and the 61 miles of driving. receive the same high standards of clinically review of community based care; and fit with The Human Resources teams from the Trust (EKHUFT) and Kent the Trust’s clinical strategy and business plans. If she could have had it all done in one effective outpatient care. Community Health NHS Trust will liaise to ensure that staff • Value for money – services should demonstrate day at the new hospital in Dover, she • Accessibility – a broader range of services more efficient use of resources. would have known the whole picture employed by the latter to support EKHUFT’s outpatient clinics, should be available as close to patients’ homes within a few hours, had one disrupted are managed appropriately within the requirements of good HR as possible. work day and one round trip of just 22 practice, national terms and conditions and current employment miles. law requirements. Outpatient Services in East Kent I 23 HOW TO PROVIDE US WITH YOUR FEEDBACK

Information about the proposals set out in this attend and discuss their views first hand with staff consultation is available on a dedicated page on and clinicians can do so. the Trust website www.ekhuft.nhs.uk where you can complete the online survey. If you would like us to come to a local meeting and listen to the views of your group or organisation, Printed copies of the main consultation document please contact us to arrange a date and time. PLEASE CONTACT US AT and summary document include a pull-out version of the survey and are being made widely available A series of focus groups will be held to gather the on hospital sites and at current outpatient clinics, views of individuals or communities who are Email: [email protected] Write To: Communications Office, in GP practices, leisure centres and community unlikely to contribute to the consultation through Call: 01227 864153 (extension 76727) Freepost RSGJ-CLYR-UCKY, Queen Elizabeth The Queen Mother Hospital, centres. the usual routes. Twitter: @EKHUFT St Peters Road, Margate CT94AN Ten public meetings will be held over the 13 week consultation period so that anyone who wishes to DATES AND TIMES OF PUBLIC MEETINGS ARE: GLOSSARY Hythe TUE 17 DEC Margate FRI 24 JAN Faversham THU 13 FEB The Imperial Hotel Global Generation Church The Alexander Centre Princes Parade Unit 2 Preston Street Ambulatory care Outpatient Hythe CT21 6AE Westwood Industrial Estate Faversham ME13 8NZ Health services provided on an outpatient basis to Someone who has a consultation, tests and/or 9.30am to 12.30pm Strasbourg Street 9.30am to 12.30pm those who visit a hospital or other healthcare treatment at a hospital or clinic with no overnight Margate CT9 4JJ facility and depart after treatment on the same day. stay. Dover TUE 7 JAN 9.30am to 12.30pm Ashford WED 19 FEB Diagnostic tests Pharmacy outlet The Ark Holiday Inn Ashford Central Blood or urine tests, X-rays, ultrasound and other A chemist’s shop which dispenses prescription Herne Bay WED 29 JAN Noah’s Ark Road Canterbury Road imaging techniques that help clinicians see what is drugs. Dover CT17 0DD The Kings Hall Ashford TN24 8QQ happening inside the body to help them diagnose a 10am to 1pm Beacon Hill 2pm to 5pm person’s condition. Pre-assessment tests Herne Bay CT6 6BA Checks made by a nurse before you have an Whitstable WED 15 JAN 6.30pm to 9.30pm Canterbury TUE 25 FEB Equalities Act operation or other healthcare procedure. Passed in 1995, this law makes it illegal to offer Seasalter Christian Centre St Mary’s Bredin Church Deal THU 6 FEB a public service which is inaccessible to someone Telehealth 52-62 Faversham Road 59 Nunnery Fields because of their physical or learning disabilities. Use of new technology to enable a clinician to Seasalter Deal Town Hall Canterbury CT1 3NJ monitor a patient who is at home. Whitstable High Street 2pm to 5pm Follow-up 6pm to 9pm Deal CT14 6TR A second or subsequent appointment to check on Telemedicine 6pm to 9pm the outcome of a treatment plan. Use of new technology to help clinicians to discuss Folkestone MON 20 JAN a patient access to relevant medical images and The Grand Hotel Option appraisal information. The Leas Comparing key points about several alternatives to Folkestone CT20 2XL guide a choice that ensures agreed objectives are Therapy met as closely as possible. Treatment that helps you regain your ability to carry 2pm to 5pm out tasks of daily living.

24 I Outpatient Services in East Kent Outpatient Services in East Kent I 25 Why can’t you keep all my outpatient services what the views of local patients, carers and open at my local hospital on the north Kent member practices are before they make their final coast (Faversham/ Whitstable/ Herne Bay)? decision on the proposals. The number of patients using the Trust’s I don’t have a car and I can’t drive, are there services at each of these sites is small due to the good public transport links to each of the six facilities available. The proposed new outpatient sites? FREQUENTLY ASKED QUESTIONS clinic on the north Kent coast will be able to cater for all these patients to the highest modern stand- The Trust has looked into this thoroughly and each ards. It is not financially possible to run services of the sites has good public transport links. It is from multiple sites and bring all of these sites up to also working with Stagecoach to improve some bus Have you factored into your planning With the planned reduction in sites, will the the required standard. routes and the frequency of bus services. deprivation and demographics? six sites become over-crowded? Does this mean my local community hospital If I attend a one-stop clinic which is going to A wide range of criteria have been used in The Trust is proposing to extend the working day will close? take several hours will I be able to leave the developing the proposals including capacity at and offer Saturday morning clinics thereby clinic to get a drink and something to eat? different sites, facilities, access for patients, areas increasing the number of appointments, and No, changing where outpatient clinics are provided of deprivation and demographics. availability over a longer period. This means that does not mean community hospitals will close. As Each of the six sites will have a snack bar, there will not be a concentration of patients with all potential change it provides local people restaurant or shop available where people will be Why have you chosen to have six sites? attending clinics between 9am and 5pm. The Trust and the NHS with an opportunity to consider how able to buy refreshments. The outpatient nurses is planning to make improvements to the community hospitals might usefully contribute to will ensure you don’t lose your place in the clinic The Trust wanted the majority of its patients to be outpatient departments in the hospitals at Ashford, the future of health and social care. NHS schedule. able to access services within 20 minutes’ drive of Canterbury and Margate. Also the new hospital at Canterbury and Coastal CCG is undertaking a their home. This plan will also enable us to offer a Isn’t this just all about saving money? Dover will have an outpatient department that will review of community based services to ensure they full range of outpatient services supported by all be double the current size, and the preferred site offer the best value for local people and make the While there will be some financial benefits and the necessary equipment and staff. This would not for the north Kent coast will have enough room for most effective use of resources. Local people and financial prudence is required inall aspects of be possible on a larger number of sites. all patients from that area. As a result of these partners such as local councils, social care and public services, the key driver behind these changes improvements patients should find the facilities providers of community based services will be is to improve the services so that patients have a Will you be providing children’s outpatient more comfortable than they do now. integral to creating a shared, sustainable plan for much better experience and greater access to clinics outside school time, and during the future of health and social care. At a time outpatient services. evenings and weekends? when many public services are planning a future Why is Deal Hospital not one of the six sites Will you text me to remind me of my with less funding, how services make best use of Yes, there will be clinics offered outside school being consulted on? appointment time like my dentist or time, during evenings and at weekends. what already exists will be crucial. A few years ago, Eastern and Coastal Kent Primary hairdresser does?

Care Trust consulted the public on the “Dover Why is the NHS in East Kent not looking at all Will parking be a problem if you are reducing Yes, the Trust has already started to do this and Project – your say” and the effect it would have on these issues together? the number of sites from 15 to six? plans to roll this out to all patients who would like services provided in Dover, Deal and the The four Clinical Commissioning Groups (CCGs) it over the next year. The Trust has looked into this very carefully and surrounding areas. As a result of that consultation do work together, however the proposals for the believe that adequate parking spaces will be and its outcome, the Trust is investing £23 million outpatient services affect the different CCGs and When I arrive for my outpatient appointment, available at each of the selected sites. By extending to re-build the Dover Hospital to provide up-to- their patients to different degrees. Three of the how will I check in? the clinics’ working day by several hours the date, modern services for the south Kent coast clinical commissioning groups: NHS Ashford, NHS Each of the sites will have a central outpatient Trust will be making better use of all the facilities, population. Dover’s new hospital will open in early South Kent Coast and NHS Thanet have considered reception where you can speak to a member of including parking. 2015. the proposals and believe that although they will staff and there will also be a self check-in screen be beneficial to their population by increasing the available similar to those used at your local GP How does a “one-stop clinic” work? NHS South Kent Coast CCG are separately number of outpatient services provided locally and surgery. working with their GP members and local people the quality of facilities available, for many patients Patients attend an outpatient appointment where on potential services to be provided from Deal services remain largely the same. On this basis it they will be seen by a clinician, have diagnostic This consultation document discusses proposed hospital. Deal hospital will provide an on-going hub was felt by their Governing Bodies that there was tests (X-rays and blood tests for example), discuss a changes to EKHUFT’s outpatient services. for community services and may include outpatient no benefit to being more involved in the treatment plan and arrange any further style services where these are needed locally. consultation. NHS Canterbury and Coastal CCG appointment where necessary. Patients who may No inference should be drawn about either the recognise there will be an impact on more of their require surgery will also be offered pre-operative services or facilities offered by other healthcare patients and therefore they are taking an active checks and should be able to arrange a date for providers. role in the consultation itself; to ensure they know their operation.

26 I Outpatient Services in East Kent Outpatient Services in East Kent I 27 If you want this document in other languages or formats, such as braille, easy read or audio, please call 01227 864153 or email [email protected]

Chinese (Simplified) 本文件是关于肯特(Kent)东部地区的门诊病人服务。本文件是关于肯特郡东部地区的门诊服务 (Outpatients Services)。如果你希望本文件是使用任何其它语言，请联络 [email protected]

Chinese (Traditional) 本文件是關於肯特(Kent)東部地區的門診病人服務。本文件是關於肯特郡東部地區的門診服務 (Outpatients Services)。如果你希望本文件是使用任何其他語言，請聯絡 [email protected]

Czech Tento dokument je o ambulantních službách ve východním Kentu. Pokud mate zajem o tuto publikaci, kontaktujte prosim Komunikacni tym na cisle telefonu 01227 864153 (extension 76727) nebo poslete email na adresu: [email protected]

Latvian Šis dokuments ir par Ambulatorajiem pakalpojumiem Kentas Austrumos. Ja vēlaties saņemt šo dokumentu savā dzimtajā valodā vai vēlaties, lai mēs apmeklējam jūs vai jūsu mikrorajonu, lūdzu, sazinieties ar [email protected]

Nepalese

Polish Niniejszy dokument dotyczy usług ambulatoryjnych we wschodniej części hrabstwa Kent. Jezeli chcieliby Panstwo otrzymac egzemplarz tego wydania, prosze skontaktowac sie z Zespolem d/s Komunikacji (Communications Team) tel. 01227 864153 (extension 76727) lub e-mail [email protected]

Slovak Tento dokument je o ambulantných službách vo východnom Kente. Ak požadujete túto publikáciu v inom formáte, kontaktujte, prosím Komunikačný tím na tel. čísle 01227 864153 (extension 76727), alebo na emaily: [email protected]