Kent and Medway Case for Change March 2018 Contents Foreword ........................................................................................................................................... 3 1. Executive summary ................................................................................................................... 5 2. Context ................................................................................................................................... 10 2.1 The local area ................................................................................................................................ 10 2.2 Commissioners of services ............................................................................................................. 10 2.3 Providers of health and social care ................................................................................................. 12 2.4 Local successes .............................................................................................................................. 14 3. The needs of local people ........................................................................................................ 16 3.1 The local population is growing rapidly .......................................................................................... 16 3.2 Local people are living longer and older people tend to have additional health needs .................... 16 3.3 There are widespread inequalities across Kent and Medway .......................................................... 18 3.4 People are living in poor health with preventable long-term conditions ......................................... 21 3.5 There are differing levels of health and social care needs ............................................................... 22 3.6 Many people have poor mental health, often alongside poor physical health ................................. 24 4. The case for change in services for children and young people ................................................ 27 5. Key challenges ......................................................................................................................... 46 5.1 There needs to be a greater focus on prevention, especially in more deprived areas ...................... 46 5.2 There are challenges in primary care, which is extremely fragile in some areas .............................. 48 5.3 There are gaps in service and poor outcomes for those with long-term health conditions .............. 55 5.4 Many people are in hospital who could be cared for elsewhere ..................................................... 56 5.5 Some local hospitals find it difficult to deliver services for seriously ill people ................................ 59 5.6 Planned care is not delivered as efficiently and effectively as it could be ........................................ 66 5.7 There are particular challenges in the provision of cancer care....................................................... 69 5.8 People with mental ill health have poor outcomes and may not always be able to access services . 71 5.9 There is a substantial financial challenge and services could be run more productively................... 72 6. Enablers .................................................................................................................................. 74 6.1 Workforce ..................................................................................................................................... 74 6.2 Estates are generally good but not always fully utilised .................................................................. 74 6.3 Information technology needs to better support integrated care ................................................... 75 7. Next steps ............................................................................................................................... 78 8. Appendix 1: population segmentation detail and methodology ............................................... 80 9. Endnotes ................................................................................................................................. 82 March 2018 2 Foreword We have come together as health and social care partners across Kent and Medway to improve the services we provide and get the best possible health and social care outcomes for local people. It is important to understand where we are now, so that we can better understand where we can improve. There is much to be proud of about health and social care services in Kent and Medway. Staff work very hard to provide high quality care and local people are relatively healthy compared with other parts of the country. Local organisations have a track record of working together to meet the needs of local people. But we have been delivering services in the same way for many years and, increasingly, this way of delivering services no longer meets the needs of local people, especially frail, older people, those with long-term health conditions and children and young people. There are, therefore, several issues that we need to tackle in Kent and Medway; there are long waiting times for some services and the quality of care is not always as good as it could be. We also need to focus on reducing the need for health and social care, through ill health prevention, self- management, and earlier diagnosis. This case for change sets out our key challenges and will make sure that we target our efforts and resources to address these challenges in the coming years. The case for change highlights many challenges but we would like to highlight some of the key facts and figures: • Over 1,600 local people die early each year from causes considered amenable to healthcare, with people in deprived areas and those with severe mental illness more likely to be affected. • There are stark health inequalities across the area; for example, men living in the most deprived areas of Kent and Medway live on average 8 years fewer than those living in the least deprived. • Only about 2% of health and social care funding in Kent and Medway is spent on public health interventions to reduce the risk of avoidable disease and disability (this includes nationally commissioned programmes as well as local ones). These budgets are expected to decline by 9% over the next 3 years (representing a decline of 3% per year). • Over 1,000 (32%) people are in hospital beds that do not need hospital based medical care and could be helped elsewhere if services were more joined up and organised differently. • People find it difficult to access GP services and there are a low number of GPs in Kent and Medway; there would be 245 more full-time GPs if we had the same numbers as the national average - and there are 136 vacant GP posts across Kent and Medway. • For stroke patients who require thrombolysis, no acute trust in Kent and Medway delivers this treatment to all patients within the national guideline recommended time of 60 minutes; in 2015/16, the worst performing trust thrombolysed just 16% of patients within 60 minutes. • The health and wellbeing of children and young people could be better. Around 1 in 5 primary school children are overweight or obese and the number of teenage pregnant mothers is above the regional average. As well as this, half of all looked after children are defined as being a ‘cause for concern’ and are at greater risk of developing mental ill health. • Local health and social care commissioners and providers are facing a £110m deficit in 2016/17 which will rise to £486m by 2020/21 if nothing changes. We are committed to working together to make sure that local services are as high quality and as accessible as possible. We will make sure that we prevent disease where possible, that we meet the needs of all local people and that we provide high quality services for all. March 2018 3 There is a clear distinction between meeting ‘patient needs’ and meeting ‘patient wants’. In this case for change we have sought to identify and highlight the needs of the population so that we can address the issues facing them. Delivering on ‘patient wants’ may not necessarily mean improved outcomes. This case for change describes the local context, the changing health and care needs of local people, and the key challenges facing health and care services in Kent and Medway. This document does not contain solutions but will be used to guide our understanding of where we need to transform local services over the next few years. A group of senior doctors, nurses and care professionals have worked together to develop this document which we hope will show where we can improve health and well-being and make local services better. We believe that every person in Kent and Medway should receive the same high quality standard of care. This will mean that we need to work more closely together to prevent ill health where we can and provide integrated, high quality services when people fall ill. We recognise that we will need to work together to achieve this. Signed by Andrew Scott-Clark, Director of Public Health (Kent County Council) James Williams, Director of Public Health (Medway Council) On behalf of the Kent and Medway Clinical Board and Professional Board Name Role Organisation 1 Ali Strowman Director of Nursing Kent Community Health NHS Foundation Trust 2 Andrew Ireland Director for Children, Young People & Education Kent County Council 4 Anne Tidmarsh Director of Older People & Physical Disability Kent County Council 5 Anu Singh