• Eliminate a projected 2020/21 deficit of £486 million;
• Delivery of an integrated health and social care model;
• Develop primary care into multispecialty community provider (MCP) type arrangements;
• A dramatic reduction in the level of activity in the acute care sector;
• Improvements in the health of the area's population.

Like other areas this STP aims to transfer services out of hospital and into the community. The concern is that cuts in hospital care will be made, helping to achieve savings, but without proper investment in community health services.

The STP aims for a considerable amount of hospital reorganisation and consolidation. There are three major hospitals in this area - the Kent and Canterbury, the William Harvey in Ashford and the QEQM in Margate - and the  reorganisation planned in the STP will mean that one hospital will become a ‘super medical site’ whilst the other two will be downgraded. The reorganisation will involve a reduction of 300 acute hospital beds and:

The reorganisation of hospitals means vascular; renal; head and neck; urology; hyper-acute stroke; haematoncology and gynaecology in patient services; as well as trauma care; would all move to the one main site.

No decision has been announced as to which hospital site will become the major medical site. However, in June 2017, the chief executive Matthew Kershaw of the Kent and Canterbury (K&C) Hospital was unable to offer any reassurances to campaigners about its future as an acute site. From June 2017, emergency heart and stroke patients would no longer be taken to the K&C because most of the hospital’s junior doctors have been moved to Ashford as there are insufficient consultants to supervise them at Canterbury.

One of the target areas for consolidation is stroke care. Plans include the consolidation of stroke care to three specialist units, in place of the current six units.

In May 2018, four East Kent CCGs announced that the planned public consultation on changes to A&E services will be delayed; the consultation had been expected to begin in early 2018.

There are two proposals that are now being considered are:

• Major A&E for the area and many specialist services to be based at the William Harvey Hospital in Ashford, with an A&E at the Queen Elizabeth, the Queen Mother, Hospital in Thanet and a GP-led urgent care centre at the Kent and Canterbury hospital in Canterbury, or
• a new hospital to be built adjacent to the Kent and Canterbury, which will become the site for a single A&E and specialist services for the whole area. The other two hospitals would have GP-led urgent care centres with diagnostics, day surgery, outpatient services and rehabilitation.

The second would be partly funded by a developer that has offered to build a hospital shell in return for planning permission for 2,000 homes elsewhere in the area.

Under NHS England plans all STP areas will develop into Integrated Care Systems (ICS), previously known as Accountable Care Systems (ACS). This is a new model of care that aims to integrate hospital, community and social care and could involve a new type of contract and capitated (i.e., fixed budget) funding. For further details see our pages on New Models of Care and Accountable Care Organisations.

The STP includes plans to bring general practices into clusters, and then aggregating clusters into multispecialty community provider (MCP) type arrangements. This would eventually lead to the development of a small number of larger accountable care organisations (ACO) that would hold capitated budgets.

The STP hopes that the use of this model will lead to the management of demand for acute services, and a significant reduction in acute activity and length of stay in hospital.

The Kent and Medway area, along with Greater Manchester, Mid and South Essex and North West London, has been chosen to test out models of regional back-office mergers. The areas will explore different approaches to making savings on back-office services that can become models for the other STPs during a national implementation phase.

The CCGs in Kent and Medway are running a consultation on changes to stroke care in the area. This began 2 February 2018 and will run until 13 April 2018; the consultation can be found here.

The consultation is on the proposed plan  to have three hyper acute stroke units operating 24 hours a day, 7 days a week, to care for all stroke patients across Kent and Medway. This would mean that urgent stroke services would not be provided by hospitals that are not identified as locations for the hyper acute stroke units.

The STP does not contain details about just how the STP will be funded. In the STP it is noted that a lack of new capital would be a “significant barrier to change”.

In February 2018 it was revealed to the publication Pulse that the STP board had paid the management consultants Carnal Farrar just over £6 million to draw up the cost-cutting plans in the STP.

The major criticisms of the STP are on the planned reorganisation of hospital services, with objections to the downgrading of any of the hospitals.

Campaigners have noted that the planned changes to stroke care (consolidation to three units) will mean long travelling times.