Minutes:
Ed Waller (Chief Strategy and Partnerships Officer and Chief Delivery /Commissioning Officer(interim) – NHS Kent and Medway - Integrated Care Board) was in attendance for this item.
1. Mrs Crouch (Consultant for Public Health) introduced the item and noted that, from a public health perspective, the team fully embraced the 10 Year Plan and supported the NHS in maintaining its focus on keeping people well rather than solely treating illness. She highlighted that this approach aligned closely with the services offered by public health and confirmed their commitment to continued collaboration in addressing the major factors influencing health.
2. Mr Waller continued to provide an overview of the 10 Year Plan and outlined how it would be taken forward, much of which would require collaboration across Kent and Medway. The plan centred on three key shifts: moving NHS service delivery from hospitals into the community, shifting focus from treatment to prevention, and transitioning from analogue to digital. While these themes were not new, the plan emphasised delivering them at scale, which had not previously been achieved.
3. The plan also described changes to the health system, including the merger of NHS England and the Department of Health, larger ICB footprints, and a new operating model for the ICP in Kent and Medway focused on strategic commissioning, separate from provider trust management. Additional themes included transparency and quality of care, workforce transformation, innovation, and a revised financial and productivity framework.
4. Particular emphasis was placed on neighbourhood health, bringing together NHS services, GPs, community health teams, acute hospitals, mental health services, and council services such as adult social care and housing to deliver integrated care locally. The clinical model would prioritise the most frail and highest users of healthcare, aiming to prevent deterioration and reduce hospital admissions.
5. It was noted that Kent had secured a place on a national accelerator and pilot programme in Folkestone and Hythe, through a joint bid by KCC and partners, to test the neighbourhood model. This area was chosen due to its high concentration of citizens who would benefit from a different approach. The pilot would enable testing of new methods, moving away from traditional models, and generating evidence to inform wider changes across Kent.
6. Further to questions and comments from Members the discussion included the following:
(a) In response to concerns regarding the problems that may transpire as a result Local Government Re-organisation (LGR), Mr Waller acknowledged the need for a very close relationship between health services and council-run services. He noted that the ICB currently covered two upper-tier councils and that NHS provider trusts straddled those boundaries. He explained that any new local government structure would require clarity on how the footprints of local government and the NHS aligned, and how systems would relate to deliver services effectively. He emphasised that these challenges would need to be overcome as it was essential they worked well together. Mrs Crouch added that local health alliances had already been established, bringing partners together across local patches beyond organisational boundaries. She highlighted this as a positive foundation for building neighbourhood health.
(b) Concerns were raised regarding the closure of Faversham’s cottage hospital and whether plans were in place for its reopening. Clarification was also sought on how cottage hospitals fitted within the 10 Year Plan. Mr Waller advised that he had attended a public meeting in Faversham three weeks earlier, where Kent Community Health explained its decision to close the hospital based on patient safety and staffing challenges. Steps were being taken to reverse this position. He noted that neighbourhood health would consider the role of beds in facilities like Faversham Hospital and what services could shift from the acute sector to community settings. Evidence showed that being at home was generally best for patients, and most preferred not to be in NHS facilities unnecessarily. He highlighted successful models such as Home First, developed during COVID, which supported patients to remain at home post-discharge. The aim was to define the best future model for neighbourhood health.
(c) In response to comments regarding staff burnout and the recent decision to halt international recruitment into the NHS, clarification was provided on the plans in place to support domestic recruitment. Mr Waller explained that there was a general consensus to rely more on a domestic supply of healthcare staff for several reasons. He noted that Kent and Medway already delivered strong healthcare professional training. While international agreements might still feature in long-term workforce planning as described in the 10 Year Plan, the short-term focus was on making the best use of nurses completing training in the UK. Recent communications had highlighted efforts to ensure newly qualified nurses were placed in productive roles locally. Mr Waller added that the ideal position would be for Kent to train as many healthcare staff as possible to work within the area, and much progress was already being made toward that goal.
(d) Mr Waller advised that significant NHS, social care, and other public sector resources were already being directed toward supporting people, though care was often experienced as fragmented. He noted that there was an opportunity to use existing resources more effectively. Patients frequently received multiple types of care from different parts of the NHS in ways that felt uncoordinated. A key aim of Neighbourhood Health was to bring those services together in a more integrated way, improving the experience for patients, making better use of resources, empowering staff, and ultimately addressing the problem more effectively.
(e) Members commented that whilst the aims of the 10 Year Plan; shifting care from hospitals to community, focusing on prevention, and embracing digital, were laudable, they were not new and had been discussed for decades. It was further noted that delivery continued to face challenges, particularly due to financial pressures on acute trusts, which limited investment in community services. There was an emphasis on the need to break down organisational barriers to enable collective responsibility for change. It was further highlighted that there was a difficulty for acute trusts, community services, and GP practices to share business and clinical risk, which often resulted in patients being directed to A&E as the easiest option. It was suggested that the Health and Wellbeing Board could play a role in promoting shared responsibility and to ensure that changes reflected residents’ needs. In response to the points made, Mr Waller commented that the 10 Year Plan explicitly referenced the role of Health and Wellbeing Boards in creating neighbourhood health plans. He agreed with previous points, noting that these changes were significant and required organisations and boards to support and encourage people to take risks and try approaches that had not been attempted before. Miss Morton (Chair) expressed that it was important for the neighbourhood pilot to be presented to the Health and Wellbeing Board at an appropriate later date.
(f) It was noted that the home-first approach for hospital discharges was supported; however, concerns were raised about the loss of step-down and rehabilitation facilities in Kent. Poor communication between hospitals and care agencies was highlighted as a major barrier, with care packages often failing due to the lack of home visits and risk assessments, leading to readmissions and higher costs. The need for joint assessments and a return to previous practice of inspecting homes before arranging care was emphasised. An example was shared of a woman discharged under a six-week care package who had to sleep on a sofa after surgery because no risk assessment had been completed for upstairs access.
(g) In response to the comments made, Mr Waller noted that that while some patients needed to remain in hospital for clinical reasons, prolonged stays could become detrimental once the primary issue was resolved. The importance of finding the right discharge solution for each individual was highlighted, which could include rehab or step-down facilities. The Home First scheme run by KCHFT aimed to replicate such support in patients’ homes to achieve better outcomes. Early discharge planning, starting at admission, was emphasised as critical to ensure timely arrangements. It was noted that this would remain a major NHS focus during winter pressures, and the neighbourhood health pilot was expected to help identify community resources to support improved discharge planning.
7. RESOLVED that the Health and Wellbeing Board note the update.