After the resignation of Matt Hancock as health secretary, there is a new man in charge of the NHS and he faces a daunting series of challenges.

The battle against the coronavirus pandemic continues but what else might be piling up in the ‘in tray’ and what are the big issues for Kent?

Sajid Javid will have to face questions about investment in new hospitals, shortages of GPs and delayed treatments and diagnosis of life-threatening conditions.

The minister will also face pressure over proposals - yet to be published - for adult social care and how the government plans to fund it in the face of spiralling numbers of elderly people living longer.

Our political editor Paul Francis casts his eye over the choppy political waters facing the NHS and what are the priorities for patients and clinicians around the county.

Transformation delayed

Health leaders in the county have prepared far-reaching plans to bring together over a five-year period all health and care services.

Kent and Medway NHS is among the 44 areas that have drawn up so-called STPs (Sustainable Transformation Plans) that will cover all aspects of funding.

Sounds like a good plan? The idea of greater integration is something both the clinicians and patients would probably agree is a good thing.

The problem? The STP has been in limbo because of the Covid pandemic - and looks like it is continuing to be stalled.

And that has meant the masterplan is now five years out of date: the first incarnation of the blueprint was published in 2016 and there are some who think that it should be “re-set” to reflect changes in the way patients access services, amplified by the growing trend for doctors to deal with patients online.

Status: Progress stalled

An acute problem: a shake-up of hospitals in east Kent

The controversial re-organisation of hospitals in east Kent has boiled down to two options being considered by hospital chiefs. One would involve building from scratch a new accident and emergency hospital in Canterbury, adjacent to the existing site.

The plan would see the costs of a shell hospital - estimated at about £150m - met by the developer Mark Quinn in return for land on which he would build 2,200 houses. The new hospital would provide all specialist services, such as trauma, stroke, vascular and specialist heart services; consultant-led maternity and frailty services and children’s inpatient services, for all of east Kent.

Under this plan, A&E departments at Ashford's William Harvey and the QEQM in Margate would be downgraded to urgent treatment centres.

The alternative would see all major services centralised at the William Harvey in Ashford, with Margate's A&E unit expanded and the K&C downgraded to a hospital specialising in diagnostics and routine planned surgery.

The options have yet to go out to public consultation but a pre-consulation business case is understood to be imminent. This would set out the funding and investment required for both options; public consultation could follow.

The reorganisation could feature in the third wave of the government’s national Health Improvement Plan, under which a £1.8 billion increase to NHS capital spending has been promised over five years from 2019/20.

Status: decision pending

The care conundrum

The costs of care for the most vulnerable and elderly is a major issue. And it was identified by the Prime Minister as such when he took office.

But despite pledging to deliver a long-awaited plan to solve the care crisis and propose alternatives that would spare families from having to sell homes to fund care costs, the government has not yet unveiled its blueprint.

Some had expected the Chancellor to set out at least a broad approach to the issue in the Spring budget statement but he did not.

Care organisations, along with local authorities, say it is essential that alternatives be found that provide a permanent solution rather than by giving councils on a year-by-year basis more freedom to increase council tax to meet the spiralling costs.

Details of how some kind of insurance scheme might work could be unveiled in the Government’s Autumn Spending Review.

Status: edging closer but stuck at first base

The doctor won’t see you now

Kent, like many other parts of the country, has seen a rising number of doctors quit in recent years, many opting to take early retirement, citing the increased workload and pressures they work under.

Various surveys have underlined the exodus from all parts of the county. Figures released in January last year by NHS Digital suggested Thanet was the fourth worst area in the country for the number of GPs per patient, with just one doctor for every 2,500 people.

That however was dwarfed by NHS Medway CCG, in Kent, had a total of 2,917 patients per FTE fully-qualified GP - the highest number of patients per GP in the country based on figures from 2018-19.

Nationally, the number of GPs working in the NHS as at September 2015 was 29,229 - but by 2017, the number fell to 27,930, according to a report published by the Commons' library.

Status: ongoing problem

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