Medway untangles its rather strange urgent care system
Plus bed bugs on Southeastern, an unusually quiet week at the council, and your chance to live in the centre of Chatham
Medway’s urgent care system has undergone a significant reshuffle, finally ending an arrangement that could have seen patients passed between two providers operating side by side at Medway Maritime Hospital. We look at what has changed and whether it might actually make things better, plus bed bugs on Southeastern, this week’s planning applications, a very new bit of Chatham and what to do around Medway this weekend.
Medway has finally untangled its rather strange urgent care system
Medway Maritime Hospital has taken control of its Urgent Treatment Centre, more than two years after NHS officials concluded that the previous arrangement was causing delays and should be changed.
Since Monday, Medway NHS Foundation Trust has run the UTC, taking it over from Medway Community Healthcare. Patients can now walk in and access diagnostics, including X-rays and scans, through the service, while the separate GP out-of-hours operation, MedOCC, has moved away from the hospital to MCH House in Gillingham.
It sounds like a fairly routine bit of NHS restructuring. In reality, it ends a peculiar system that could see patients passed between two organisations operating urgent care services side by side in the same hospital.
Under the old arrangement, the hospital trust ran A&E while MCH provided the primary care element of the UTC through MedOCC. Patients arriving at Medway Maritime could be assessed by the hospital, sent to MedOCC, assessed there, and sometimes sent back again if they turned out to need acute hospital care.
By 2024, MCH itself was saying this needed to change. A report to Medway councillors said it was commissioned to see 145 UTC patients each day but regularly treated more than that, and that the way patients moved between the two services contributed to delays.
MCH found that more than 50% of breaches of the four hour target involved patients taking more than 30 minutes simply to transfer from the emergency department to the co-located MedOCC service. On individual sample days, some patients took more than two hours to make the move.
Around one in five patients sent to MedOCC were then found to need acute hospital treatment anyway, meaning they had to be referred back into services run by the hospital itself.
MCH's proposed solution was fairly straightforward, separating its GP out-of-hours operation from the UTC and bringing the UTC itself more closely into the hospital's emergency services. It said doing so should improve both performance and patient care.
More than two years later, that is essentially what has happened.
On paper, the new arrangement should also give patients access to more through the UTC itself. Under MCH, the service dealt primarily with minor illnesses and did not accept ordinary walk-ins, with patients generally reaching it through NHS 111 or after being directed there from A&E.
The new UTC can take walk-in patients as well as referrals from NHS 111, GPs and ambulance crews. Patients can also access diagnostics, including X-rays and scans, through the service rather than being sent back to A&E for them.
Medway NHS Foundation Trust says the changes bring the service into line with national standards and should mean more people receive the right treatment without unnecessarily entering the main emergency department.
Siobhan Callanan, interim chief executive of the trust, described the takeover as “a significant opportunity to strengthen urgent care and make these vital services as accessible and joined-up as possible for our local community.”
That may prove to be true, but the new structure is not automatically a fix. Medway’s own emergency services remain under pressure, so integrating the UTC into the hospital could just as easily move bottlenecks around as remove them. The old arrangement clearly had flaws, but whether the new one works better will depend on how it performs in practice.
The previous service had other problems too. A CQC inspection carried out last October and published in August left it rated Requires Improvement, with breaches relating to premises and equipment, infection control and governance.
Inspectors found parts of the unit were dirty or poorly maintained and said some patients had waited for more than two hours without being checked on or offered help with pain. Some longstanding problems identified at an earlier inspection remained unresolved.
The clinical picture was more positive. The CQC rated the service Good for effectiveness, caring and responsiveness, and patients generally spoke positively about staff. But its patient survey found a fairly divided experience, with 52% rating their care good or very good, while 38% described it as poor or very poor.
There is no suggestion that the CQC findings caused this week's transfer. The paper trail shows MCH and the hospital were already working towards the same structural change more than two years ago.
Staff nevertheless regarded the transfer as the end of something significant. In a final internal circular seen by Local Authority, MedOCC medical director Dr Simon Collins called it “the end of an era.” He told colleagues that some staff would remain with the UTC at the hospital while others would move “back” with MedOCC to MCH House, likening the split to cells dividing into “two separate, functioning cells, each doing their own thing.”
The timing is part of an even bigger NHS reshuffle. Three days after the UTC changed hands, Medway Community Healthcare itself ceased operating as a standalone provider, with most of its services and more than 1,000 staff transferring into Kent Community Health NHS Foundation Trust.
For patients, the important bit is considerably simpler. The Urgent Treatment Centre remains at Medway Maritime, but can now take walk-ins and provide a wider range of tests without sending people into A&E. Anyone needing the separate GP out-of-hours service will still access it through NHS 111, but face-to-face appointments are now provided from MCH House in Gillingham.
The old system was clearly awkward, and MCH itself had concluded more than two years ago that it needed to change. The new one looks tidier on paper. Whether it actually makes urgent care in Medway work better is something patients, rather than organisational charts, will eventually decide.
Catch Up
If you missed some of our other reporting over the past week, we somehow managed to cover Tesco, parks and £20 million for Twydall, which feels like a fairly representative spread of Medway life.
First, the conclusion to a licensing saga that really should not have required nearly two years. Tesco has finally secured permission to sell alcohol from its planned Rochester store after Medway Council refused its application and the supermarket appealed to the Magistrates’ Court. The eventual licence allows precisely the hours the council previously rejected. After two applications, objections, a hearing and a trip to court, Rochester is finally one step closer to achieving the radical ambition of having a small supermarket beside its railway station.
Ed Jennings
We also turned our attention to Medway’s eight Green Flag parks. Eight awards sound impressive, and Medway Council is understandably fond of mentioning them. The slight problem is that broadly the same eight parks keep winning them. With around 140 other urban parks across Medway, Stuart Bourne looked at why the list has barely changed and what that says about all the green spaces that never make it onto the podium.
Stuart Bourne
Finally, Steven met Glyn Griffiths, the new chair of the Pride in Place Twydall board. He has £20 million of government funding to help improve the area over the next decade, although importantly not £20 million sitting in a bank account waiting to be spent. They talked about what Twydall actually needs, the danger of spending regeneration money badly, his hopes for some early wins and why rebuilding community involvement may matter as much as whatever eventually gets built.
Steven Keevil
In brief
🚄 There are bed bugs on Southeastern trains. Cool.
🏘️ A plot of land in the Intra area with planning permission for 28 new homes is on the market for £2.25m.
💷 George Perfect, leader of the opposition at Medway Council, has written for ConservativeHome about Medway's increasing debt.
⚽ Free entry is being offered for Chatham Town vs Gillingham in the Kent Senior Cup on Tuesday, with donations for the Friends of Wisdom Hospice being welcomed instead.
Council matters
Meetings next week:
- Absolutely nothing of any interest is happening next week.
New planning applications:
- Construction of 9 new homes off Dongola Road in Strood.
- Construction of two-storey building as an addition for Eclipse Gaming in Chatham.
- Extension of Rainham Cricket Club pavillion.
- Construction of storage building at BP oil terminal in Grain.
Property of the week
It is still slightly novel to have genuinely new homes in the middle of Chatham, but Garrison Point is now established enough that some are already coming back onto the market. The 115-flat development replaced the former Whiffens Avenue car park as part of Medway Council’s attempt to get people actually living in the town centre. This two-bedroom apartment is on sale for £290,000, with two bathrooms, a large open-plan kitchen and living room, utility space, and a long private balcony overlooking the surprisingly leafy surroundings. It is all smart brickwork, landscaped grounds, big windows and greenery, while the Pentagon sits a few minutes down the hill, reminding you exactly where you are. The 990-year lease means somebody has also taken an unusually optimistic view of both Chatham and human civilisation.
Events this week
🎸 Sat 3 Oct - Adam Ross + The Love Family // Scottish indie-folk singer-songwriter returns to Medway, supported by Medway legends. Oast Community Centre, Rainham. Tickets £10.
🧪 3 - 4 Oct - Medway Fun Palaces Trail // Free community weekend of art and science activities across Medway. Various venues. Free.
🏛️ Sun 4 Oct - Commissioner’s House Open House // First chance to explore the Dockyard’s newly restored 300-year-old Georgian house, following a £3.8m restoration. Historic Dockyard, Chatham. £29, includes Dockyard entry. Guided tour £6.
🤼 Sun 4 Oct - UKPW // Wrestling action returns to its spiritual home in Medway. Parkwood Community Centre, Rainham. Tickets £10.
Footnotes
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