The Health Overview and Scrutiny Committee (HOSC) convened to discuss several key healthcare issues affecting Kent, including structural changes to the NHS Kent and Medway Integrated Care Board (ICB), integrated mental health services, updates from Maidstone and Tunbridge Wells NHS Trust (MTW), and the temporary pause of inpatient services at Faversham Cottage Hospital. The committee noted reports on these topics, and considered whether the Integrated All-Age Mental Health Services model constituted a substantial variation of service¹.

Structural Changes to NHS Kent and Medway Integrated Care Board

The committee reviewed the structural changes occurring within the NHS Kent and Medway ICB, which are part of a broader national reform of the NHS. A key focus is the requirement for ICBs to reduce their operating costs by approximately 50% by December 2025. This is in addition to a 30% reduction over the previous two years, bringing the total reduction in operating costs to 65% since July 2022.

The report, Structural Changes to NHS Kent and Medway Integrated Care Board - Covering Report, assured the committee that these reductions would not affect commissioning budgets used to pay for local health and care services, and therefore should not directly impact patient care.

The changes are in response to the NHS 10 Year Plan, published on 3 July 2025, which envisions a leaner and simpler NHS operating model. The plan emphasises the importance of ICBs as strategic commissioners of local health services, responsible for using multi-year budgets to improve population health, reduce health inequalities, and improve access to high-quality services.

The committee heard that the ICB blueprint lists functions that ICBs should retain and grow, share with partners, or transfer out of ICBs altogether. These include:

• Retain and invest: Assessing population needs, developing long-term strategies, market shaping, and engaging with service users.
• Retain and adapt: Quality management, clinical and corporate governance.
• Transfer to regions/national: Provider performance oversight, strategic workforce planning, national data and digital infrastructure, and emergency preparedness.
• Transfer to providers: Local workforce development, sustainability, and local digital and technology leadership.

The ICB has initiated the 'Change-25' programme to manage these changes, aiming to reduce operating costs from £73.5 million to £38.3 million, which will require a reduction of approximately 49% of its 770 full-time equivalent staff. The estimated redundancy cost is around £21 million.

The committee was informed of several challenges and risks associated with the programme, including:

• Funding: Uncertainty around funding arrangements for redundancies.
• Living within means: The need to transfer functions out of the ICB to meet operating cost caps.
• Delivering in-year priorities: Balancing the Change-25 programme with the need to deliver significant efficiency savings and improve services.
• Workforce: The impact of the programme on staff, with concerns about anxiety and the need for support.

The ICB is providing a colleague support package, including career coaching and job searching support.

Integrated All-Age Mental Health Services

The committee considered a report on NHS Kent and Medway's decision to award a new Integrated All-Age Mental Health Services (IAAMHS) contract to Kent and Medway NHS and Social Care Partnership Trust (KMPT). The report, Integrated All-Age Mental Health Services - Covering Report, outlined the rationale for the contract award, and confirmed a commitment to service continuity and workforce stability. The report also detailed how the contract safeguards Kent's voice in future service development.

The committee was asked to determine whether the proposals constituted a substantial variation of service. The report included a questionnaire, completed by the ICB, to aid the committee in its decision.

The report noted that the current provider of Kent's Children and Young People's Mental Health Service (CYPMHS) and All Age Eating Disorder Service (AAEDS) is North East London NHS Foundation Trust (NELFT), who intend to exit Kent and Medway when their contract expires on 31 March 2026. The new contract with KMPT is intended to strategically align service provision into an Integrated All-Age Mental Health Service.

The committee heard that KMPT was the only capable provider able to meet the requirements in terms of experience, infrastructure, workforce, and clinical governance. As a result, NHSKM applied Direct Award A under the PSR (Regulation 6(3)), which permits direct award to a provider where:

• the services are not materially different from existing provision
• there is a single capable provider in the context of the local market
• the route offers the lowest delivery risk and best assurance of continuity and safety.

The committee was assured that KMPT will work closely with NELFT to ensure a smooth transition and safe handover, drawing on existing clinical infrastructure and staffing models. The contract includes a requirement for KMPT to adhere fully to agreed protocols for managing service change, including public engagement and formal consultation where applicable.

The committee was also updated on the successful conclusion of NHSKM's recent competitive procurement for Kent's Children and Young People's Emotional Wellbeing and Mental Health Therapeutic Alliance contract, which was awarded to Salus CIC².

Maidstone and Tunbridge Wells NHS Trust

The committee received updates from Maidstone and Tunbridge Wells NHS Trust (MTW) on its clinical strategy and the acquisition of Fordcombe Hospital.

Clinical Strategy

The committee received an update on the refreshed clinical strategy of MTW, as described in the Maidstone and Tunbridge Wells NHS Trust - Clinical Strategy - Covering Report. The strategy takes into account how MTW:

• Plays a full role in elective care recovery for patients in Kent and Medway.
• Contributes to the three big shifts indicated within the 10-year health plan of providing more care in community settings, moving from digital to analogue, and shifting in focus from sickness to prevention.
• Responds to the NHS England's medium-term plan requirements.
• Aligns with Kent and Medway's commissioning plans.

The committee heard that MTW has already delivered the vast majority of its original plans for its clinical strategy, including:

• Robotic surgery at Maidstone and Tunbridge Wells sites
• An enhanced care team to support improved mental health and well-being for patients
• Achieving a good CQC rating for maternity services
• Implementing same-day emergency care services across a range of specialties
• Building and opening the Kent & Medway Orthopaedic Centre in Maidstone
• Building and opening a 147-room academic centre for K&M medical students at Tunbridge Wells
• Acquisition and development of services at Fordcombe Hospital

Fordcombe Hospital

The committee received an update on the extent to which the acquisition of Fordcombe Hospital by MTW has been beneficial, one year after the opening of the hospital. The report, Maidstone and Tunbridge Wells NHS Trust - Fordcombe Hospital - Covering Report, stated that since October 2024, a total of 26,269 episodes of care have been provided at Fordcombe.

Fordcombe Hospital offers a wide range of activity, including general surgery, urology, orthopaedics, gynaecology, respiratory, gastroenterology, dermatology, breast, ENT, cardiology, general medicine, and pain management.

MTW has worked in partnership with Kent and Medway Integrated Care Board (ICB) to develop additional services, including:

• Provision of cardiac MRI services
• Development of a venesection service for oncology patients

MTW is working to expand the outpatient capacity at Fordcombe Hospital from 10 to 14 consultation rooms.

Faversham Cottage Hospital

The committee received an update on the temporary pause to inpatient ward services at Faversham Cottage Hospital. The decision to pause inpatient admissions was made on the grounds of patient safety, due to ongoing staffing challenges, particularly within registered nursing and leadership roles.

Despite efforts to bolster staffing, the situation became unsustainable and was placing pressure on other services. The Faversham Cottage Hospital - Covering Report noted that in considering whether service changes constitute substantial variations of service, the NHS is not required to consult with the committee where the NHS has acted because of a risk to patient safety or to ensure the welfare of patients or staff. Nonetheless, the committee has to be informed as soon as possible.

Work Programme

The committee considered and noted the work programme, as detailed in the Work Programme - Covering Report. The proposed work programme has been compiled as a result of recommendations from previous meetings and from topics identified by committee members and the NHS.