1. Proposed integration of Medway NHS Foundation Trust and Dartford and Gravesham NHS Trust Better care together

2. Dartford and Gravesham NHS Trust and Medway NHS Foundation Trust, the two trusts that run Darent Valley and Medway Maritime hospitals, are exploring the possibility of coming together to form one organisation. Just 15 miles apart, the hospitals have a lot in common and have already been working together successfully over the last 18 months on some joint clinical and support services. Senior doctors and local GP leaders believe there could be significant clinical benefits in bringing the trusts together.

3. ► 27 th September – Medway NHS FT Board Meeting ► 29 th September – Dartford and Gravesham NHS Trust Board Meeting ► Both trust boards decided to proceed to the next stage with plans to integrate into one organisation. ► They agreed that integration would bring considerable benefits to patients, the public and staff and ongoing financial stability.

4. Before the two trust boards could agree to proceed with integration, they needed to be satisfied that: ►Integration will deliver significant tangible benefits for patients and the public. ►The clinical strategy for the integrated organisation is acceptable to both trusts and is supported by local commissioners. ►The long term financial plans for the integrated organisation are robust and will meet the criteria required by Monitor, the foundation trust regulator. ►The outline integration plan sets out clearly how the clinical strategy, patient and public benefits and financial benefits will be achieved. Both boards were satisfied that all these criteria were met and so decided to proceed with the integration process.

5. Mar – Aug 2011 Feasibility study Detailed background work to check that integration is practical and will deliver anticipated benefits. September 2011 Boards decisions Based on the feasibility work, the two hospitals’ boards will decide whether to proceed or not with integration. Oct ‘11 – July ‘12 Implementation We will take the official steps to integrate, including approval from DH, SHA and Monitor. Summer 2012 Integration Aim for the new organisation to come into being from Summer 2012 May Jun July AugSep Oct Nov Dec Jan Feb Mar Apr MayJun Jul Aug

6. For patients and the public: ►Protected and strengthened local services, with a wider range of more specialist services. ►Larger catchment area means we can develop specialist services not currently provided locally, so patients no longer need to travel to London. ►Merging boards and some support functions means we can cut duplication and be more efficient, releasing savings that can be put back in to deliver more and better frontline care. For staff: ►More opportunities for staff to develop skills and expertise and to share specialist knowledge.

7. The economic climate means that the NHS budget will not increase as it has in the past. At the same time, demand for services will continue to rise as more people live longer. In addition, the cost of providing those services will continue to rise because of inflation and the availability of new medical advances. Becoming more efficient will help, but to fully meet this challenge, the NHS needs to radically re-think its clinical pathways (how it provides services), with more joined up working between hospitals, GPs and community services. By joining together, the hospitals will be in a much better position to work with GP commissioners and others to develop new clinical pathways to benefit patients across the whole local area.

8. Medway is an NHS foundation trust (FT). This means that it ►has greater freedom from central government control and is more accountable to its local community through its members and governors ►has more flexibility with its finances and can make long term investment decisions to develop new services and facilities for local people Dartford and Gravesham is not currently an FT, but wants to become one. The Government wants all hospitals to become FTs because of their ability to better meet the needs of local communities. The criteria for becoming an FT are tough are very rigorous and focus on strong governance and robust financial plans. Trusts that continue to fail to meet the criteria face being taken over by another organisation. Because it was built under the Private Finance Initiative (PFI) it is very difficult for Darent Valley to meet the criteria on its own. But by integrating with Medway, which is an FT already, the new organisation can stay in control of its own future.

9. Both hospitals will continue to offer full A&E, maternity, children’s and outpatients services. For some specialities, it may be that we could offer more specialised treatments for local patients if those services were centralised at one hospital. However, we would still expect to offer clinics and outpatients appointments for that specialty at the other site too. The purpose of coming together is to build on the range and quality of local services we already have, not to reduce them. We are not proposing any significant changes to the services we provide. We will not make any significant changes to our services, now or in the future, without consulting local people first.

10. We have a responsibility to spend the NHS budget wisely and if we can make savings by merging the boards and some management and support posts then we will. However, we plan to minimise any redundancies and, as a large organisation, would be able to make many of the savings through natural staff turnover; for example retirement and those leaving to move onto other jobs. For many staff the integration offers an opportunity to further develop skills and expertise and to share specialist knowledge working as part of a larger team.

11. ►This is only the first of many milestones in the journey towards a single organisation. ►We are planning a programme of engagement with patients, the public and staff over the winter months. ► More detailed plans will need to be submitted to several organisations, including: Department of Health Monitor (regulator of NHS foundation trusts) Competition and Co-operation Panel South East Coast Strategic Health Authority

12. We are involving staff, patients, governors, our local public, GPs, our commissioners and local authorities throughout the process. We are planning a series of events with patients and the public, staff and stakeholders for the winter months so that everyone has an opportunity to find out more and raise any comments or queries. In the meantime, if you would like any further information or have any questions or comments, please contact us: ►E-mail: bettercaretogether@nhs.net ►Telephone: 01634 830000 x 6761 Up to date information will also be available on our websites: ►www.medway.nhs.uk ►www.dvh.nhs.uk