What follows isn’t Adam Doyle’s actual words, and it’s not some leaked chinwag from the snug. It’s our straight-talking take on NHS Kent and Medway’s board papers of the 19th May 2026, written as if the chief executive had binned the management guff, got the pints in and told it how it is down the local.
Right. Pint’s here. Let’s stop pissing about.
I’m Adam Doyle, Chief Executive of NHS Kent and Medway. We’ve got £5.385 billion coming in this year and plan to spend £5.436 billion. So we’re £50.8 million short. We’re expecting to be another £40.4 million down next year, then we say we’ll balance the books in 2028/29. Maybe. But as things stand, the numbers don’t add up.
We also need to hack £79.7 million off this year’s bill. Some savings schemes are properly worked out. Others are still being “matured”, which is boardroom waffle for “not ready”. There’s no general contingency and no spare reserve. If demand goes up, a contract costs more or one of the schemes falls on its arse, we cut somewhere else or the deficit gets bigger. No magic wand. No secret stash. That’s it.
We’ve also banked on £21 million of one-off NHS England money which hadn’t been confirmed when the plan was written. We got similar cash before, so we’ve assumed it’ll show up again.
It might.
But let’s not kid ourselves: that’s a punt.
Then there are the staff.
We’re gutting the place: 770 jobs down to 340. Nearly 100 people are taking redundancy, about 200 are being shunted into other NHS outfits, and the rest are either scrapping over what’s left or hoping we can find them another berth before the axe falls. We call it a “new operating model”. That’s cobblers. More than half the jobs are going, and whoever’s still standing will be told to crack on, do more with less and somehow keep the whole bloody show on the road.
Morale’s through the floor. Fourteen of our staff felt things were bad enough to go over the usual chain of command and use Freedom to Speak Up, mostly because of the shake-up. They raised complaints about people behaving out of order and relationships with managers going sour. We say every case was dealt with or kicked upstairs. Maybe it was. But let’s not kid ourselves: people don’t put themselves through that palaver unless they reckon the normal route is a dead end.
To be fair, not all of it’s been a cock-up. We moved the Cancer Alliance and Diagnostic Network without the service going belly-up, shut the Compass Centre and reckon that’ll save us £219,000 a year. We’ve also signed £2.9 billion-worth of local NHS contracts and sorted £116 million-worth with NHS bodies outside Kent and Medway. NHS England even gave us a nod for getting on with it. Credit where it’s due: on this bit, we stopped faffing about and got the bloody job done.
But let’s not get carried away. We’re judged on 43 things nationally, and 22 of them are either bad or close to it. That’s more than half. Every corner of the system has something propping up the wrong end of the league table. Even our own report calls the overall picture “unacceptable”. Too bloody right. Strip away the guff and too much of what we’re doing simply isn’t up to scratch.
We’re trying to stop so many people ending up in hospital and get more of them seen by GPs, community teams or at home. We call it the “left shift”. Truth is, if there aren’t enough staff, appointments or kit outside hospital, it’s bollocks. We haven’t shifted care at all — we’ve just shifted the queue and left patients being bounced from pillar to post.
We’ve put £38 million into it. If people get seen quicker and the care’s actually better, fair enough. If they’re still being bounced from pillar to post, then we’ve spent a shedload of cash moving the queue around, talking bollocks and calling it reform.
Then there’s “assurance” — our fancy way of the Board asking, “Is this lot about to go tits-up?” Honest answer? Bits of it might. Our own paperwork admits the budgets are shaky, the forecasts could be wrong, contracts and buying are a muddle, nobody’s always clear who owns what, and we still haven’t nailed down all the savings. Some of the fixes won’t be in place until March 2027. Till then, we’ve got plans, deadlines and meetings coming out of our ears. If they sort it, great. If not, it’s just arse-covering with a stapler.
And here’s where it turns into a right bloody farce. Our Transition Committee says we could lose staff we need, get lumbered with bills for bits we’ve already moved elsewhere, end up with digital systems that aren’t up to the job, and leave the smaller organisation struggling to cope. Then it gets to “items to escalate” and writes “None”. None? That’s taking the piss.
The People Committee’s no better. It writes down redundancies, staff being shunted about, speaking-up complaints and a culture problem, then sticks “None” in the box for anything worth flagging. None? Do me a favour. You can’t list page after page of grief and then pretend there’s bugger all to kick upstairs.
And the money plan? That really takes the biscuit. We signed off a £50.8 million deficit behind closed doors on 7 April, then wheeled it into the public meeting in May and called that “public approval”. Come off it. The call had already been made. The public didn’t get a look-in. By the time we showed them the papers, it was already a done deal.
That’s the long and short of it.
We’ve done some difficult jobs properly. Services kept running, contracts got signed and we saved a few quid. Fair play where it’s due.
But the books are on the wonk, we’ve taken an axe to the workforce, too many services aren’t up to scratch and parts of the governance are, frankly, bollocks. Writing “None” in a box doesn’t make the risk disappear. It just makes it look as though we’re taking the piss.
That’s the honest version.
Drink Up.
The Shepway Vox Team
Delightfully Different Dissent
