Commissioners outline stroke services shake-up

All five options going to consultation include reducing the six hospitals admitting patients with suspected strokes to three, providing hyper-acute and acute stroke care.

David Hargroves, clinical lead for the stroke review, said: “Currently, although stroke staff do their very best, the way services are organised means that some people do not get the right treatment fast enough, particularly overnight and at weekends. Centralising urgent stroke care in three excellent hyper-acute stroke units would change all that.”

All the options include services in east Kent being based at the William Harvey Hospital in Ashford. The Queen Elizabeth, the Queen Mother, Hospital in Thanet would stop provision. A protest against this is scheduled to take place on Saturday.

Three of the options would also mean no urgent care for strokes at the new Tunbridge Wells Hospital, which serves west Kent and parts of east Sussex. In two of these, services would be based at Maidstone Hospital – where the accident and emergency does not take some categories of patients. In the third, Medway Hospital and Darent Valley Hospital would host acute and hyper-acute stroke services, plus the William Harvey, leaving west and mid Kent without a stroke unit.

All the scenarios would involve significant capital investment – between £30m and £38m. Up to 10 additional stroke doctors would be needed.

While all options would mean over 90 per cent of the Kent and Medway population could reach one of the sites within 45 minutes by ambulance, only one proposal – involving the William Harvey, Tunbridge Wells and Medway – would offer over 80 per cent access within 30 minutes. This option also scores well on other criteria, including the potential to move to mechanical thrombectomy (the physical removal of blood clots causing strokes) in future.

The decision is complicated by separate proposals for emergency and specialist acute services in east Kent, which are expected to go out to consultation later in the year.

Hazel Smith, accountable officer of South Kent Coast and Thanet clinical commissioning groups, said: “It would be wrong to wait for this work to conclude and slow down the essential decisions we need on stroke. If, through the east Kent emergency and specialist service review, William Harvey Hospital were no longer to be a long term option for emergency and specialist services and these moved elsewhere – then we would anticipate that any hyper acute stroke service would move with the co-dependent services.”

Consultation on the five options was backed by a joint committee of CCGs on Wednesday. The plans are likely to go out to public consultation this month with a decision made later in the year. Implementation is expected to take two years. The cost of the consultation and analysis of the results is expected to be £250,000 plus staff costs.

An urgent review into the county’s stroke services was ordered in 2014, amid concern that the seven hospitals accepting stroke patients were unable to provide high quality care consistently. Since then, Kent and Canterbury Hospital has stopped taking patients and there has been improvement in services elsewhere. However, the county still trails other areas on many measures of stroke care including 24/7 access and the use of “clot busting” drugs.