‘Patients at risk’ as ministers take two years to decide on reconfiguration

The Independent Reconfiguration Panel, the government committee which advises ministers on controversial service changes, has also noted — in an unusual move — that it has been a very long time since it delivered its view on Kent and Medway stroke services to government.

The IRP’s recommendations on centralising stroke units in Kent and Medway have sat on the desk of, first, Matt Hancock and, more recently, Sajid Javid since 30 September 2019. It is thought to be by far the longest time any health secretary has taken to consider an IRP recommendation.

Paul Bartlett, Kent County Council health overview and scrutiny committee chair, told HSJ the delay was “disappointing”, adding: “Patience [is] wearing thin.”

He said: “I had hoped when the new [health] secretary took over that we would see a rapid resolution of the issue. The best healthcare outcomes for residents of Kent and Medway are dependent on all parts of the NHS moving at pace to open the new [hyper acute stroke units].”

The most recent minutes of an IRP meeting, in July, showed members “noted that the panel gave its advice on this case in 2019 and has not yet received a decision from the secretary of state”.

The two-year anniversary comes as the Health and Care Bill is making its way through Parliament. The legislation as currently drafted would give the health secretary the power to intervene at an earlier stage in reconfigurations. However, HSJ recently learned Mr Javid is considering dropping or watering down some of these powers. 

The review of Kent and Medway’s stroke services started in 2015. In early 2019, a joint committee of clinical commissioning groups took the decision to create three hyperacute stroke units, at Dartford, Ashford and Maidstone. In the summer of 2019, Medway Council referred the decision to the health and social care secretary, as it was concerned Medway Hospital’s stroke unit would close. Mr Hancock passed it to the IRP, which responded on 30 September 2019.

A judicial review of the CCG decision was also launched by campaigners in Thanet, where the unit at Queen Elizabeth, the Queen Mother, Hospital, would close. This was unsuccessful but at the time — February 2020 — the Kent and Medway Sustainability and Transformation Partnership warned further delays to the HASUs “would lead to even further avoidable death and disability”.

One of the consultants involved in the reconfiguration had previously suggested 20 to 25 patients a year would avoid death or disability if HASUs were set up.

Meanwhile, staffing shortages have led to the “temporary” closure of stroke units at two sites not chosen for HASUs — Tunbridge Wells Hospital and Medway Hospital. Services in East Kent — formerly at the William Harvey and the QEQM — have been concentrated at Kent and Canterbury Hospital, in Canterbury, during the pandemic. No sites in the county yet operate as a HASU.

When the CCGs approved the plan in 2019, it was anticipated HASU units could be set up at the William Harvey Hospital, in Ashford, in 2021 and at Darent Valley Hospital, in Dartford, and Maidstone Hospital by March 2020. Even if work started tomorrow, it would be the spring of 2024 before the unit at the William Harvey would be ready for use.

Kent and Medway CCG declined to comment. A Department of Health and Social Care spokeswoman said: “The health secretary will announce a decision on this issue soon.”