• Proposals expected to be approved in January but would mean no hyperacute and acute stroke unit in Medway 
  • Clinical senate warns services in Medway could be destabilised 
  • Council leader says decision making process “has not been carried out properly”

Controversial plans to halve the number of hospitals admitting stroke patients in Kent and Medway could face judicial review after mounting concerns from councillors about the proposals.

The NHS’s recommended preferred option would create combined hyperacute and acute stroke units at Darent Valley Hospital in Dartford, the William Harvey Hospital in Ashford and Maidstone Hospital. However, this would mean Medway Hospital and the Queen Elizabeth, the Queen Mother Hospital in Margate would lose their existing stroke services.

The plans are expected to be signed off by a committee representing all eight clinical commissioning groups in Kent and Medway in January – but have been criticised for not placing units in the deprived areas of Medway and Thanet. Medway Council leader Alan Jarrett said the council’s cabinet would be asked to back a judicial review at its meeting tomorrow.

A joint health overview and scrutiny committee for Medway Council and Kent County Council, with representatives from Bexley Council and East Sussex County Council, has heard concerns about last minute changes to the way in which the different options for siting stroke units had been assessed – which had mainly disadvantaged an option which included Medway and favoured the option which was eventually selected.   

Mr Jarrett has told NHS England a final decision should not be taken until “these flaws in [the] process have been addressed and a proper decision-making process put in place”. He told HSJ: “I think any reasonable person looking at the process would come to the conclusion that it has not been carried out properly in a number of respects.”

The joint HOSC also heard a review by the South East Clinical Senate had warned of the risk of destabilising the workforce in sites not chosen to host a HASU, especially Medway.

Under the current proposals, Medway would be the one trust which will not have an HASU; other trusts which will lose stroke services from one site will have an HASU at another hospital and could transfer staff between them.

The senate suggested that Medway might not be able to continue providing adequate services after the decision on sites was made and stroke activity might have to be moved elsewhere in the west of the county before the planned “go live” date of March 2020.

The clinical senate also challenged an assumption that there would be no growth in the number of strokes. Capacity planning at the trusts chosen for HASUs and acute stroke units needed to take account of potential increases, it said.

The draft decision making business case for the reconfiguration argued it will improve clinical outcomes for patients, help to resolve workforce issues and will improve financial sustainability. Increased travel times for some patients would be offset by the improved care they would receive.

Rachel Jones, senior responsible officer for the Kent and Medway Stroke Review, said: “We firmly believe that our proposals will improve stroke care for everyone in Kent and Medway compared to now – regardless of their location. It does not matter if the units are in densely populated areas, or areas of deprivation, what matters is that people having a stroke have access to a specialist unit, within the specified timeframes, and that the first 72 hours of care is delivered by a specialist stroke team on hand 24/7.”

Kent and Medway sustainability and transformation partnership and the CCGs have been approached for a comment.

Updated: This story was updated to include comment from Kent and Medway Stroke Review at 17:16 on 17 December