Staff shortage leads to emergency reconfiguration of stroke services

Patients who would have gone to Medway Foundation Trust will now go to Maidstone Hospital or Darent Valley Hospital, in Dartford. The FT has said the reorganisation of services will be temporary.

Medway’s stroke unit was already expected to close as part of a wider reconfiguration of services across Kent. But this has become bogged down in a judicial review and a referral to the Independent Reconfiguration Panel.

Now the trust has lost half of its specialist stroke nurses with two more leaving at the end of the month. The trust says uncertainty about the stroke service’s future is part of the reason it has not been able to replace them with either temporary or permanent staff. The nurses currently provide a day time service seven days a week. When they are not on duty, the on-call medical registrar liaises with the on-call consultant over whether patients need thrombolysis.

But with no specialist nurses on duty during the day, the trust is likely to struggle to treat daytime patients within the four and a half hours where thrombolysis is seen as useful.

A paper to the Medway Council health overview and scrutiny committee says other options such as staff secondments were considered but it was decided that a temporary closure was the best option. The covid crisis has already created additional space at Maidstone Hospital as stable rehabilitation patients are being treated at a local private hospital: this means there is capacity for patients from the Medway area.

“This does not represent the implementation of HASUs [as put forward in the planned service reconfiguration] and is a temporary measure to preserve the quality and safety of patient care,” Medway FT chief executive James Devine and Rachel Jones, director of strategy and population health for the Kent and Medway Clinical Commissioning Group, say in the paper.

Stroke services were moved from Tunbridge Wells Hospital to Maidstone in another temporary reorganisation last year and, in the east of the county, services are temporarily concentrated at the Kent and Canterbury Hospital in Canterbury because of the covid-19 crisis.

The long term plan is to create three hyperacute stroke units at Darent Valley, Maidstone and the William Harvey Hospital in Ashford. This would see units in Tunbridge Wells, Medway and Thanet closed.

This has been challenged in a judicial review, which campaigners lost but are hoping to appeal. The reconfiguration has also been referred to the IRP by health secretary Matt Hancock. Although the IRP is understood to have given its advice, it has not yet been published.