County leaders plan major stroke service shake-up

Leaders in the county are currently drawing up plans to consolidate stroke centres, including reducing the existing six centres offering immediate stroke care to three, each with a combined hyper-acute stroke and acute stroke service.

HSJ has learned that under current plans, one of the three hyper acute units could be developed as a thrombectomy centre. This could potentially slash travel times for Kent patients as these services are currently not available in the county – and establish the first such service outside a dedicated neuroscience centre.

A review of local stroke services is due to conclude next year.

Thrombectomy involves the physical removal of a clot blocking a blood vessel and can avoid serious disability or even death for some patients.

Only 23 trusts provide thrombectomy services in England – mainly teaching trusts or specialist centres. This currently means Kent patients who need the procedure are taken by air ambulance to St George’s Hospital in south London, which takes an average of two hours from the decision to transfer.

However, David Hargroves, clinical lead for the Kent stroke review, said the aim would be for a 45 minute ambulance transfer to the unit offering the service.

The intervention would need to be provided by skilled and competent staff – potentially interventional radiologists or cardiologists. This means an interventional radiology suite or a cardiology unit could become a local “hub” site for thrombectomy.

Dr Hargroves said: “We are absolutely adamant that our patients in Kent and Medway will not be denied this excellent treatment.” He added that he had discussed the scheme with national stroke lead Tony Rudd, who was supportive.

The service would need to be developed after the three hyper-acute stroke units are established, which is likely to be 2019 at the earliest.

The six sites currently providing stroke services are: Queen Elizabeth, the Queen Mother, Margate; William Harvey Hospital, Ashford; Maidstone Hospital; the New Tunbridge Wells Hospital; Medway Hospital; and Darent Valley Hospital, Dartford.

Although the sites for the three hyper-acute units have still to be decided, the William Harvey Hospital is a leading candidate for the thrombectomy service. This is because it has other cardiology services identified by the south east’s clinical senate as necessary to run hyper acute stroke services, and could be reached in 45 minutes from most other hospitals in the county.

Currently thrombectomy is provided in tertiary neuroscience centres, often serving a large urban population. NICE produced guidelines on it last year and NHS England announced plans earlier this to expand provision using 24 neuroscience centres. Even if this expansion happened, the nearest centres to Kent would be London and Brighton.

Up to 9,000 patients a year nationally could benefit from thrombectomy – between 5 and 10 per cent of those who have a stroke – but the numbers receiving it are still low. It is hoped that the additional cost of the procedure would be offset by reductions in long term health and care costs.