• Dartford, Maidstone and Ashford proposed sites for hyper acute stroke units
  • Medway expected to lose acute stroke unit
  • Proposals would need £36m capital investment, according to previously released figures

Proposals to replace six stroke units with three new hyper acute stroke facilities across Kent and Medway have been revealed.

Under the preferred option, set out by commissioners, Medway Foundation Trust will lose its stroke services with three HASUs at Darent Valley Hospital, in Dartford, Maidstone Hospital and the William Harvey Hospital In Ashford.

The Queen Elizabeth, the Queen Mother, Hospital in Margate had already been expected to lose services, leaving one unit in East Kent. But Medway FT had hoped to retain stroke services at the expense of Dartford and Gravesham Trust – which is closer to HASUs in London.

In a statement, the NHS in Kent and Medway said: ”Currently stroke services do not consistently meet best-practice standards across the whole of Kent and Medway. The identification of a preferred option brings the NHS a step closer to improving stroke outcomes and reducing deaths and disability because of stroke.” Several other regions in England have already centralised acute stroke services, most notably London and Greater Manchester, with subsequent evidence of improved outcomes.

The preferred option was announced last night after a workshop involving representatives from all 10 affected clinical commissioning groups – including NHS Bexley and NHS High Weald Lewes Havens. Five options were put out for public consultation earlier this year.

Patients from Medway are likely to travel to either Dartford or Maidstone if the preferred option is adopted.

Medway FT has an income of around £2.5m a year from existing stroke services and made a deficit of £66m in 2017-18: it is thought to have argued hard to keep stroke services.

If the preferred option is adopted, figures released earlier this year as part of the proposals suggest it will need over £36m in capital spending – mainly for a £22m new build unit at the William Harvey. A new build at Maidstone Hospital would cost an additional £11m, the earlier information stated.

According to earlier modelling by the Kent and Medway sustainability and transformation partnership stroke beds at the William Harvey would need to increase from 24 to 51, at Maidstone Hospital from 12 to 36 and at Darent Valley from 23 to 33. All three hospitals would provide both hyper acute and acute care for stroke patients, with further rehabilitation provided closer to home.

The impact would be felt in other areas as well with some patients in East Sussex who currently look to the Tunbridge Wells Hospital, potentially travelling to Eastbourne DGH which has a stroke unit and some limited impact on the Princess Royal Hospital in south London, according to background documents posted on the stroke review website.

Patricia Davies, the senior responsible officer for the Kent and Medway Stroke Review, said: “It is important to stress there are still several hurdles to clear before a final decision is made about the future of urgent stroke care in Kent and Medway.

”I appreciate this is a time of uncertainty, but I believe there is an exciting future for everyone working in stroke services across Kent and Medway. The identification of a preferred option brings us closer to being able to deliver the first class care our stroke teams strive for.”

Alan Jarrett, leader of Medway Council, said the preferred option would potentially put lives at risk and warned the council would challenge the decision. 

Lesley Dwyer, Medway Foundation Trust chief executive, said the trust was “very disappointed” not to be selected as a HASU site but it supported the development of HASUs as there was evidence they would improve outcomes for patients.   

“We will now continue to build on improvements already made to the care of stroke patients at Medway, such as receiving clot-busting thrombolysis drugs more quickly, and with access to consultants on a rota 24 hours a day, seven days a week,” she said.

“We need stroke services in Medway to be the best we can provide now for our patients, in the knowledge that they can be safely transferred to a HASU in future.”

The next step is the development of a detailed business case which will be examined by a joint committee of the CCGs, which will then make a final decision in early 2019. Implementation of changes is expected to take at least two years.

This story was updated at 11.30am on 18 September to include the views of Medway FT and council and at 13.50 to incorporate additional quotes