• A judicial review has been brought against CCGs planning to centralise stroke services
  • Plan for services across Kent and Medway challenged on health inequalities grounds
  • Case heard at Royal Courts of Justice on Tuesday

The NHS in Kent failed to take account of its duty to reduce inequalities when it decided where to place hyperacute stroke services, a court was told.

The eight Kent clinical commissioning groups – plus CCGs from Bexley in greater London and High Weald Lewes Havens in East Sussex – did not take account of the impact on deprived communities in Thanet when they decided on the three locations for combined hyperacute and acute services, said David Blundell, in the first day of a judicial review hearing on Tuesday.

Mr Blundell is representing a man from Thanet, who cannot be named, who currently would be taken to the Queen Elizabeth, the Queen Mother, Hospital in Thanet if he suffered a stroke.

Under the CCGs’ proposals from February last year – which have yet to be implemented – the man would have to travel to Ashford’s William Harvey Hospital, 37 miles from his home. Medway Council and a second claimant from Thanet and are also represented at the hearing in London’s Royal Courts of Justice.

They are asking Mrs Justice Farbey to overturn the CCGs’ decision to place hyperacute stroke services at the William Harvey, Maidstone Hospital and Darent Valley Hospital in Dartford. Services at Medway, the QEQM and Tunbridge Wells Hospital would be closed – although the Tunbridge Wells service has already been temporarily centralised at Maidstone.

Mr Blundell argued that the Health and Social Care Act 2012 not only required the NHS to take account of the impact of such changes on health inequalities but also to take decisions which reduced health inequalities, under section 14T of the act. This has not yet been tested in court so the judicial review could provide an important precedent for other decisions.

“This is a duty which applies both to access to health services and outcomes,” he said. “An improvement for all will not meet the need to reduce inequalities.”

Mr Blundell said the case was not a challenge to the clinical merits of the decision but whether the duties around inequalities had been met by the decision. He pointed to guidance from the National Institute of Health and Care Excellence and the Royal College of Physicians which said treatment should start “as soon as possible”.

The planned reconfiguration would lead to much longer journey times for patients with strokes who lived in the most deprived areas of Kent and Medway, he said. “You have to have regard to reducing the [inequalities] gap and the most obvious way is maintaining services in these deprived areas.”

Lawyers for the CCGs are expected to argue that implementing hyperacute stroke units will improve the quality of care and therefore outcomes for all Kent and Medway patients – and that, as people living in deprived areas have a greater chance of strokes, they will benefit most.

Director of acute strategy and partnerships for the NHS in Kent and Medway Rachel Jones said: “We cannot comment on the proceedings at this time, nor can we speculate on the outcome of the hearing. However, we welcome the opportunity to present our case to the court.

“We are looking forward to reaching a resolution so that we can make plans for the next phase of our work to improve stroke services for patients across Kent and Medway. In the meantime, we are grateful to our stroke teams for their ongoing hard work and commitment.”

The hearing is expected to continue for several days.