• Judge turns down challenge to Kent and Medway acute stroke centralisation
  • Campaigners argued CCGs’ decision failed to take into account health inequalities
  • Health secretary and IRP decisions still pending

Campaigners fighting a regional centralisation of stroke services have lost their judicial review.

A judgment handed down this afternoon found in favour of the Kent and Medway clinical commissioning groups’ decisions to close stroke services at three sites, and create hyperacute stroke units at three others.

However, implementing the changes still depends on the decision on a referral to the health and social care secretary, which has been passed to the Independent Reconfiguration Panel. This is expected to be made public soon.

Save Our NHS in Kent — one of the groups which launched the judicial review — is considering whether to appeal. The judge accepted two of their eight points were “arguable” and warranted a judicial review, although then decided the claim failed on both of them.

When the case was heard at the Royal Courts of Justice in December, the campaigners argued the decisions did not take account of the level of deprivation in Thanet — which would lose stroke services at the Queen Elizabeth, the Queen Mother, Hospital — which the judge accepted could “warrant permission to apply for judicial review”. 

David Blundell, who is counsel for one claimant, an unnamed Thanet man, argued the Health and Social Care Act 2012 required the NHS to take account of the impact of changes on health inequalities, and also to take decisions which reduced health inequalities.

However, Mrs Justice Farbey found the commissioners had taken into account “all relevant factors including the impact on travel times for deprived communities” and the act did ”not mandate a particular outcome”. 

Justice Farbey also accepted judicial review could be warranted on the basis of an argument the consultation process had been unlawful. In particular, Jenni Richards QC, who represented Ramsgate resident Marion Keppel whose claims were supported by Save our NHS in Kent, argued the consultation did not include an option to retain services at QEQM.

However, the judge noted there had been “significant public involvement across the various stages” of the consultation which led to the chosen reconfiguration and concluded the consultation was “fair and adequate”. 

The campaigners’ other six grounds, including one focussed on patient choice, were all refused judicial review. 

Rachel Jones, senior responsible officer for the stroke review, which is led by the CCGs and sustainability and transformation partnership, said: “We are extremely pleased that the judge’s ruling means that we can improve stroke care and outcomes for local people.

“Our review of urgent stroke services, which started back in late 2014, has always been about providing the highest quality stroke care for patients and certainty for our hard-working staff.

“Evidence from other parts of the country, and from around the world, shows that this new way of providing stroke care reduces death and disability from stroke. Our focus now will be on implementing the new stroke units as soon as possible so we can deliver much-needed improvements.”

Carly Jeffrey, from Save our NHS in Kent, said: “We will be calling for effective measures to be put in place so that we can see a true picture of the before and after impact of these plans being implemented. Surprisingly, this end-to-end data isn’t recorded currently. It should be tracked from emergency call to outcome, and should apply to all changes in acute services — not only stroke, but also A&E and maternity, which are due to be reconfigured next.”

A joint committee of CCGs took the decision to set up combined hyperacute and acute stroke units in Maidstone, Ashford and Dartford last February. Units in Medway, Thanet and Tunbridge Wells were meant to close when these came on stream — but last September the unit at Tunbridge Wells closed due to staff shortages and services were temporarily concentrated at Maidstone.

Building work at the three hospitals due to host hyperacute units — the William Harvey Hospital in Ashford, Maidstone Hospital and Darent Valley Hospital, Dartford — has been delayed by the judicial review and by the referral to the health and social care secretary. The latter only relates to Medway Hospital, and was initiated by Medway Council. The Dartford and Maidstone units will now not open until at least April 2021 and the Ashford HASU has been delayed until at least October 2022.

The NHS commissioners have argued throughout that care for all stroke patients would be improved by creating hyperacute units, despite the increased travel time for some patients.