STRUCTURE: There is an ‘urgent need’ to improve stroke services across Kent and Medway, commissioners have decided.
Eight local clinical commissioning groups are reviewing the area’s stroke set up because of concern over the performance of seven units currently admitting patients in the area.
None of the units treat enough patients in a year to meet guidelines, according to an update from the CCGs given to the Kent Health and Overview Scrutiny Committee. The national recommendation is that a unit should see more than 600 patients a year.
Access to a specialist unit within four hours of being taken to the unit is also below the national average.
There is a shortage of specialists. Consultant numbers are “around 50 per cent” of recommended levels, while nurse and therapist numbers are also “significantly low”.
Only one unit in the area has seven day consultant cover and there is no specialist nurse cover at any of them over the weekend.
Stroke performance across the units is “variable” and improvements made are “slow and difficult to sustain”, the CCGs said.
All units have improvement plans in place, but several have recognised that continuing with the current model is “unsustainable”.
Stroke services are currently delivered from seven units at:
- Darent Valley Hospital;
- Medway Maritime Hospital;
- Maidstone Hospital;
- Tunbridge Wells Hospital;
- William Harvey Hospital;
- Kent and Canterbury Hospital; and
- Queen Elizabeth The Queen Mother Hospital.
Kent and Medway is one of the few areas in the country not to have fully implemented the National Stroke Strategy 2007, which sets out best clinical practice.
The commissioners’ “case for change” focuses on the first two weeks of care following stroke – hyper acute and acute stroke care.
It is currently being reviewed by the CCGs and the South East Coast Clinical Senate. If approved, options for reconfiguration will be drawn up. A preferred option is expected to be approved this year.
A spokeswoman for the CCGs said: “Stroke is a major cause of death and disability across Kent and Medway, with around 2,500 people having a stroke each year.
“Although there is no national specification in place for stroke services, the National Stroke Strategy provides guidance on recommended best practice.
“This shows that key to successful outcomes for stroke patients is a high quality stroke unit with rapid access to diagnostics, specialist assessment and intervention, 24 hours a day, seven days a week. Currently, a number of these requirements are difficult for Kent and Medway admitting units to achieve or sustain.”