I am the senior stroke consultant at East Kent Hospitals, working in Margate, Canterbury and Ashford, and I am passionate about people getting the best treatment for stroke. I have dedicated my career to it and it saddens me deeply that local people do not always get the best care currently, despite the efforts of our fantastic stroke teams.
Based on overwhelming evidence, I am certain that the way to save lives and reduce disability for stroke patients is to set up three excellent hyper acute stroke units in Kent and Medway. In these, you would get expert care from a 24/7 stroke specialist team for the vital first 72 hours. As set out in our public consultation, acute stroke units and TIA clinics would be based there too.
I am also firmly convinced, as services are currently configured, that Ashford is the right place for the proposed east Kent hyper acute stroke unit, and that it will reduce deaths and long-lasting impairments for the people of Thanet, as well as the wider population of east Kent.
I know that some people are questioning why we need to change. I am touched that they value our existing stroke service at Queen Elizabeth the Queen Mother Hospital (QEQM), which is good, but it can, and should, be better.
The reality is that the stroke care we can provide in Ashford and Thanet is not meeting national standards, and is not as good as our patients deserve. We do not have true hyper acute stroke units anywhere in Kent, and we do not provide a full service seven days a week at any, due to a national shortage of trained staff.
The stroke team at QEQM and Ashford do not have all the specialist staff that patients need, such as speech and language therapists, for example. We do not have stroke consultants on the stroke unit every weekend and we cannot give patients seven-day assessments by a multi-skilled team.
The brutal truth is that we do not save as many lives as we could if people had access to a hyper acute stroke unit, with a specialist team providing 24/7 care. I am surprised that members of the public have not demanded this change sooner. We, certainly, working within stroke, have thought about it for a number of years.
I sympathise with people who feel the solution is a hyper acute stroke unit at QEQM and another at William Harvey. On the face of it, this looks like an attractive option.
As a hospital trust, we feel we could not deliver two hyper acute stroke units. Despite our best efforts, we struggle to recruit specialist NHS staff in east Kent. Existing stroke services in north and west Kent are so near London that if they closed, it would be natural for their staff to commute there, rather than to Margate.
The options set out in the consultation were arrived at after a really careful, detailed evaluation of the places where the proposed new units could be based. People taking part did not know which sites they were commenting on – the evaluation was “blind” for complete fairness. This concluded that QEQM would not be sustainable, given the lack of adjacency to other specialist services recommended such as PPCI for the most serious heart attacks, interventional radiology, trauma, and vascular surgery.
I understand why some people in Thanet are concerned about the proposal that they travel to Ashford for urgent stroke care instead of going to QEQM. This appears to go against the well-known ‘Act F.A.S.T.’ advice.
But, as a stroke consultant, I must stress that the most important thing is to get to the right place as quickly as possible. The F.A.S.T. message is: call 999 as soon as you spot the symptoms of stroke. After that, what makes the difference is having the first 72 hours of your care delivered 24/7 by a specialist team, and getting clot-busting treatment swiftly if you need it. It is better to have an hour in an ambulance to a specialist unit where you will be treated quickly, than travel for 15 minutes and wait for over three hours in A&E, which can happen, I am sorry to say.
In the south east, we have set ourselves a standard of two hours from 999 call to thrombolysis (treatment to dissolve clots) for the ten to 20 per cent of stroke patients who need it. I am proud of this stringent standard.
I am confident that added investment in ambulance services as part of the implementation plan, and the new way of working at hyper acute stroke units, would see the vast majority of people from Thanet getting clot-busting treatment at Ashford (if they needed it) within two hours or very close to it.
I cannot tell you how wonderful it is to see a stroke patient walk out of hospital after a few days, going back to their normal life. That is what I want for as many people as possible.
As a doctor who treats patients who have had a stroke every day of my working life, I believe the proposed changes are the right thing to do for everyone in east Kent, and this very much includes residents in Thanet. And that’s why they have my full support.
To find out more: www.kentandmedway.nhs.uk/stroke – please read our consultation document, come to one of our meetings if you can, and respond to our questionnaire.
Did the “blind” consultation, consider where most stokes at present occur, it would appear a simple decision to put the Acute Stroke Unit where most potential clients are. There by assuring a FAST response time.
No account of demographics of Thanet has been taken as I can see.
Travel to Ashford is going to put lives at risk.
Again this man thinks Ashford is in east Kent , and has publicly said he drove from Ashford hospital ( postcode tn24) to Margate (ct9) in less than 45 minutes driving within the speed limit I will give £500 to his given charity if he can drive from Margate (east Kent) to Ashford (MID Kent) in less than 45 minutes during office hours . His policy will mean more deaths in Thanet and I as a ELECTED councillor will oppose this UNELECTED outsider who is trying to destroy the NATIONAL health service in my patch
The QEQM currently has out of hours access to consultant assessment for serious strokes that require clot busting drugs to be administered urgently. All of Kent’s hospitals do. QEQM hospital’s stroke unit is also above the national average in terms of rapid and accurate diagnosis, which means imaging (scanning) within one hour of admission. This information comes from the committee’s own consultation materials (Fig. 7 Pre Consultation Business Case, page 38). Myself and the group I campaign with, Save Our NHS in Kent (www.saveournhskent.org.uk) would like to see improvements to speed and quality of care across all of Kent in regard to stroke provision. We do not believe that relocating the unit to Ashford will be safe due to the long journey time. We have seen the report that Dr Hargroves refers to which concludes that a longer journey time to a better hospital is safer that a short journey to a bad hospital. That report also concludes that once the journey is over a certain length, the benefits of the best clinics will be reduced. It is about balance. Patients require the best hospital care AND a reasonable journey time. Proximity and quality of care are ultimately both important. Save Our NHS in Kent has a number of doctors that support our case, for example Dr Appleyard, Dr Richard Symonds and Dr Coral Jones all gave speeches at our last protest. We are meeting more doctors, nurses and paramedics all the time who don’t think the plan is realistic. We will be putting together an open letter from all those doctors in due course and will present it to the Kent and Medway STP group (the committee that designed this plan) and to the public.
Dr Hargroves needs to think outside the box! Use telemedicine. As we learned the nurses already administer thrombolysis at QEQM and are happy to continue to do so. Paramedics say that only on a perfect day with no traffic issues {very rare} do they reach Ashford from Margate in 45 minutes. They say usually much longer. How dare this man not consider the impact of shutting a vital service to the poorest & most vulnerable area of Kent who have a much lower life expectancy. There are plenty of ‘co-adjacent’ professionals in Thanet to offer rehabilitation to the stroke victims of Thanet.
Much of what your article sets out begins with a false premise.
This is not, and should not be, an either/or situation. Currently patients living in London suffering a stroke arrive at a HASU within sixteen minutes on average. The entire point of restructuring was (supposedly) to reduce disparities in care across regions.
Deciding that it’s fine for patients in one area to be treated within sixteen minutes whilst others are more likely to be treated within an hour and a half/two hours (potentially longer depending on ambulance availability and traffic) is the very epitome of a postcode lottery.
As you say, we deserve excellent care. So provide it.
Thanet needs a HASU.
When I drove to Ashford today, driving past QEQM, then to William Harvey… it took one and a half hours! Just saying…. perhaps though, a matter of LIFE or Death, or severe disability through a stroke not getting treatment quickly enough.
Recommend: A Helicopter being ‘at the ready’ at QEQM and William Harvey specially for the job of transporting stroke patients more quickly than that by road.
This consultation document, which cost £6 million, does NOT support the conclusions in the article. The map in the consultation which shows very good access for the whole of Kent is number 13, where the units are at QEQM, Ashford and Maidstone.
This configuration is not even in the final consultation ‘choices’.
Are the PFI hospitals determining which of the configurations are offered?
The 5 options, which all include one or both of the PFI hospitals, do not make any sense in terms of rapid access nor where strokes are most common. The need is Thanet, NOT Tunbridge Wells.
At QEQM and Ashford there are already well functioning units which score above the national average for arrival to diagnosis time, and slightly below for diagnosis to treatment time. The money earmarked for the reconfiguration would be much better spent improving these times in both hospitals.
In terms of difficulty recruiting staff, money should be spent on implementing the government recommendations for agenda for change (which have been drawn up), even before these are formally agreed. There could be an ‘east Kent weighting’ to help to attract people to Margate and Ashford.(similar to London weighting)
If you want to improve the health of the people of Kent, which you claim, then the A&E at Canterbury must be re-opened to prevent the appalling waits at QEQM and Ashford A&E and to give people effective treatment at Canterbury.
Suspected stroke patients need to be seen immediately at QEQM and Ashford by efficient triage. We hope that at the moment suspected stroke patients, heart attack or sepsis patients, are not left in an ambulance for 3 hours!!
If the requirement to have a HASU is to have speech & language therapists and physios every day (they do not need to be there 24 hours per day) then use this available money to increase the cover of the existing services.
The need for urgent thrombectomy after stroke is very rare according to NICE guidelines, these patients could be the ones who are transported.
It will worsen the health of people in the area of Kent already with the worst health outcomes if the existing stroke unit at QEQM is closed.
Once again Dr Hargroves I ask the question ‘When is a Listening Event not a Listening event’ As the question hasn’t been answered I suggest this:
When local people are asked to choose between options that are unacceptable to them, with no possibility of influencing the outcome, in a process that doesn’t consider their needs and fears. That.Dr Hargroves and your Unlistening Events is Is the reality and gloss and spin wont alter that. Its wrong, you know its wrong and you know we know it’s wrong. We will not accept a degrading of services for those most in need in our communities. Ian Venables
Received the consultation leaflet today and was surprised to see that the organisers aren’t planning to hold an event in either of Thanet’s largest towns, Ramsgate and Margate.
My partner was recently blue lighted to Ashford from QEQM with an emergency heart condition. So I know what it’s like sitting with your loved one in an ambulance and knowing he may die if you don’t get there in time. It was the middle of the day and light traffic and it took an hour. This proposal is about cutting funding and imposing a worse service on Thanet than we currently have.
The journey from Thanet to Ashford takes a minimum of 90 minutes, in heavy traffic even longer. What about patients who have strokes in bad weather like last week’s snow, they’d be lucky to make the journey at all! This will kill people.
Thanet is good now, it has the potential to be great. Give us a chance!
But what if you can’t get to Ashford easily from Thanet? The roads are often congested. This has to be the worst consultation ever. It just asked if you’d like a shiny new unit but didn’t make it clear that if you want a new unit you will lose your local services in Thanet.
The nature of a stroke call means that the stroke team are aware of the incoming patient with stroke symptoms and are present on the patients arrival at QEQM. To say that they wait three hours is scaremongering and very inaccurate- statistics please!
First we are not defending the status quo we have put forward an alternative that deals with the question of a lack of specialist staff. It allows for a HASU to do the intensive 72 hours but also allows people to get the earliest screening and thrombolysis if appropriate at the nearest hospital with a video link to the HASU which means being seen earlier and given a better chance of the best possible outcome. Secondly can Dr Hargroves point us to the research that demonstrates the improvements he claims in an area similar to Kent & Medway and not London where the situation is very different
As I understand from your own comments you have been running the EK teams since 2010. You felt in 2010 that you could match the service being pioneered with HyperAcute units in London and then Manchester. Although you say there is overwhelming evidence, your own documentation has no research which shows that reducing disability for stroke patients will be impacted by setting up three excellent hyper acute stroke units in Kent and Medway.
I have heard no-one question the desire to improve services. The CCG are being questioned because their legal obligation is to reduce inequalities, and they seem to be making a choice which increases inequality (same access to the same services as the West of Kent).
Regarding the 24/7 and seven days a week service – you currently make available 144 beds in Kent for stroke patients, all of which are staffed by trained professionals 24/7 and at weekends. There is no evidence in your documentation the stroke care you can provide in Ashford and Thanet is not meeting national standards, and is not as good as our patients deserve. I suspect it is inaccurate that the stroke team at QEQM and Ashford do not have some of the specialist staff that patients need, such as speech and language therapists. Again, you provide no clear documentation to show what is and is not provided at present. I suspect np specialism has it’s consultants working every weekend. As the person whose been in charge of this since 2010 (I think) – when you say you don’t provide seven-day assessments by a multi-skilled team, do you really mean that someone who has experienced a serious stroke gets none or insufficient or inadequate medical attention between a Friday afternoon and a Monday morning?
When you say “The brutal truth is that we do not save as many lives as we could if people had access to a hyper acute stroke unit, with a specialist team providing 24/7 care.” you are presumably assuming you will repeat what looks like a success in London. However, this wasn’t replicated at all in Manchester so it’s questionable that lives saved will be an outcome of this change.
“I am surprised that members of the public have not demanded this change sooner. We, certainly, working within stroke, have thought about it for a number of years.” That makes sense because it is your career and you are naturally engaged with it. We’re surprised you haven’t been able to maintain your standards against the national average – although actually right now QEQM is in the top quartile in the country for rapid and accurate diagnosis which seems the most important determinant in stroke care. Do you understand why you have not maintained your standards and if it relates to both the cuts in NHS funding and to the almost 50% cut in social care since 2010 – which would have much more impact in Kent, and especially Thanet, than in London?
The solution of a hyper acute stroke unit at QEQM and another at William Harvey was the only option (option13 in the original designs) which actually allowed you to get most people in Kent to a hyperacute unit in 30 minutes (bluelighted down to a maximum of 27) and everyone in Kent to a hospital within 45 minutes which the ambulance think they can blue light down to about 40. In Thanet (which has the most complex combinations of deprivation, and old age) it would take less than the 16 minutes which is the time it takes the London service to get people to hospital.
It’s difficult to understand why as a hospital trust, you feel you could not deliver two hyper acute stroke units. Given you tell us this change is happening throughout the country there will be a natural reduction in staff places and Thanet is becoming more and more attractive as a life style choice for couples with young children. So, with fewer places to fill, and such a wonderful place to live it’s hard to see that your past experience would extrapolate into the future as you are imagining.
Although you say the options set out in the consultation were arrived at after a really careful, detailed evaluation of the places where the proposed new units could be based – many aspects of your own evaluation are contradictory. In addition, siting the service at QEQM would logically expand the adjacency of other specialist services – unless NHSEngland wants to run down the service.
As a stroke consultant, I think you have to back up this “wait for over three hours in A&E” comment with clear data. It’s such a serious condemnation of the current A&E service at QEQM it cannot be repeated so regularly in this process without a more serious examination. Jeremy Hunt is free to embellish his claims and we temper our listening of them because we know he is a politician. The heads of our Clinical Commissioning Groups endorsing this sort of claim is a different matter because if accurate it raises serious questions about the current service. I think if you provide real data for the past year we may see that difficult to diagnose individuals have been left waiting and that it is likely they would be under the new system.
“In the south east, we have set ourselves a standard of two hours from 999 call to thrombolysis (treatment to dissolve clots) for the ten to 20 per cent of stroke patients who need it. I am proud of this stringent standard.” In your place I would be proud – except this whole change and it’s benefits are predicated on the London experience and they set a target of 30 minutes in the ambulance and this has in actuality been 16.
Then you mention people “getting clot-busting treatment (if they needed it) within two hours or very close to it” so regularly I think it’s important to note how few people this applies to. Part of the issue here is that of the 58 people who you say at present have strokes each week in Kent, only 11 will need treatment to dissolve clots, and on the Northumberland experience only 3 will actually be right for it – and of those 3 only 1 in 7 will get any benefit from it. Every person matters – it’s just important to not leave people thinking there is this magic solution to strokes when it is applicable to so few people and effective on so few of those who it is applied to.
“I cannot tell you how wonderful it is to see a stroke patient walk out of hospital after a few days, going back to their normal life. That is what I want for as many people as possible.” I think this comment is really difficult. I think you are suggesting an experience which may be being provided at present with the current units to the extent it can. What you aren’t addressing is the fact that acute units will discharge people around 15 days and some strokes take a long rehabilitation. You’re wanting to loan £36million over 20 years with £6million in interest payments to provide a very high quality initial short experience, when all the research is that prevention and rehabilitation are where the money produces results – this change addresses neither of these.
As a doctor who treats patients who have had a stroke every day of my working life, and is utterly committed to finding the right thing to do for everyone in east Kent, including the people of Thanet – perhaps you could slow down, look again at the fine detail of our experience in Kent which is distinct and work out how this fits with the other plans around the hospitals. I think if you could approach this differently you would find a creative way to up your game and match what London is accomplishing by re-configurating without the enormous expense and with solid improvements in outcomes which at the moment there is no evidence that any hyperacute unit is producing. You have my full support in doing this.
This excuse about not attracting staff is nonsense. I’m a young professional who recently moved to Margate and the idea that doctors don’t want to live by the sea with cheaper costs of living is nonsense.
Would East Kent potentially be an ideal place to explore or trial a ‘mobile’ stroke unit?…….just a thought. It would be expensive to implement but the ‘care at scene’ model would fit well in this geographical area?
The advice is clear you need to be seen within the “golden hour” however it is obvious to anyone surely the quicker the better. So wait for an ambulance the get loaded and off to Ashford with your chances of a good recovery diminishing every minute and if traffic heavy or an accident occurs then you have no chance. If those who make decisions were actually caring about stroke victims then it should be K&C Canterbury at the most surely?
If the proposal goes ahead, 134,000 Thanet residents, who now have a treatment 10 minutes away, will have to travel a minimum of 90 minuets. Aren’t the first 90 minutes supposed to be so crucial? This plan condemns 134,000 Thanet residents to death or disability in case of a stroke. The consultation is totally misleading. There is no mention in the consultation of the fact that the plan implies the loss of the stroke unit in Thanet.
Please not that this is happening around the country and the ‘critical’ ambulance journey time that they agree to stay within is different in each case – 30 mins in London, 45 mins in Yorkshire.
In Yorkshire, a senior consultant agreed with protestors that there was an absence of evidence for centralising stroke care in HASUs.
Please join Save Our NHS in Kent if you want to resist this unrealistic and unevidenced plan. http://www.saveournhskent.org.uk
Here’s the article about the Yorkshire consultant Prof Graham Venables, who admitted there was a lack of evidence:
https://calderdaleandkirklees999callforthenhs.wordpress.com/2017/08/21/west-yorkshire-and-harrogate-sustainability-and-transformation-partnership-bolts-towards-un-evidenced-stroke-services-centralisation/