GP urges colleagues to reject hyper-acute stroke unit plans as decision looms

Dr Coral Jones wants the hyper-acute stroke unit decision to move services to Ashford to be rejected

A doctor and NHS campaigner is calling on her colleagues to vote against plans to close emergency stroke units, including the one at Margate’s QEQM Hospital, in favour of three hyper-acute bases for the region.

Dr Coral Jones, who is a GP and an active member of the Save Our NHS in Kent campaign, has spoken out as the stroke decision announcement becomes imminent.

The NHS in Kent and Medway – which includes all 8 Clinical Commissioning Groups – Bexley in south east London and the High Weald area of East Sussex, has plans for three hyper-acute stroke units in Kent and Medway with services earmarked to be provided at William Harvey Hospital in Ashford for all east Kent patients.

An announcement is expected this month following a meeting of the Joint Health Overview and Scrutiny Committee, made up of the clinical commissioning groups. The stroke review will present the final business case to the committee. A date will then be set for the Joint Committee of Clinical Commissioning Groups and a final decision made.

The NHS says hyper acute stroke units will reduce deaths as each will have a multi-disciplinary team of specialist stroke clinicians, seven days a week caring for patients in the critical first 72 hours.

As part of the review, health professionals in Kent and Medway say they are now designing new stroke rehabilitation services, including local hubs.

SONIK

But Dr Jones says a paper authored last year by Professor Pervinder Bhogal at St Bartholomew’s Hospital, London, brings to light evidence that must be considered before a decision is made.

Dr Jones says the contents of the paper are adequate to halt the stroke plans as it is made clear that the debate about journey time versus being treated in a specialist centre is still unresolved, with local treatment being recommended in the interim.

She said: “The study says that if the additional journey to a specialist centre is longer than 15-20 minutes, local care to stabilise the patient is a better course of action.”

Thanet stroke patients will face a one hour journey by ambulance to Ashford under the new plans. SONiK says most isle residents could reach the existing unit at QEQM by ambulance in 5-20 minutes. They say plans should include a fourth hyper-acute unit to be based at QEQM.

Dr Jones said “Our MPs and decision makers need to wake up. The decision to cut stroke units in Kent is not justified by evidence; in fact it flies in the face of the best evidence available.”

She is calling on all of the GPs on the committee that will be signing off the decision at the end of this month to vote against the plans. She said: “These GPs hold the lives of Kent residents in their hands. I hope they will make the right decision, despite the pressure on them from NHS managers.”

Letter

In a letter to GPs and the isle MPs Dr Jones writes: “The Bhogal paper and the NHS document highlight the lack of evidence supporting delay in primary treatment of stroke which will result from the closure of the stroke unit in Margate.

“The decision to close the Margate stroke service, which offers the recommended facilities of a Primary Stroke Centre of clinical assessment, CT scan and thrombolysis, is premature when plans for thrombectomy centres are being developed, and the results of the Barcelona RACECAT trial are not yet known.”

Thrombolysis is the treatment of a stroke with clot-busting drugs. Thrombectomy is the physical removal of a blood clot in the brain. Thrombolysis is administered in all of the six Kent hospitals that currently have acute stroke units, whereas thrombectomy is not.

SONIK spokesperson Carly Jeffrey

Save our NHS in Kent spokesperson Carly Jeffrey added: “We have been writing to councillors and the GPs who have a vote on the committee in recent months, providing details of all the flaws in the Stroke Review plan. If they do not take all of these factors into account it will be a serious breach of their responsibilities.

“If the GPs vote to approve the stroke plans, then we can call on KCC and Medway councillors to refer the plan back to government, and that is what we will be doing.”

Dr David Hargroves

Commenting on Professor Bhogal’s paper, Dr David Hargroves, Senior Stroke Consultant for Queen Elizabeth and the Queen Mother Hospital and William Harvey Hospital, said: “Professor Bhogal is an interventional neuro radiologist. The paper he co-authored highlights the absolute need for suitable stroke patients to receive thrombectomy (manual removal of blood clots in the brain) in a timely manner.

“We wholeheartedly support this and, while we don’t provide this very specialist service anywhere in Kent and Medway now, it is part of our longer term vision to provide thrombectomy in Kent and Medway in the future. The paper discusses the transfer of patients who are suitable for thrombectomy from stroke units to very specialist comprehensive stroke centres which can carry out the procedure. This is very different to the type of service Dr Jones is calling for, where she has suggested patients should be given clot busting drugs in A&E, and then transported to a hyper acute stroke unit. This approach is not suggested nor supported by the evidence in this paper.

“We are proposing to establish three hyper acute stroke units, or ‘HASUs’, at Darent Valley, Maidstone and William Harvey hospitals with one of these equipped to deliver thrombectomy in the future. These units will improve stroke care and outcomes for people, and we believe we will save an additional life every fortnight as a result.”

Carly Jeffrey disputed Dr Hargroves comments, saying: “Dr Coral Jones and SONiK are suggesting that Kent needs at least 4 HASUs with one located at QEQM. We are not suggesting that clot-busting drugs be administered in A&E. Dr Hargroves is missing the point of Dr Jones’ letter, which is that patients with severe strokes need to be stabilised within a reasonable amount of time, and that current thinking does not back up the stroke plans for Kent.”

Rachel Jones (pictured), Senior Responsible Officer for the Kent and Medway Stroke Review, said: “While I know Dr Jones is not a Kent GP but is based in London, I am surprised that any doctor would argue to maintain the below-par service currently provided to people in Kent and Medway.

“Despite the tireless hard work and commitment of our staff, at the moment our local stroke services are rated as some of the poorest in the country. This is wholly unacceptable and has to change. On average, 50 per cent of our stroke patients are not currently getting clot busting drugs within an hour of arriving at hospital and, in some places, as many as 83 per cent of stroke patients are waiting over an hour.

“This is mainly because we only have a third of the stroke consultants we need to deliver best care, and aren’t able to consistently provide specialist stroke teams to meet stroke patients directly as they get to hospital. Our proposals would see stroke services in Kent and Medway changing for the better. Combining our staff and resources into three hyper acute units, able to run 24 hours a day, seven days a week, will allow us to deliver excellent care to stroke patients.”

Protest

Save Our NHS in Kent are organising members of the public to attend a public meeting of health committee councillors held at County Hall on Friday,  January 25 at 9.30am.

If people want to attend but can’t afford the train fare to Maidstone, contact SONiK which will try and subsidise some costs. Those who are interested should email saveournhskent@gmail.com

15 Comments

  1. Fantastic that SONiK are keeping the pressure on. As the Ramsgate County Councillor I will be speaking against the removal of the Stroke Unit and calling for a HASU in Thanet at the next HOSC and at the JHOSC. The Kent County Council committees where the decisions are ratified. I have also written recently to our local MP, who now agrees, that Ashford is too far. The decision to have a HASU, is the correct clinical decision, but as I have being saying since this was first mooted in 2017, Ashford is just too far away. As ever please feel free to contact me, the information local residents provide to me is invaluable.

  2. Rachel Jones makes claims in this article about having support from councillors on the Health scrutiny committees which are, at best, misleading. Watch these videos to see what councillors really think think about the Stroke plans and the 4 year process that has attempted to drive this reconfiguration through: https://www.facebook.com/pg/SaveOurNHSKent/videos/?ref=page_internal

    Rachel Jones also talks about existing acute stroke units not meeting certain standards. We would all like to see improvements made in stroke care, but these proposals are not the way to do it. You will notice that NHS senior managers who want to ‘transform’ the NHS by cutting services (like Rachel Jones) will refer to ‘standards’ much more than ‘outcomes’. That is because this plan to halve Kent’s stroke units from six to just three has no evidence to back claims that it will improve patient outcomes in terms of death or disability – and that is what counts.
    Those driving this plan through are not paying attention to the fact that recent evidence goes against their proposals; they are also driving this through in a hurry before new evidence can be published, such as the Barcelona RACECAT trial and a new paper (due in Feb 2019) which is expected to show whether or not the London HASU reconfiguration outcomes were actually sustained beyond the initial trial period, where financial incentives were awarded to the participating hospitals to meet a set of agreed standards.
    Thanet is the area most adversely affected by this plan. Patients will have to travel one hour in an ambulance to Ashford for treatment in an emergency, driving past QEQM where they currently would be treated with life saving drugs. Some patients may wait 40 mins or more for an ambulance to arrive. The roads to Ashford are bad and in some cases too narrow to let a bluelighted ambulance past. There is a level crossing on one of the routes out of Thanet. And now we face the prospect of roads clogged with lorries due to arrangements to mitigate traffic at the port of Dover.
    We urge everyone in Thanet/Kent who objects to write to their councillors, both at district and at county level. write to your MP. Write to your local paper or phone up your radio station. Join Save Our NHS in Kent and come to our protests.
    Your silence on local NHS service cuts will be taken as consent for what is happening, so please speak up and spread the word.

    Contact your councillors here: https://www.writetothem.com/
    Carly Jeffrey, Save Our NHS in Kent

  3. I would agree that not all councillors on the Joint Health and Overview Scrutiny Committee are happy about this report – I am on this committee and I have severe reservations about the plans. I cannot see how the numbers in the report add up and feel that the huge ‘catchment’ area needs more than 3 centre. Rachel Jones is well aware and have confirmed these in writing.

  4. There is a fundamental flaw in the plans which is evidenced by the NHS 2019 ten year plan and in this proposal – a complete absence of a workforce and HR plan.SE coast health trust and Medway have no joined up thinking or a training plan in place with medical and nursing schools …they have been winging it with agency,locus and oversea imports for years and ten chief executives have left us with nothing to base this reform on…which is simply about ‘economies of scale’ not clinical needs of a growing elderly population of Thanet .

  5. Every Public consultation held in Thanet Overwhelmingly rejected all 5 options being considered; so did Thanet Council. Thanet Commissioners (TCCG) have ignored their own constitution where they are duty bound to “ensure services are easily
    accessible for the population” and the Kent & Medway Stroke Review have broken a huge part of their – ‘Guidance for NHS commissioners on equality and health inequalities legal duties’. As they are due to break much of this guidance, surely legal action should be possible. Unfortunately NHS England to whom they are responsible ignores my emails regarding this.

  6. Would it not be more acceptable to the people of Thanet to have a HASU based in the centre of East Kent in peference to one being planned on its furthest point at Ashford? Should we not all be campaigning to have a mobile Stroke Ambulance in East Kent such as the one currently being trialed in Essex that has already been shown to save lives and prevent permanent disabilities? Please note, I am commenting here in a personal capacity.

    • It’s not that simple Peggy. The roads of east Kent are poor, an getting to Canterbury from Thanet (and vice versa) take 45-55 minutes, depending on what part of Thanet you are in. The reason why Thanet residents do not feel travelling to Canterbury is safe in emergencies are the same reasons why Canterbury residents currently feel so strongly about having to go to Ashford or QEQM. They should not have to, as Thanet residents should not have to. Improving the roads is categorically not part of this plan. And another important factor is jobs. Thanet is a deprived area with high unemployment. Economically, it desperately needs a boost, not a kick in the teeth… QEQM employs 2000 people currently. The QEQM is an anchor institution that should be used to build the economy of the area; it should not be whittled away until there’s nothing left. Also, the whole point of this article is this: “The study says that if the additional journey to a specialist centre is longer than 15-20 minutes, local care to stabilise the patient is a better course of action.” Centralising emergency stroke care should not be happening at all if journey times are increased by more than 15-20 mins. Thrombolysis should be available at ALL Kent district general hospitals, with Thrombectomy being offered in a specialist unit after a patient has been stabilised locally with Thrombolysis.

      • Your not wrong. The heslth economic multiplier is important. I wrote to Paul Carter (Leader of KCC) last year and he wasn’t ‘moved’ by the argument. We need more Councillors who are prepared to act in favour of the residents needs, and rights.

        Dear Karen

        Thank you for your email regarding stroke services and the current NHS consultation on developing hyperacute stroke services for the populations of Kent & Medway.

        I fully understand your concerns, concerns that will be echoed in the rest of Kent & Medway no doubt as the NHS progresses with public meetings and briefings. I understand that the NHS has given due consideration to all current sties that provide stroke services, but have equally considered the clinical evidence of benefit, travel times and numbers in order to arrive at the current options. The QEQM has been considered but ruled out in terms of not having desirable clinical co-adjacencies, the likelihood of attracting the specialist staff to effectively manage a hyperacute stroke unit, and the fact that a unit based in Thanet is unlikely to reach the clinically safe threshold of 500 cases per annum.

        I understand stroke outcomes are particularly poor in the current QEQM service which is not operating at HASU standards, which, like you, I am particularly concerned about, and know this situation can’t continue.

        However, I do think we need to take our steer from the clinicians, the NHS and the experts who are collectively advising that although travel times may well be longer, outcomes will be much better for all people of Kent regardless of where they live, including residents of Thanet.

        I understand the NHS consultation team have offered to meet with you and we are seeking a full Member Briefing as part of the consultation.

        I hope that sets out my position.

        Regards,

        Paul Carter, CBE
        Leader of Kent County Council

        —–Original Message—–
        From: Karen Constantine [mailto:karen@karenconstantine.co.uk]
        Sent: 11 February 2018 13:54
        To: Carter, Paul – LEADER
        Cc: Tony Martin ; Hazel Smith ; cllr-Jennifer.Matterface@THANET.GOV.UK; isleofthanetnews@gmail.com; cllr-stuart.piper@thanet.gov.uk; Bob Bayford ; cllr-chris.wells@thanet.gov.uk; newsdesk.thanet@krnmedia.co.uk
        Subject: Re proposals to move the Stroke Service out of QEQM Thanet.

        Dear Paul,

        As you will be aware there is a proposal on the table which effectively plans to remove stroke services from QEQM Hospital Margate. The current consultation excludes Thanet as an option under consideration for the citing a new Hyper Acute Stroke service, ( HASU ) in Kent.

        It is my belief, based on the evidence that I have found. That commissioning such a service outside of Thanet, possibly in Ashford, would be a disservice to the people of Thanet and perpetuate poor health outcomes.

        The current consultation does not adequately address the undisputed low health outcome discrepancies between Thanet and the rest of Kent. These should be fully taken into account. Unless they are taken into account in a robust and meaningful way the commissioners are not properly discharging their statutory duties to reduce such inequalities.

        Further, urgent consideration should be given to the opportunity to improve Thanet’s economic prospects, again it is undisputed that Thanet lags woefully behind the rest of Kent. By siting a HASU in Thanet the local economy would be boosted. For every pound invested in health services you get between £2.60 and £6 back. Vital for our local economy.

        It is imperative that both the health and economic opportunities, are fully considered in this proposal. Will you support me in asking for the consultation to be redrafted to include Thanet as part of the equation?

        Kind regards

        Cllr Karen Constantine Ramsgate.
        Cc Dr Tony Martin
        Hazel Smith
        Patricia Davis
        HOSC committee members
        Cllr Chris Well TDC
        Cllr Bob Bayford TDC
        Cllr Stuart Piper TDC
        Cllr Jenny Matterface

      • I wrote to KCC leader Paul Carter about this on 11th Feb last year. The health multiplier is an important issue. The response completely ignored the economic grounds!

        Dear Paul,

        As you will be aware there is a proposal on the table which effectively plans to remove stroke services from QEQM Hospital Margate. The current consultation excludes Thanet as an option under consideration for the citing a new Hyper Acute Stroke service, ( HASU ) in Kent.

        It is my belief, based on the evidence that I have found. That commissioning such a service outside of Thanet, possibly in Ashford, would be a disservice to the people of Thanet and perpetuate poor health outcomes.

        The current consultation does not adequately address the undisputed low health outcome discrepancies between Thanet and the rest of Kent. These should be fully taken into account. Unless they are taken into account in a robust and meaningful way the commissioners are not properly discharging their statutory duties to reduce such inequalities.

        Further, urgent consideration should be given to the opportunity to improve Thanet’s economic prospects, again it is undisputed that Thanet lags woefully behind the rest of Kent. By siting a HASU in Thanet the local economy would be boosted. For every pound invested in health services you get between £2.60 and £6 back. Vital for our local economy.

        It is imperative that both the health and economic opportunities, are fully considered in this proposal. Will you support me in asking for the consultation to be redrafted to include Thanet as part of the equation?

        Kind regards

        Cllr Karen Constantine Ramsgate.
        Cc Dr Tony Martin
        Hazel Smith
        Patricia Davis
        HOSC committee members
        Cllr Chris Well TDC
        Cllr Bob Bayford TDC
        Cllr Stuart Piper TDC
        Cllr Jenny Matterface

  7. Canterbury isn’t a viable option for us Peggy. More importantly it isn’t an acceptable option.

    Thus far studies do not back centralisation of emergency care, including stroke for areas such as ours. And even if they did, the disparity in attendance time is such that the outcomes of such a decision are unacceptable. Parity of care is supposedly the aim of the current government, via the Getting It Right First Time initiative. Parity of care is not simply having access to the same services; it is those services being accessible in a timely manner, especially for time critical matters such as stroke. Two stroke patients accessing the same services but an hour apart is not parity of care, in any sense, and everyone involved knows this.

    Canterbury needs a new hospital. But it is not and will not be acceptable for the current option to be chosen in order to enable that. Thanet needs emergency care, in both a moral and economic capacity.

  8. We need more councillors like Ida Linfield, Barry Lewis and Karen Constantine who are prepared to speak out about this. We need councillors to take action.

  9. Excellent article. We cannot afford to lose the stroke unit at QEQM, just for the sake of cutting costs at the expense of people’s lives. And where are our two MPs? Instead of raising the matter in parliament, they are conspicuous by their silence.

  10. The members of the stroke committee, voting on this , have a duty to take notice of evidence such as the one highlighted by Coral Jones here.

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