The Secretary of State for Health and Social Care, Sajid Javid, has given the go-ahead for changes to stroke services across Kent and Medway.
The decision means three ‘hyper acute stroke units’ are to be established at Darent Valley Hospital, Maidstone Hospital and William Harvey Hospital – meaning the closure of acute services at Margate’s QEQM Hospital as well as at Medway Hospital, Tunbridge Wells Hospital, and Kent & Canterbury Hospital – which has already had its service withdrawn due to the removal of training doctors by Health Education England in March 2017.
The go-ahead comes despite several years of campaigning against the changes from Save Our NHS in Kent and Ramsgate county councillor Karen Constantine.
Since the plans were revealed campaigners have held numerous protests and judicial review challenges were launched.
Two Thanet groups, Save Our NHS in Kent and Thanet Stroke Campaign, took a case to the High Court – alongside Medway Council- to fight the decision made by a Joint Committee of Clinical Commissioning Groups’ (JCCCG) to remove acute services from six hospitals in favour of three specialised units for Kent and Medway. A key part of SONIK’s case was that Kent needs at least four hyper acute stroke units (HASUs), and one must be in Thanet, to ensure that health inequalities are not exacerbated and all patients reach the care they need within approximately 35 minutes. However, these cases were rejected.
The referral to the Secretary of State for an independent review of the process was the last hope of campaigners but this has now been dashed.
The Secretary of State has supported in full advice received from the Independent Reconfiguration Panel (IRP) which reviewed and supported the decision by doctors from the as-was eight Kent and Medway clinical commissioning groups (CCGs), along with Bexley CCG and East Sussex CCG, to move from six general stroke units in Kent and Medway to three hyper acute stroke units (HASUs).
Kent and Medway NHS can now implement the HASUs and says it will also deliver a business case for investment in comprehensive stroke rehabilitation and prevention services across Kent and Medway.
Speaking about the decision, Dr David Hargroves, Senior Stroke Consultant for East Kent Hospitals University NHS Foundation Trust, and lead clinician for the Kent and Medway acute stroke review said: “The review of urgent stroke services in Kent and Medway has always been about improving the quality of care and outcomes for patients leading to fewer deaths and less long-term disability from stroke.
“All patients, no matter where they live in Kent and Medway, will benefit from being admitted to units that are able to provide excellent stroke care 24 hours a day, seven days a week.
“This welcome announcement from the Secretary of State for Health and Social Care means that we are able to proceed in earnest to deliver much needed improvements to acute stroke services, and certainty for our hard-working staff.”
Rachel Jones, Executive Director for Strategy and Population Health at Kent and Medway CCG, added: “We now have the go-ahead to focus on implementing our plans to deliver three hyper acute stroke units in Kent and Medway – a widely recognised way of delivering high quality hospital-based care for people in the immediate days after a stroke.
“We will continue to work closely with the doctors, nurses, therapists, other front-line staff and stroke survivors who have been so central to the design of these plans, as we seek to implement the HASUs as quickly as we can.
“I am also delighted to announce a wider package of investment, including £100,000 investment into Medway to support neuropsychological rehabilitation for the local Medway population. In addition we are working on a detailed business case for stroke rehabilitation and prevention services that will deliver further investment across Kent and Medway. We will have a clearer picture of this investment once the business case has been fully developed.”
In April 2020, in response to Covid and the need to separate non-covid inpatients from covid inpatients, East Kent Hospitals University Foundation Trust transferred its stroke services at William Harvey Hospital in Ashford and Queen Elizabeth the Queen Mother Hospital in Margate to the Kent and Canterbury Hospital. The stroke service remains at Kent and Canterbury at this time.
Carly Jeffrey of Save Our NHS in Kent said “Sajid Javid has closed our stroke units, and he’s done it with his eyes open. He knows the risks to the people in Thanet and other parts of Kent, and he knows the strength of public concern here. He knows because SONIK wrote a report detailing the medical studies which show how damaging closing essential emergency health care is.
“There’s so much evidence that closures of this kind will result in increase loss of life and lead to more people with severe disabilities. These cuts will take areas with already-poor health outcomes, and worsen them. We submitted our report to the IRP, which meant that Javid will have been required to read it. We want to make it very clear that Sajid Javid had it in his power to throw these plans out completely or to demand changes to the plans. He has chosen to approve them. Our politicians do not listen to the people they are supposed to represent, and they don’t appear to give a damn about us either.”
Cllr Constantine, who assisted resident Marion Kepple to bring a Judicial Reveiw attempt for the Thanet Stroke Campaign, said: ” The residents of Thanet have been massively let down by the SoS Sajid Javid. This is political chicanery.
“This decision is a disaster and will cost lives. Residents were so concerned that they took a Judicial Review and an appeal to fight this proposal. They failed. The people of Thanet have been utterly short changed. The Government have promised new and additional money for NHS, including a new hospital in East Kent. This is still a vague proposal. I’d welcome a discussion about the high level longer term plans for health and well being for Thanet residents. We also demand robust consultation.
“I’m particularly worried that the rate of strokes in Thanet is stubbornly high, the ratio of patients to GPs is amongst the worst in the country, the life expectancy gap between those in the poorer wards of Thanet like Cliftonville, compared to Royal Tunbridge Wells is a staggering 15 years difference. Moving stroke services from the very place they are needed most is simply stupid.
“In addition, not having a HASU in Thanet helps to continue the downgrading and hollowing out of QEQM. Nor have we heard about how more ‘hard up’ residents will get financial assistance to travel to see loved ones. This was promised.
“New radical treatment for strokes is coming on stream. A new clinical process called mechanical Thrombosis – MT, is now included as part of the treatment options for strokes. Figures for East Kent need to be looked at very carefully indeed.
“I believe we are close to the threshold required to justify a fourth HASU. As the local representative on the Kent HOSC I will continue to push for provision. We will keep fighting these wrongful decisions. Thanet residents cannot be treated like second class citizens when it comes to access to health.
“In light of Covid, the figures for predicated population changes and health needs to be freshly reviewed. We don’t know what the full impact of long Covid is, nor did we anticipate the dramatic influx of either tourists or those now seeking to move to coastal areas like Thanet. It is vital the the NHS are responsive to changing health and population needs.”
South Thanet MP Craig Mackinlay MP said: “My priority has always been to support the NHS and secure better stroke outcomes for my constituents. These 3 new HASUs achieve this.
“It has been admitted by clinicians that the current arrangements across 6 sites in Kent do not consistently meet standards that we would all expect. We deserve the best, and the fact is that current services as configured across six sites across Kent fall far short of national standards.
“Of course, a 4 centre option which upgraded QEQM to include a HASU for Thanet would have been my preferred outcome.
“But health ministers and NHS clinicians assure me that the shift to 3 HASU specialist centres to form part of the stroke care pathway for residents in Thanet will reduce disability and save an additional life every fortnight.
“In addition, high quality rehab will continue to be delivered locally to Thanet residents through the appropriate setting, including community, at home or in hospital.
“I have every confidence that our NHS clinicians and healthcare professionals will continue to have the best interests of my South Thanet constituents at the centre of all that they do.”
UPDATE: In response to statements made by campaigners NHS Kent and Medway has issued a letter:
There are an alarming number of inaccuracies and misleading statements from campaigners designed to scare the local community in Thanet. The overwhelming evidence on hyper acute stroke units (HASUs) is that they reduce death and disability from stroke, even if people travel further to get to them.
The independent report prepared for the Secretary of State for Health and Social Care makes abundantly clear that local doctors were right to decide to go from six general stroke units to three HASUs for Kent and Medway. The advice in the report is emphatic that the consultation and scrutiny process was robust and comprehensive.
A Judicial Review brought against the stroke review process and consultation found entirely in favour of the NHS. The courts also refused requests to appeal the outcome of the Judicial Review.
We started the review of urgent stroke services in Kent and Medway because, despite the hard work of our amazing stroke teams, stroke units were not meeting best practice standards. Patients were not getting the treatment they needed within the required timeframes.
During the consultation people told us they were worried about going from six to three stroke units. Over the last two years we have had to make emergency changes to stroke services because of staffing challenges and the Covid pandemic, meaning we now have three stroke units for Kent and Medway. Since this has happened, we’ve seen very significant improvements in care, evidenced by national data.
Going forward, we are committed to identifying solutions to help people visit their loved ones in hospital. This work has been on pause while we awaited the outcome from the Secretary of State but will begin again now we have the go-ahead to develop the HASUs.
There is no doubt in our mind that stroke patients are already getting better treatment and care than they were when our proposals were first put to the public in 2018 – and that this will only improve further once the HASUs are implemented.
Executive Director of Strategy and Population Health, Kent and Medway CCG
Dr Navin Kumta
Clinical Chair, Kent and Medway CCG
Dr David Hargroves
Senior Stroke Consultant and clinical lead for the Kent and Medway acute stroke services review