Concerns have been raised following an update on the long-running plans to create three hyper acute stroke units (HASUs) in Kent and Medway given to county councillors this month.
County Councillor Karen Constantine has questioned why the date for the planned HASU at Ashford has been pushed back to 2025/26; why services cannot remain at Kent & Canterbury where they are currently being carried out and, separately, why a patient at QEQM Hospital suffered a stroke that the family say could have been avoided if an MRI (medical imaging) had been completed earlier.
The HASU decision process
The Kent and Medway Stroke Review was commissioned in 2014 in response to concerns by Kent and Medway Clinical Commissioning Groups (CCGs) about the performance and sustainability of hospital stroke services across all units in Kent and Medway.
The CCGs and hospital trusts were tasked with developing proposals to improve outcomes for patients, reducing deaths and disability.
The review recommended a model of care involving specialist stroke services consolidated at three hospitals, each with a hyper-acute stroke unit (HASU) and an acute stroke unit (ASU), to ensure rapid access to specialist staff, equipment and imaging to improve quality and outcomes for patients.
Public consultation on the proposal was undertaken in 2018.
The decision was made for three ‘hyper acute stroke units’ 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.
The decision was approved by the Secretary of State in November 2021.
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 the three specialised units.
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 was also dashed.
HASU dates
The plan was initially for Darent Valley and Maidstone to go live in March 2020 followed by the William Harvey Hospital in spring 2021.
Legal challenges meant this was then set back to Darent Valley Hospital and Maidstone Hospital to open in April 2021 and the William Harvey Hospital to open in autumn of 2022.
Target opening dates for the HASUs was Darent Valley and Maidstone hospitals were once again set back to mid-2023 and Ashford by late 2023.
Phase 1 capital works are now nearing completion at Dartford and Maidstone with go-live dates now earmarked for on or soon after 1 April 2024, dependent on recruitment.
The East Kent Hospitals University NHS Foundation Trust (EKHUFT) scheme at Ashford is being developed as a second phase due to a lack of finances and the target date is now 2025/26.
An EKHUFT spokesperson said of the latest Ashford target date: “This is due in part to the pandemic but also due to the need to secure significant new NHS investment to build the Hyper Acute Stroke Unit at William Harvey Hospital. East Kent’s build will take place in the second phase due to capital constraints. Work is currently focussed on preparing for procurement.”
Funding
A bid to government for £460million to transform health care in east Kent was rejected earlier this year.
The funding from the government’s New Hospitals Programme had been earmarked to radically improve services in east Kent but East Kent Hospitals University Foundation Trust was informed that the bid was denied.
This has created uncertainty over how the Trust will fund its hospital transformation proposals, which had two options – the creation of a new “super” hospital in Canterbury or expansion of emergency services at the William Harvey in Ashford and QEQM in Margate.
This week it was also revealed EKHUFT is to hold a crunch meeting over its finances as its deficit grows to more than £50 million.
East Kent Hospitals £460m funding bid for service improvements rejected by government
Crunch meeting for East Kent hospital trust over £50m deficit
County Councillor Karen Constantine, who attended Health Overview and Scrutiny meeting for the update, said: “The full reconfiguration of HASU’s, Hyper Acute Stroke Units was unfortunately interrupted by Covid, and this saw Thanet patients being sent to Kent and Canterbury at Canterbury for assessment and treatment.
“However the full reconfiguration is now going ahead although the HASU at William Harvey is not expected to be operational until 2025.
“At the moment those who are suspected as suffering from a stroke and requiring a scan to determine lifesaving treatment of either an injection or Thrombectomy will continue to be taken to Canterbury.
“Many Thanet residents remain deeply concerned about the distance and time to get to Ashford. I remain seriously concerned about the call to needle time.
Scan failure
“I am also concerned about stroke treatment at QEQM. A recent incident has been bought to my attention, when a failure to scan a patient at QEQM led to a stroke that could have been avoided.
“This was an otherwise healthy patient who I am told, was slipping in and out of consciousness, had a continued headache, was lethargic, who was nauseous and vomiting with sensitivity to light who wasn’t scanned for over four days, and was then only scanned after a seizure which was in fact a stroke.
“These symptoms do indicate a potential stroke and should have been acted on.”
Sarah Hayes, Chief Nursing and Midwifery Officer for East Kent Hospitals said: “We sincerely apologise to (the patient) for the delay in his MRI scan. We are looking into why this happened and are in touch with his family.”
Stroke services at Kent & Canterbury Hospital
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.
Health activist Caroline Heggie says the stroke facilities at Kent and Canterbury are providing a good service and ideally geographically placed.
She said: “ Given they are now proposing thrombectomy at Kent and Canterbury, which was in large part the reason for the reorganisation, why can’t they simply leave it there? This would give much needed certainty to staff and patients alike.”
Cllr Constantine added: “We have a culture of reorganisations in the NHS which are difficult to keep up with and use up valuable resources. Perhaps it’s now time to see how a HASU located close to Thanet performs before finally committing to a HASU at Ashford’s William Harvey Hospital.
“This isn’t an ideal solution for Thanet – which should have its own HASU – but it’s much better than the option of nightmare journey of more than an hour.”
The EKHUFT spokesperson said: “A comprehensive review of the service was undertaken. Following public consultation, a decision to cite these units at William Harvey, Maidstone and Darent Valley hospitals was taken by the NHS in Kent and Medway in 2018 and approved by the Secretary of State in 2021”.
The NHS says Kent and Canterbury Hospital (KCH) does not have an A&E department and services are not expected to remain on that site because data evidences improved outcomes when a HASU is co-located with an A&E.
Stroke rehabilitation
This summer a new specialist stroke rehabilitation unit opened in Thanet
The unit, which is run by Kent Community Health NHS Foundation Trust (KCHFT), is based at Westbrook House, Margate and provides round-the-clock care, seven days a week.
