Cllr Karen Constantine Seeing Red: Ashford Hyper Acute Stroke Unit back on the table. 

The HASU, hyper acute stroke unit, is back on the agenda.

When it comes to recognising a stroke, I’m sure we’re all familiar with the Act FAST campaign

• Face – has their face fallen on one side? Can they smile?
• Arms – can they raise both their arms and keep them there?
• Speech – is their speech slurred?
• Time – to call 999

We know that getting treatment as fast as possible is important. ‘Time is brain’ they say; you lose about 1.9 million nerve cells every minute that a stroke is left untreated. This can result in slurred speech and paralysis. If left untreated, a stroke can result in permanent disability and of course death. However, deaths related to strokes have decreased by 49% in the past 15 years. This is due to better prevention and quicker, more advanced treatment. That’s what HASUs provide – expert treatment in one place – ensuring better clinical outcomes. Thanet residents need access to a HASU.

The Kent HASU plans and subsequent reconfigurations of services started in 2014. Thanet residents were vehemently opposed to the closure of the stroke unit at QEQM hospital, and appalled that this service was planned to be delivered in Ashford. Many of us will remember signing a petition to Jeremy Hunt, then Secretary of State for health, which drew more than 5,000 signatures.

We also demonstrated to show our opposition, with hundreds, waving placards outside QEQM saying ‘Ashford is too far!’ Along with supporting our community champion Marion Kepple in her judicial review to challenge this decision. In the event, our judicial review was unsuccessful. Covid then interrupted plans to develop a HASU at the William Harvey Hospital in Ashford. Stroke treatment was provided in the interim at Kent and Canterbury hospital in Canterbury, and with very satisfactory outcomes. But it’s all change, the Ashford HASU is back on the table.

Refreshed plans will see the HASU at the William Harvey Hospital opening in 2027. I still wholeheartedly believe Ashford is too far!

Let’s remember the key facts.

• In England, one in six people will have a stroke in their lifetime, around 30% of people who have a stroke will go on to experience another stroke.
• Stroke is a leading cause of death and disability in the UK. There are around 32,000 stroke-related deaths in England each year.
• While the majority (59%) of strokes occur in the older generation, Public Health England’s recent figures also found that over a third (38%) of first-time strokes happen in middle-aged adults (between the ages of 40 to 69).
• More first-time strokes are now occurring at an earlier age compared to a decade ago.

Thanet’s health metrics are concerning. We have the highest rate of stroke in Kent. And yet we are the population who will have to travel furthest for treatment. How can that make sense?

A stroke is considered a Cat 2 ambulance call out. That means an individual calling 999 with a suspected stroke should be seen by ambulance staff within 18 minutes. Then transferred to a HASU for treatment. Remember, the clock is ticking. Over the last eight years we’ve witnessed a fluctuating service by ambulances.

I just checked Google, a trip to William Harvey Hospital now is estimated to be 1 hour and 2 minutes. Even with blues and twos, Imagine that trip in adverse weather – Storm Éowyn anyone? Or in extreme heat which happened to me when my partner was taken into William Harvey! My two and a half hour journey to see him in Ashford was a stressful, exhausting, blistering-hot, nightmare. Consider also that we still anticipate significant increased congestion on the roads due to the new Brexit impacts on Dover. (All those pesky border checks!)

I say ‘refreshed’ plans because Thrombolysis and Thrombectory treatments are now going to be provided on different sites. William Harvey Hospital and Kent and Canterbury Hospital respectively. But as you might know, you cannot assess what type of stroke you’re having until you’ve had a scan. And the treatments for both are very different.

Thrombolysis which is a blood clot in a blood vessel, is treated by injecting a clotbusting drug. Thrombectomy is a blood clot on the brain and is treated by a surgical procedure that removes the blood clot. In order to make the right clinical decision, the patient i.e. you and me, must first be scanned to understand what sort of stroke we’re having and therefore what sort of treatment is appropriate. At this stage, I cannot understand why these two services would be delivered into entirely different geographical locations. I doubt the staff at Kent and Canterbury are happy about this either!

It is due for discussion at the Health Overview and Scrutiny Committee (HOSC) next week. However, I am so concerned about the update I have received, that I have already submitted a list of detailed questions, which I would ideally like to be fully answered at next week’s meeting.

Health is both an important and a complex area. In order to understand what the integrated Care Board’s plans are and to cooperate and assist them to ensure we get the best for Thanet residents, submitting questions in advance seems sensible on this occasion.

The questions that I have submitted are as follows.

1 Where will scans be done? Will suspected stroke patients be scanned in QEQM or Thanet’s new health hub?

2 Where else is thrombectomy and  Thrombolysis on separate sites, and what is the distance between them. I’d like to be reassured that this isn’t a departure from usual practice and that the clinical pathway and efficacy are solid.

3 Do we have any thrombectomy capacity at William Harvey Hospital? If not why not.

4 We need call-to-needle times for Thanet (and the assumed call-to-needle times) and comparisons for Kent and Medway.

5 Given the known risk to Thanet residents, the HOSC will need to receive Cat 1 & Cat 2 figures much more regularly updates, every three months from when the unit opens.

6 Are we planning to scan patients from the Canterbury area at William Harvey Hospital and then potentially return the thrombectomy patients to Kent and Canterbury?

7 Can we have more detail on the proposed admission pathway. For instance when patients are in a queue for admission who would be given priority. Will travel time be considered? Or will it be first come first served?

8 Given the delay in commissioning the HASU can we know up-to-date figures on the percentage of people who are within 1 hour of a HASU and the percentage of those who are more than an hour away. Can we have a map to illustrate this please?

9 Despite the passage of considerable time, and reassurance that was given around the time of the Judicial Review there is no detail on how economically disadvantaged relatives (or close friends) will be financially supported to travel to Ashford. The up-to-date one way costs are –

Taxi £140 – £180

Train £16 – £23

Car £9 – £13

The times vary but the absolute minimum is one hour. Taxi’s may be required from Ashford railway station and parking fees are payable.  Thanet is the poorest area in Kent, both in terms of average earnings and disposable income. Very few people have any savings.

These are important questions that require detailed responses. Do we need a HASU closer to our deprived coastal community? We need the Integrated Care Board to get this right. If not, Thanet might need to complain and campaign – again.