The battle over the future of Urgent Stroke Services continues in Kent and Medway, even after a unanimous decision of the Joint Committee of Clinical Commissioning Groups on February 14 to nod through a controversial plan to centralise services in new specialist units in Maidstone, Dartford and Ashford.

Each of the “Hyper Acute Stroke Units” are also supposed to have an acute stroke unit to give patients expert care after the first 72 hours until they are ready to leave hospital, and a clinic for assessing and treating transient ischaemic attacks (TIAs or mini strokes).

Medway is one of the four hospitals that now stands to permanently lose its existing stroke services when the HASU/ASUs are developed: the others are Tunbridge Wells Hospital; Queen Elizabeth, the Queen Mother Hospital in Margate; and Kent & Canterbury Hospital (where services are already “temporarily closed”). Medway Council has confirmed that it will seek a judicial review of the decision. The council has cross-party agreement to allocate £50,000 towards the cost of the challenge. Medway is about 12 miles by road (30 minutes in light traffic) from Maidstone, and 18 miles down the A2 from Dartford: these journey times increase at peak times of congestion, which delay even blue light ambulances.

Medway’s Conservative leader Cllr Alan Jarrett told Kent Online: “I am deeply concerned by this decision, especially as Medway Maritime Hospital is the local hospital for more than half a million people across Medway and Swale. When these changes happen, if any of them have a stroke they and their families will no longer be able to receive care locally.”

Even longer journeys are on the cards for stroke patients from Margate: from there to William Harvey Hospital in Ashford is around 40 miles, an hour’s journey by car at off peak times, while the other alternative, Maidstone, is five miles further away.

Journeys from Tunbridge Wells to Maidstone are around 20 miles (40 minutes in light traffic). In each case public transport options for relatives wishing to visit take even longer.

The business case document argument for the centralisation of services admits that “There was also some challenge and criticism,” and concedes that “some people must travel further to access acute stroke services,” but claims “this will be more than offset by the improvement in clinical quality from the introduction of HASU/ASUs.”

Yet campaigners have highlighted a number of concerns over the way the case has been argued and the statistics that have been used, which rely heavily on claims of numbers of lives saved by centralising stroke care in London.

These figures take no account on the number of lives that might have been lost as a result of increased delay in reaching hospital from areas where local services had closed down: and of course journey distances and travel times in Kent are much longer than London.

There are concerns about capacity of the new system: the plan involves a permanent 16% reduction in bed numbers for stroke patients, from 154 at present to 129: although 24 of these beds are already effectively closed by the “temporary” closure of stroke care at Kent & Canterbury, it’s clear the system will not be expanded despite the growing population..

Each of the three new centres will require additional beds to handle the extra caseload, with Maidstone and William Harvey Hospital more than doubling their current bed numbers.

to the stroke service plans, Medway Council warned of the danger that patients from South East London could wind up using a growing share of the remaining beds, especially in Dartford.

Medway is the largest and fastest growing urban area outside London: “the location of the HASUs outside of Medway will increase health inequalities”.

Medway’s response goes on to quote the Clinical Senate’s warnings on the likely pressures on the centralised stroke services, which “suggested that the increasing proportion of elderly people in Kent and Medway together with the increase in the overall population is ‘likely to result in an actual rise in the total number of stroke cases per year, even if the age-related stroke incidence remains the same’.”

Nor is it guaranteed that a centralisation will raise performance as promised. Comparative figures in a recent report on similar centralisation in Manchester reveal that many of London’s performance figures on stroke, even after its expensive centralisation, are not even in the top quartile of stroke units.

Indeed some Kent services, including the potentially doomed QEQM in Margate, are already outperforming London on access to imaging within an hour of admission.

Worryingly, the Business Case also points to the danger that one or more of the existing units could close even before the new services come on stream, or as they put it: “the risk of closing units becoming unsustainable due to an inability to retain and recruit staff”.

This risk is of course multiplied many times over by the blight that will inevitably fall on the doomed stroke units now it is clear they will close in a couple of years at most.

Health campaign group Save Our NHS in Kent claim staff are already leaving QEQM. Spokesperson Carly Jeffrey told the Isle of Thanet News:

“SONIK has been told that since staff at QEQM’s stroke ward were issued documents about their future employment, a number of skilled nurses have found new jobs elsewhere, as they were not able to move to Ashford. EKHUFT appears to have effectively decimated their own workforce at a time of national shortages. These are people with specialist skills and experience. We are told only two nurses from the stroke ward are willing to move to Ashford.”

The changes have been under debate for five years: if they are not held up by the judicial review (or staff shortages) they will move into the implementation phase. The CCGs anticipate that the new stroke service will begin at Maidstone and Darent Valley hospitals in about a year’s time, and at William Harvey Hospital in spring of 2021.

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