STROKE SERVICES-WORKING TOWARDS EXCELLENT STROKE CARE IN KENT AND MEDWAY

The NHS in Kent and Medway, Bexley in south east London and the High Weald area of East Sussex, is holding a public consultation on the future of urgent stroke services in Kent and Medway.

 

The NHS is asking for people’s views on proposals to establish new 24/7 hyper acute stroke units in Kent and Medway. The consultation runs from Friday 2 February 2018 for 10 weeks until midnight on Friday 13 April 2018.

To take part, people can read the consultation document, participate in public meetings and events, and complete an online or postal questionnaire.  There will also be specific engagement through focus groups and other work with people whose views are less likely to be heard, and people whose age, ethnicity or other factors puts them at higher risk of a stroke.

At the moment, there are no hyper acute stroke units in Kent and Medway, and urgent stroke care is provided at six hospitals. The changes to stroke services are being proposed because currently hospitals are not able to consistently deliver the standard and quality of stroke care that people should be able to expect.

The proposals have been developed by stroke doctors and other stroke specialists. They are in line with evidence-based best practice on how urgent stroke services can be run to give patients the best possible outcomes and reduce death and disability from stroke.

The proposals recommend creating three hyper acute stroke units in Kent and Medway, and give five different options for where these three new units could be located. If the proposals go ahead, urgent stroke services would not be provided in other hospitals in Kent and Medway.

Each of the proposed hyper acute sites would also 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).

The shortlist of possible locations is:

  1. Darent Valley Hospital, Medway Maritime Hospital, William Harvey Hospital
  2. Darent Valley Hospital, Maidstone Hospital, William Harvey Hospital
  3. Maidstone Hospital, Medway Maritime Hospital, William Harvey Hospital
  4. Tunbridge Wells Hospital, Medway Maritime Hospital, William Harvey Hospital
  5. Darent Valley Hospital, Tunbridge Wells Hospital and William Harvey Hospital

The order of the shortlist is not a ranking and no preferred option will be identified until doctors and others taking the decision about the future organisation of stroke services have fully and carefully considered all the evidence and data available, including feedback from the public consultation.

“There is clear evidence that patients benefit most from being treated at a hyper acute stroke unit in the first 72 hours after their stroke, even if that means ambulances driving past the nearest A&E department to get to one,” said Dr David Hargroves, clinical lead for the stroke review and senior stroke consultant at East Kent Hospitals University NHS Foundation Trust.

“We know that patients might currently be able to get to an A&E fairly quickly and the thought of travelling further seems to go against the ‘Act F.A.S.T.’ advice. With stroke, what counts is the total time it takes from calling 999 to having a scan and starting the right treatment. Spending 15 minutes in an ambulance but waiting three hours in A&E is worse than an hour in an ambulance going to a specialist unit that can scan you and start treatment within 30 minutes of arrival. It is also vital for patients’ recovery that over those first three days they are seen by a stroke consultant every day, and regularly assessed by specialist therapists – something we can’t offer at the moment.”

The consultation is overseen by the Joint Committee of Clinical Commissioning Groups for Kent and Medway Hyper Acute and Acute Stroke Services,  which has delegated authority from 10 clinical commissioning groups (CCGs): the eight CCGs in Kent and Medway, NHS Bexley CCG, and NHS High Weald Lewes Havens CCG.

  • Read our  frequently asked questions to find out more about the review The review has been focusing throughout on best clinical practice to improve outcomes for patients, particularly in the first 72 hours after a stroke.
  • The public consultation comes after work in partnership by all eight clinical commissioning groups (CCGs) in Kent and Medway to review acute stroke services. The review started in 2015 in response to national evidence, requirements, and recommendations specifically for ‘hyper-acute’ and ‘acute’ stroke care – in particular, the need for a specialist stroke unit to be available seven days a week.

Developing the proposals

In developing the proposals, there has been a rigorous process to review how urgent stroke services could be organised. The process involved stroke doctors, nurses, therapists and other stroke specialists, along with stroke survivors, carers and the public. They considered how many hyper acute stroke units would be needed in Kent and Medway and what combinations of existing hospitals could deliver the best access to patients, quality of care, and ability to recruit and retain staff, as well as many other factors. The shortlist of possible options for the location of hyper acute stroke units in Kent and Medway is based on this work.

Stroke survivors, their families and carers, and members of the public played a key part in shaping potential future models of care. Varied, robust and in-depth engagement took place to gather people’s views and insight.  This included surveys, focus groups, listening events and clinical engagement events.

In November and December 2015, three in-depth deliberative events, ‘People’s Panels’, looked in detail at the case for change, and questioned and challenged the proposals for improving future stroke care. They also voted on different aspects of services – establishing what they, as patients and carers, value most. 

In September and October 2016, there was a further series of events involving people who have had a stroke, their carers, and members of the public.  Healthwatch Kent and Stroke Association quizzed Dr Hargroves and the Programme Director Oena Windibank, commissioners and representatives from other organisations including the ambulance service and public health, about the work to date.

Travel times

Each option allows at least 98 per cent of people treated in Kent and Medway to access a hyper acute stroke unit by ambulance within an hour. This is particularly important for people – 10 to 20 per cent of stroke patients – whose stroke is caused by a blood clot. Best practice standards say all patients should have a brain scan and those with a blood clot should start treatment with clot-busting drugs within two hours of calling 999. The review team of stroke specialists believes a journey time of an hour allows hospital staff to achieve this standard.

Cost

Making these changes would require up to £40million investment in building work and equipment at hospitals and for recruiting more staff across the county, but experience from elsewhere shows it costs less overall when patients are treated in hyper acute stroke units. This is because, when more patients can leave hospital sooner, and with less disability, they need less support in the long-term.

Symptoms of stroke

Public Health England’s Act F.A.S.T. stroke campaign urges the public to call 999 if they notice even one of the signs of a stroke in themselves, or in others:

  • 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 – time to call 999
  • For further information, please visit www.nhs.uk/actfast