Agenda and minutes

Apologies for absence were received from Councillors Clarke and Fearn. 

There were none. 

Members are invited to disclose any Disclosable Pecuniary Interests or Other Significant Interests in accordance with the Member Code of Conduct.  Guidance on this is set out in agenda item 4.

Disclosable pecuniary interests

There were none.

Other significant interests (OSIs)

There were none.

Other interests

There were none.

This report advises Members of the decision made by the Joint Committee of CCGs for Stroke Services (JCCCGs) on 14 February 2019 to locate Hyper Acute Stroke Units (HASUs) at Darent Valley Hospital in Dartford, Maidstone Hospital and the William Harvey Hospital in Ashford. Acute stroke treatment in Kent and Medway is currently provided at these three hospitals as well as at Medway Maritime Hospital, Queen Elizabeth, the Queen Mother Hospital in Margate and Tunbridge Wells Hospital. Development of the NHS agreed option will result in the removal of treatment of stroke patients from these hospitals.  

The Kent and Medway Stroke Review Joint Health Overview and Scrutiny Committee (JHOSC) met on 26 February 2019 and recommended the relevant committees of the four partaking authorities to support the decision of the JCCCGs, subject to the NHS making an undertaking to review the provision of acute and hyper acute units, should demographic changes require it. 

This Committee is invited to consider whether to accept the JHOSC recommendation or to report the matter to the Secretary of State for Health. A report can be made to the Secretary of State where the Committee is not satisfied that the NHS consultation with the Joint Overview and Scrutiny Committee has been adequate in relation to content or time allowed or where the Committee considers that the proposal would not be in the interests of the health service in its area.

Discussion

The Director of Public Health introduced the report, summarising Medway’s concerns in relation to the NHS chosen option for the Kent and Medway Stroke Review.

The report set out the outcome of the Kent and Medway Stroke Review Joint HOSC (JHOSC) meeting on 26 February 2019 that had considered the outcome of the review. This had followed the meeting of the Joint Committee of Clinical Commissioning Groups for Stroke (JCCCGs) on 14 February. This had selected Option B, which would locate Hyper Acute Stroke Units (HASUs) at Darent Valley Hospital in Dartford, Maidstone Hospital and the William Harvey Hospital in Ashford.

Medway Members of the JHOSC did not consider that Option B was in the best interests of the population of Kent and Medway. A motion was put to the JHOSC requesting that it recommend that the individual health scrutiny committees of Medway, Kent, Bexley and East Sussex consider referring the decision to the Secretary of State for Health. This motion was not agreed. The JHOSC then recommended that the individual committees do not make a referral. The Medway Health and Adult Social Care Overview and Scrutiny Committee needed to determine whether the decision to select Option B warranted referral to Secretary of State for Health in view of the issues identified in relation to it.

Medway had relatively high levels of deprivation with some of the population living in areas amongst the most disadvantaged communities in England. Medway Maritime Hospital served a population of approximately 500,000 from Medway, Swale and elsewhere in Kent. Evidence from the Sentinel National Stroke Audit programme that monitors outcomes for people who have had a stroke showed that people from more disadvantaged communities had worse outcomes if they had a stroke.

The proposed HASUs set out in Option B were located in some of the more affluent CCG areas in Kent and Medway. The JCCCG had been told that Option B would reduce health inequalities but Medway Council had seen no evidence that this would be the case and none had been presented to the CCGs. Furthermore, Option B would increase the likelihood of health inequalities persisting in Medway and disadvantaged parts of Kent.

Mitigation work had been undertaken by the NHS to ensure that Option B would provide sufficient bed capacity. However, under Option B, bed capacity would be insufficient by 2023 without further action as the proposed mitigations were based on the assumption that patient length of stay could be reduced in order to free-up beds.

The Council had commissioned an independent review of the Stroke Review decision making process. This had identified that the weighting of additional factors, not considered at the consultation stage, had resulted in Option D not being identified as the preferred option. Had these factors not changed, it was considered likely that Option D would have been selected.

A range of issues had been identified by the NHS that needed to be resolved in order to make the stroke system work effectively post HASU implementation. The  ...  view the full minutes text for item 875.