Agenda item

This report updates the Health and Wellbeing Board on the current status of the stroke review currently being undertaken by the NHS in Kent and Medway.

Discussion

Five options had previously been identified as part of the Kent and Medway Stroke Review, which was looking to develop Hyper Acute Stroke Units (HASUs) at three hospital sites in Kent and Medway. The Review had announced Option B as its preferred option. This would see the development of HASUs at Darent Valley, Maidstone and William Harvey hospitals with there being no HASU in Medway. A Decision Making Business Case (DMBC) in support of the preferred option was currently being developed by the Stroke Review team.

From a Medway perspective, it was important to ensure that the people of Medway had good access to services. There was a strong case for a HASU being located in Medway in view of cardio vascular mortality rates locally being higher than the English average, Medway having one of the highest rates of admissions for stroke amongst the under 75 age group and local health inequalities. The next stage in the process would be for the Stroke Review Joint Health Overview and Scrutiny Committee to review and comment on the DMBC and proposal to develop option B. It was noted that the NHS Clinical Senate had recently provided its assessment of the proposal to the Stroke Review team. The Clinical Senate’s findings and input from NHS England would then be considered by the Joint Committee of Clinical Commissioning Groups, which was due to make a final decision in January 2019.

A number of Board Members expressed their support for the principle of developing HASUs and recognised that while it may sometimes be in the interests of Medway patients for services to be located outside Medway, this was not the case for the provision of acute stroke services in view of local health inequalities and incidence of stroke. A Board Member said that the Council was at the start of its journey to challenge the preferred Option B. The Member also noted that the Council had needed to submit a Freedom of Information Request in order to obtain key information in relation to the stroke review and that this request was being followed up.

A Board Member said that the evidence presented in the Stroke Review consultation document had suggested that option D would be the overall best option for the people of Kent and Medway. He emphasised the strength of feeling in support of a HASU being located in Medway and that people were understandably concerned about the future of Medway Hospital if services such as stroke were removed from it.

The Clinical Chair of Medway CCG advised that the Joint Committee of CCGs was formed of representatives of all the Kent and Medway CCGs as well as Bexley and one East Sussex CCG. The Committee was responsible for determining the best location of the three HASUs for the benefit of all of Kent and Medway. Two Medway Councillors had attended the Evaluation Workshop held on 13 September, where Option B had been identified as the preferred option. He stated that the Councillors had participated in the discussion, although they had observer status. Other Board Members said that these Councillors had been dissatisfied with the outcome of the workshop and noted that the Freedom of Information request subsequently submitted by the Council had been made as the Councillors had not been allowed to take the papers with them when they left the meeting.

A Board Member noted that East Sussex and Bexley had only been invited to join the Stroke Review Health Overview and Scrutiny Committee six months previously, although it appeared that these areas had actually been involved in discussions since the early stages of the project. The Member felt that Medway CCGs position was particularly disappointing given that a meeting held following the establishment of CCGs had agreed that Medway CCG would be supportive of the best interests of Medway.

Following discussion, it was agreed to change the wording of the recommendations set out in the report. This was to make clear that the preferred option B identified was the preferred option of the NHS and not of the Health and Wellbeing Board and also to make clear the Board’s preference for the development of Option D, which would include provision of a HASU in Medway.

The Chief Operating Officer of Medway NHS Clinical Commissioning Group (CCG) advised that he would not be able to support the recommendation before the Board to oppose option B as the CCG was of the opinion that the correct process had been followed, that the correct evidence had been obtained and assessed and that the development of Option B would provide a better service for the people of Kent and Medway.

It was moved that the recommendation set out in report, subject to the changes set out above, be agreed by the Board.

The recommendation was put to the vote and was carried.

Decision

The Board:

i)     Noted that Option B had been published by the NHS in Kent and Medway as the preferred option of the NHS for the location of three Hyper Acute Stroke Units (HASUs) across Kent and Medway at Darent Valley Hospital in Dartford, Maidstone Hospital and William Harvey Hospital in Ashford;

ii)    Considered the potential risks to the population of Medway as a result of the proposed option that would not award HASU status to Medway Maritime Hospital;

iii)   Supported the position of Medway Council in opposing the proposed option (B) and strongly supported continuing to press for its own preferred option D.