The NHS in Kent and Medway is establishing three Hyper-Acute Stroke Units (HASUs). This report sets out details of Medway Council concerns in relation to the matter. Medway Council believes that the sites that have been selected are not in the best interests of the health service in Kent and Medway. Furthermore, Medway Council believes that there were flaws in the way that the Joint Committee of Clinical Commissioning Groups was led to choose the selected sites.
The Chairman welcomed Rachel Jones, Senior Responsible Officer (SRO) for the Kent and Medway Stroke Review, who was present at the meeting to answer questions from Members in relation to the review of urgent stroke services in Kent and Medway. He thanked her for attending.
The Director of Public Health for Medway Council explained to the Joint Board that whilst Medway Council welcomed the creation of Hyper Acute Stroke Units (HASUs) there were some concerns in relation to the preferred option which had been selected by the Joint Committee of CCGs, option B. He drew the Joint Board’s attention to the concerns set out in section 3 of the report, in particular he questioned whether option B took proper account of population growth and disadvantage levels in Medway and other localities across Kent, namely Swale and the South Kent Coast.
He also highlighted the clinical implications for local hospitals who would not be designated a HASU under stroke reconfiguration plans, set out at section 4 of the report, as summarised from the 2016 review published by the South East Clinical Senate. In particular, he drew the Joint Board’s attention to issues around workforce, the potential impact on social care services and the implications for families and carers following removal of specialist stroke services from Medway. It was recognised that mitigation was proposed in the Decision Making Business Case (DMBC), however it was considered that these areas were particularly challenging to address.
Members raised a number of points and questions, including:
Methodology - with reference to the response from the NHS on Medway Council’s Freedom of Information (FOI) request, set out at Appendix 3 to the report, a Member expressed concern regarding a lack of transparency and explanation in relation to the decision. He noted that the methodology was amended 24 hours ahead of decision making and he considered that changes to the methodology had disproportionately impacted option D. In response, the SRO for the Kent and Medway Stroke Review explained that the final decision had not been made and she confirmed that the final decision on the location of the HASUs would not be taken until January 2019. She also advised that with respect to the amendments made to the selection criteria, refinement of the criteria from the Pre-Consultation Business Case (PCBC) was considered an accepted part of the process to reach a preferred option from the five original shortlisted options. She assured the Joint Board that a clear rationale and evidence base was needed to make a recommendation or levy for any change. She stated that amendments to the criteria had been presented to several forums ahead of the evaluation workshop, including the Joint Health Overview and Scrutiny Committee.
Population growth and deprivation - A Member reiterated concerns that the selection of the preferred option did not take proper consideration of the level of: deprivation in Medway, the largest conurbation in the south east, outside of London; population growth, particularly in light of government housing targets; or transport and access to services located further afield. He expressed the view that the preferred option would deprive people of an essential service and amounted to switching a service off for a large number of residents. In response, the SRO for the Kent and Medway Stroke Review explained that the reconfiguration of Stroke Services represented a “switch on” of services for the whole population of Kent and Medway, with better services and better outcomes which would save lives. She recognised concerns in relation to travel times for ambulances, as well as families and carers and explained that this would be a critical part of any implementation plan. In referring to section 4 of the report, the SRO recognised that there were a series of risks and mitigations which needed to be considered. She gave the Joint Board an assurance that necessary mitigations would be considered for the whole of Kent and Medway, including more rural and deprived areas to ensure travel and access are not negatively impacted.
The Chairman of the Joint Board concluded that Medway Council believed that the proposed sites that had been selected for the provision of HASUs were not in the best interests of the health service and residents in Kent and Medway. He added that Medway Council considered that option D, which included Medway Maritime Hospital, would provide a more sustainable solution for the population of Kent and Medway going forward. He advised the Joint Board that Medway Council’s Health and Wellbeing Board and Full Council had considered the review of urgent stroke services and he thanked the Joint Board for considering the concerns of Medway Council.
The Kent and Medway Joint Health and Wellbeing Board:
a) noted the questions raised by Medway and commented on the likelihood that option D (which would locate HASUs at Medway Maritime, Tunbridge Wells and William Harvey Hospitals), would have emerged as the preferred option had questionable changes to the methodology and selection criteria not been introduced at a late stage in the process; and
b) requested that the concerns raised be taken into account by the Joint Committee of CCGs before a decision is made.