Agenda item

The report updates the Committee on the following:

i)     The Proposed consolidation of the stroke service at Maidstone and Tunbridge Wells (MTW) NHS Trust onto a single site at Maidstone Hospital.

ii)    Medway's referral to the Secretary for Health and Social Care of the NHS decision to establish Hyper Acute Stroke Units (HASUs) at Darent Valley Hospital in Dartford, Maidstone Hospital and the William Harvey Hospital in Ashford and the result that there would be no acute stroke provision at Medway Maritime Hospital.

iii)   The possible submission of a Judicial Review by Medway Council and an update on Judicial Reviews already submitted.

Discussion

The report provided an update on Medway’s referral, to the Secretary of State for Health, of the decision in relation to the Kent and Medway Stroke Review as well as in relation to two Judicial Reviews on the same matter. It also provided the rationale for the consolidation of stroke services, currently provided at Maidstone and Tunbridge Wells Hospitals, onto a single site at Maidstone Hospital. In March 2019, the Committee had referred the decision made by the Joint Committee of Clinical Commissioning to establish hyper acute stroke units in Dartford, Maidstone and Ashford and not in Medway, to the Secretary of State for Health and Social Care. On 19 June, the Minister of State for Health referred Medway’s request to the Independent Reconfiguration Panel (IRP), requesting an initial response by the end of June. The IRP advised that it would not be able to meet this deadline due to other referrals it was already considering. It is not currently known when the IRP will consider Medway’s referral. Two parties had also made a submission for Judicial Review. The courts had decided to join these into a single action, with Medway Council having been named as an interested party. A decision on whether the Judicial Review could proceed was due to be taken on 3 and 5 December.

Maidstone and Tunbridge Wells NHS Trust had made the decision to consolidate its stroke services onto a single at Maidstone Hospital. This was on safety grounds, with the service provided at Tunbridge Wells having become unsustainable. The Trust said it respected Medway’s referral and the Judicial Reviews, advising that the change was reversible.

A Committee Member said that no issues in relation to the sustainability of the Tunbridge Wells service had been raised during discussion of the stroke review and that the frailty of the Tunbridge Wells population had been one reason for the option of locating a HASU there. The Member questioned whether the safety of patients at Maidstone Hospital could be assured.

The Chief Operating Officer of the Trust said there was confidence that Maidstone would be able to absorb the additional patients safely. The additional patients averaged just 1.2 per day or a maximum of 3. The stroke service at Maidstone was a highly performing service with good clinical leadership. Despite attempts to recruit, it had not been possible to retain enough staff at Tunbridge Wells Hospital in order to safely provide a stroke service. This was in view of the fact that Tunbridge Wells would not be providing stroke services in the longer term with staff being aware that the service would close. The standard of service provided at Tunbridge Wells was therefore not as good as the one that could be provided at Maidstone. Engagement had been undertaken with the Kent Health Scrutiny Committee, the local MP and other stakeholders.

The Chief Executive of the Trust added that there had been a material change in the ability to staff the stroke unit at Tunbridge Wells since the stroke review decision had been taken. The focus was on ensuring the quality and safety of services and that patients requiring thrombolysis would receive it 24/7. Maidstone had sufficient staff to accommodate the changes and would be opening an additional ward.

A Committee Member was concerned that the Trust appeared to be stating that Tunbridge Wells would not become a HASU when this decision was subject to the outcome of Medway’s referral and the Judicial Review of other parties. The Member said that this would have contributed to Tunbridge Wells no longer being able to retain or recruit sufficient staff to provide a stroke service. The Member also asked for clarification of which patients would be taken to Eastbourne Hospital once the service was no longer provided in Tunbridge Wells.

The Chief Executive said that there had been hard work to try to retain and recruit adequate staff for the stroke service at Tunbridge Wells and consideration had been given as to whether other staff could help to fill the gap. The Trust had reached the conclusion that to maintain quality and patient safety it would be best to consolidate services onto a single site at Maidstone. It was acknowledged that the language used in relation to the future of the Tunbridge Wells stroke service could have caused confusion. It was clarified that the catchment area for Tunbridge Wells included part of East Sussex and that some of these patients would, in future, be taken to Eastbourne instead of Maidstone.

In response to a Member’s concern about the possible impact of the changes and outcome of the Stroke Review on Medway, the Chief Executive of Medway Foundation Trust said that the stroke unit at Medway was fully staffed but that there was risk that, as it had not been chosen as a HASU, it was possible that staffing could become more of a challenge.

Decision

The Committee:

i)    Considered and commented on the report, including the possible impact of the consolidation of stroke services on Medway residents.

ii)   Requested that the Committee be kept updated, via Medway Foundation Trust’s regular update reports, on the staffing of the stroke unit at Medway Maritime Hospital.