The NHS in Kent and Medway has announced proposals to create three new ‘hyper acute’ stroke units in Kent and Medway.  Although general stroke services are currently provided in Kent and Medway’s hospitals, there are currently no specialist hyper acute units that in other parts of the country have been shown to improve outcomes for people who have had a stroke.

These new units will allow people to get the best possible care in the vital first few hours and days immediately after their stroke – saving lives and reducing disability.

After intensive work by doctors, nurses, therapists, other stroke specialists, stroke survivors and other members of the public to look at the evidence on best care, the NHS is proposing to turn three existing stroke units into specialist hyper acute stroke units, providing expert care from a team of stroke specialists and therapists round the clock with consultants on the wards seven days a week.

“This is incredibly good news because it means we will be able to ensure everyone treated in Kent and Medway gets the best care, no matter what  time of day, day of the week or where they are when the stroke happens,” said Dr David Hargroves, clinical lead for the stroke review.

“Currently, although stroke staff do their very best, the way services are organised means that some people do not get the right treatment fast enough, particularly overnight and at weekends. Centralising urgent stroke care in three excellent hyper acute stroke units would change all that. Our dedicated staff would then be able to ensure the 3,000 people treated in Kent and Medway for a stroke every year get care which is right up there with the best in the country.”

In developing the proposals there has been a rigorous process to review combinations of existing hospitals, considering many different factors.  From this we have developed a proposed shortlist of possible options for the location of hyper acute stroke units in Kent and Medway.

The proposed shortlist, which is subject to further thorough assessment and final approval, is[1]:

  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

There will be a full public consultation on the proposals to reorganise the way urgent stroke care is delivered and the potential locations of hyper acute stroke units in Kent and Medway.  We will do this following further assessment of the proposed shortlist, and final approval. The consultation could start in early February.

Each option allows at least 98 per cent of people in Kent and Medway to access a hyper acute stroke unit by ambulance within an hour.

This is particularly important for people whose stroke is caused by a blood clot. They need to have clot-busting treatment, known as thrombolysis, within two hours of calling 999. Currently, only half of people in Kent and Medway who need this treatment get it within two hours. This is partly because specialist staff are spread across too many sites.

Each of the proposed hyper acute sites will 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).

With the creation of the new hyper acute stroke units, the proposals mean urgent stroke services would not be provided at the other acute hospitals in Kent and Medway.

“I very much support the plan for three hyper acute stroke units in Kent and Medway so that the people of Medway and Swale get the best possible care,” said Dr Diana Hamilton-Fairley, Medical Director at Medway NHS Foundation Trust.

“I am pleased that Medway features in three of the options, however I am absolutely confident that even if there is no hyper acute stroke unit at their nearest hospital, all stroke patients will benefit hugely from getting expert care round the clock.

“What is most important is getting to a specialist unit after a stroke for your assessment and treatment, even if that means taking longer to get there and the ambulance bypassing your nearest hospital.

“In London, hyper acute stroke units have reduced deaths from stroke by nearly 100 a year. We want similar benefits for the population of Kent and Medway.”

“Concentrating stroke services on fewer sites will enable the staff available to provide the best care for patients suffering from the effects of stroke,” said Dr Steve Fenlon, Medical Director of Dartford and Gravesham NHS Trust.

“We are pleased to be considered a suitable site in three of the options and our staff have always and will continue to deliver care to the very best of their abilities for stroke patients.

“We support this endeavour to improve the care of all patients across Kent and Medway and we are sure all the providers will work together to deliver the best solution possible.”

Dr Peter Maskell, Medical Director at Maidstone and Tunbridge Wells NHS Trust, said:

“We welcome the opportunity to take part in this important forthcoming consultation to improve stroke care for patients across Kent and Medway, and encourage people locally to take part when it launches in the coming weeks.”

“All the options involve the William Harvey Hospital for east Kent because, as things stand, the William Harvey Hospital offers the other services that are beneficial to have on the same site as a hyper acute stroke unit.”.” said Hazel Smith, Accountable Officer of NHS South Kent Coast Clinical Commissioning Group and NHS Thanet Clinical Commissioning Group.

“There is a separate review of the possible options for the future location of emergency care and specialist services in east Kent. It would be wrong to wait for this work to conclude and slow down the essential decisions we need on stroke. If, through the east Kent emergency and specialist service review, William Harvey Hospital were no longer to be a long-term option for emergency and specialist services and these moved elsewhere – then we would anticipate any hyper acute stroke service would move with the co-dependent services.”

Making these changes will 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 costs reduce overall when patients are diagnosed and treated faster. This is because they need less care after they leave hospital with less disability, and can leave hospital sooner.

As well as the immense benefits in human terms for patients and their families from fewer deaths and less disability, these proposals should also mean long-term financial efficiencies for the NHS and social care and, therefore, significantly contribute to the longer-term sustainability of health and social care services in Kent and Medway. It is a real example of the NHS investing in change that will be better for patients, better for staff, and save money in the long-term.

[1] The order is not a ranking and we will not identify a preferred option until we have fully and carefully considered all the evidence and data available to us, including the views and feedback gathered through the forthcoming public consultation.