How the review of stroke services in Kent will cause a domino effect on E Sussex

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Campaigners  in Kent have been battling against proposals to reduce the number of Hyper-Acute Stroke Units in the area, creating fewer units which will supposedly be centres of excellence.  The argument has been that survival rates are greater when a patient is brought to a hospital with a specialist unit.  This policy has already been carried out in London, but Kent is hardly a large urban area.  Much of the argument has focussed on the critical call to hospital time (the time it takes from when an ambulance is called to the patient arriving at  hospital).  With a largely rural area such as Kent campaigners have been arguing that merging units to create specialist centres will place some people at risk of being unable to get to hospital quickly enough.  The final decisions have been made on where these specialist units will be based and so now we can see the effect this wil have on patients in East Sussex.

Despite some fierce opposition it has been decided that Hyper-Acute Stroke Units will be based at Maidstone General; William Harvey Hospital in Ashford and Darrent Valley in Dartford.  This will mean that in an emergency some patients in East Sussex will be sent to the William Harvey Hospital in Ashford.  There is huge concern that the hospital will not have the capacity to handle al of East Kent’s patients as well as those from E Sussex.

Treatment is prioritised in order of the level of urgency.  In the case of a patient who has suffered a stroke researchers believe 1.9m nerve cells will die each minute and the oxygen-starved brain will age 3.6 years each hour.  If patients are being brought to the William Harvey Hospital from Thanet they are likely to be at least 2hrs away from the time an ambulance was called when they arrive at the hospital.  These patients will be treated first leaving those who live nearer the hospital still having an unnacceptably long wait for treatment.

The review was made by looking at journey times for everyone in the area to get to a hospital.  But they have assumed that everyone in the area will be with somebody else when they have a stroke who will call an ambulance immediately.  They have also assumed that ambulances when called will arrive within the time frame they are expected to arrive.  Sadly, neither of these assumptions is true.  Increasingly we hear of patients having outrageously long waits for ambulances called in an emergency.

If patients from East Sussex cannot be treated on time at the William Harvey Hospital then they may be brought to other hospitals in East Sussex, so we also need to consider whether those units will also be able to handle an increased demand.  Just as with patients travelling to the William Harvey Hospital from Thanet, patients brought to the Conquest or Eastbourne’s DGH from Wealden area may possibly be prioritised due to urgency.

Here are the SECAMB‘s response times

 

SAVE OUR NHS IN KENT’S FOUR REASONS WHY THE STROKE PLAN IS NOT FIT FOR PURPOSE

Save Our NHS in Kent is campaigning to stop the closure of QEQM hospital’s stroke unit. It is a local campaign group run by volunteers who seek to challenge cuts and privatisation to NHS services across the county. We have been scrutinising the documents regarding the Stroke Review since January. I am one of those volunteers, and here is a summary of my reasons why the Stroke plan put forward is unjustified and should be halted.

1). It isn’t an improvement.
The Stroke Review plan relies entirely on the myth that the system proposed is an ‘improvement’, and not a cut. Claims have been made, and are still being repeated, that the proposal will bring about improved patient outcomes and reduce death and disability; and they refer to ‘evidence’ behind this. The tragic fact is that there is no such evidence. The claims are based on one study that took place in London, but this evidence is not fit for purpose, and here’s why: The London example cannot be applied to Kent, as in London there was an upper limit ambulance journey time of 30 minutes for all patients, and most of those patients are getting to their nearest HASU in 16 minutes. Doesn’t sound much like Thanet’s one hour journey to Ashford, does it? Also, the London study showed a very tiny uplift, which if applied to Kent, would equate to 1.5 lives saved per year (but how many could die en route in an ambulance? How many will suffer disability due to the longer journey).

Another fact about the London study – deaths in ambulances were not recorded; they simply didn’t take that data into account when calculating the number of lives saved.

Another study occurred at the same time in Manchester – there, no uplift in terms of death or disability was found. This is why we say that this plan is unevidenced, and cannot be called an improvement for the Kent area. Which raises the question: if there is no improvement, isn’t this just a bad plan without any merits for the population of Kent?

2). It will very likely lead to further cuts at the QEQM
The NHS bosses pushing this plan (the STP) also claim there aren’t “other services” in QEQM, and that these other services (such as Trauma) mean that certain hospitals were chosen over others. We say that Trauma was taken from QEQM a few years ago with consultation; the removal of that service is now being used to justify another cut. Each time a service goes, it means the hospital in question risks further losses, as (in the current climate) trusts are looking for justifications to thin out the services offered and move them to fewer locations. Just look at what has happened to the Kent and Canterbury Hospital.

3). A temporary lack of staff cannot dictate major and permanent reconfigurations
Staff shortages and staff retention issues are given as the other main reason to centralise stroke care into just 3 (rather than the current 6) units. There are shortages of consultants nationally, but anecdotal information about local shortages given at consultation meetings have not been backed up with facts; the STP have claimed not to hold the information that was given verbally by their own panel at their own meetings.

QEQM, which will close under these plans, has a staff better retention record than other hospitals which will stay open under this plan; it also has its full complement of allocated stroke specialist consultants currently. Yet they say they can’t recruit to QEQM. Where is the evidence that this is the case?

The Stroke Association assert in their own materials that stroke units should never be closed using the excuse that there aren’t enough staff.

If, as a nation, we are to start centralising all our NHS care into fewer units due to staff shortages, then this is a very serious matter, and a national matter of substantial urgency. The idea that this is an improvement is totally flawed. There is no evidence that this works better outside London (where it was an insignificant uplift anyway), so this does seem to be about money (which the Kent and Medway STP deny), OR it is solely about staffing. If it is (as claimed) about staffing, then this MUST be debated in public at a national level (it is a national plan, after all); this should be subject to thorough parliamentary scrutiny to assess whether staff shortages really necessitate this action, if there really is no other solution, and why the hell it was allowed to get this bad in the first place.

4). We don’t know if it’s safe
The Kent STP have stated that all patients seen within a two hour window from call to treatment will not suffer adverse effects, and that it is their ‘aspiration’ to ensure Kent patients get treatment in that 2 hour timeframe, even with the longer journeys required. But even if we are willing to dispense with the ‘golden hour’ and the stipulations of F.A.S.T., their two hour ambition is blown immediately for the 145,000 residents of Thanet, as time taken from call to hospital door could be 2 hours in itself (40 minutes ambulance response time, 40 mins* + loading, 15 mins + journey to Ashford, 1 hour). Nowhere else in the country are there journey times of one hour for emergency stroke care. This is an experiment on the people of Kent, and most notably on Thanet, one of the most deprived and stroke averse areas in the South of England.

 

Our Government is aiming too break our NHS up into regions with potentially different bodies responsible for the services in easch region.  But as we can see in this example each regional plan may impact on neighbouring regions.

 

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