Stroke Units in Kent – Our questions need answers

Many of us are now aware of the threat of closure of emergency stroke services at QEQM Hospital in Margate. A plan is on the table to rationalise the service and cut the number of stroke units in Kent from seven to three. The implication for residents in Thanet is that our nearest unit will be in Ashford. It is acknowledged that the William Harvey Hospital (WHH) in Ashford is over an hour away when traffic is good. Add in time spent waiting for an ambulance to arrive and a stroke victim is more likely to suffer irreparable damage by not being treated within the ‘Golden Hour‘ that is so often quoted as crucial.

Paramedics in the ambulance are normally unable to treat the victim for the stroke because the difference between one caused by bleeding or one caused by clot needs specialist diagnosis. Getting it wrong could be fatal.

Questions about the consultation.

As County Councillor for Ramsgate and member of the Health Overview and Scrutiny committee I have written to Patricia Davis who is heading up the consultation about reorganising Kent’s Stroke Services. My questions submitted about the plans and the consultation are below.

I understand the clinical evidence supplied so far. We all want the best health outcomes for people of Kent. NHS workers are greatly appreciated for the outstanding work they do, especially when they are often ‘going the extra mile’. However I’m aware that this change to the QEQM Stroke service, which is being presented as a positive change, is brought about by the introduction of Strategic Transformation Partnerships and is part of a £486 M cut to budgets.

Thanet, as you know, has poor health outcomes. Life expectancy is 8 years less than in Canterbury and Ashford. Cancer outcomes, especially bowel cancer, are especially poor. Our hospital and A&E is poorly rated and is perhaps the worst in the country. We have the closure of GP surgeries and are also losing a large dental practice serving 8,000 residents.

Put yourself in the shoes of Thanet people. Local residents know this and live with the reality of what appears to be a declining service.

These are key questions, I would value a response please.

Looking across the Kent which area has the highest stroke rates, and what type of stokes?

Can you be unequivocal that all stroke patients will arrive at the WHH within 1 hour. (Blue lit or otherwise).

Will all patients requiring a clot busting drug (door to injection) receive this in all cases, within 1 hour?

Can you confirm what exact investment from the £40M will go into the ambulance service so that  999 stroke call outs will be responded to promptly?

What is the planned target time for an ambulance and suitable qualified paramedics to arrive at a stroke patient in Thanet?

How many ambulances and fully qualified paramedics do we have in Thanet? Where are they located? What are the plans to modify this in line with proposed changes?

What are the workforce plans to recruit and train more paramedics, stroke consultants, stroke nurses, physiotherapists, etc?

What is the plan to give clot busting treatment to stoke victims in Thanet. Will this be done in the ambulance?

Will all Stroke patients be taken to WHH?

Are you currently certain that you have adequate staff to deploy to the three locations? Some staff may choose not to travel from a current base to a new one. Will they be sufficient to cover an expanded population, which takes in South London and East Sussex.

Can Thanet be included as one of the options for a location of a hyper acute stroke unit? Given the equality impact assessment. Can you please state that you will make it clear in the consultation that Thanet could ‘come back in’?

What % of the Kent population are currently within 1 hour car journey to a stroke unit. I note your comments yesterday about Thanet being 63 minutes away.

How many people in Kent will potentially be located with access within one hour of two acute stroke units?

Regarding workforce, we are lacking in consultants. If we do move to 3 specialist units can we be sure that we will have enough staff to populate them? Including the extra population from East Sussex and South London.

Is this the beginning of downgrading services in QEQM?

What stroke services will be offered at QEQM after this restructure?

How has the CCG arrived at a decision to make the people with the worst health outcomes, travel the farthest? Are Thanet residents’ needs expedient when weighed against the needs across Kent?

Can Thanet residents be assured that following the extra time they have spent in the ambulance, compared to other Kent residents, they will be the very front of the queue as a priority for urgent treatment?

Will the 38degrees online petition and paper petition I have started be counted as part of the consultation? This wasn’t answered at the 31st Jan meeting.

What provision will this model, 7 > 3 bring for the better linking of discharge and social care, how will that be managed? What are the specific plans for Thanet where social care can be inconsistent and is a difficult role to recruit to? Which companies will be involved in this?

Can the social care staff be ‘bought back in house’ rather than being outsourced to private providers?

How many operations at QEQM have been cancelled due a lack of post hospital social care in the last 36 months?

Also, as the population ages, will the likelihood of stroke increase and has this been modelled to see the scope of increase? How does that affect Thanet?

As NHSE have released figures today,  1st February ’18, saying that 20% of strokes occur in 40 – 59 age bracket, does this affect the plan in any way?

Will firefighters be expected to attend stroke victims (save for those that are involved in a fire or accident situation)?

Can the CCG comment on the broader workforce issues which are ‘upstream’ that the Government need to deal with?

Can the CCG comment on the challenge of meeting increasing clinical need and equality challenges without the full funding required being made available?

Should we scrap STPs, and start again with resources, including adequate budgets aligned to patient need, rather than being aligned to the current plan to save £486M?

 

There is a great deal of confusion in the proposals. For instance is the ‘golden hour’ still clinically important and how will that affect Thanet people if they have to travel all the way to William Harvey? We are awaiting a response.