The Joint Health Overview and Scrutiny Committee (JHOSC), established to scrutinise the Kent and Medway review of urgent stroke services, met on Thursday 5 July 2018 to receive and consider the recently published reports on the stroke consultation and to receive an update on the next steps in the stroke services review process. The JHOSC is a committee spanning four local authorities and is formed of local councillors from Kent, Medway, Bexley in south east London and East Sussex.

The JHOSC councillors put questions to two members of the Kent and Medway stroke review leadership team, about the approach to consultation presented in the activity report and the outcomes presented in the consultation response report.  Overall the members were pleased with and supported the extent of the activity undertaken and they commented on the quality of the formal public consultation and engagement. The chair took the unusual step of formally recording that all the JHOSC members noted the high quality of the consultation activity and agreed it had been comprehensive and well managed.

With regard to the responses to the consultation, the JHOSC discussed the themes that had emerged from the independent analysis of well over 5,000 responses. They acknowledged the concerns raised about travel times and asked that the Kent and Medway stroke review team ensure they have carefully reviewed the data and evidence available before reaching a preferred option. The committee also discussed the importance of rehabilitation services, and requested that the NHS ensures sufficient, high quality rehabilitation services are in place at the same time as any hyper acute stroke units are implemented.

See the recording of the JHOSC meeting on the Kent County Council website

Other areas of discussion included:

  • what consideration had been given to prevalence and incidence of stroke in, and the health needs of, different communities
  • the impact on families and carers of potentially longer and more complicated journeys to visit loved ones for some people
  • how the consultation reached areas outside Kent and Medway and what the implications are for those communities – particularly whether the proposals would negatively impact the Princess Royal University Hospital in south east London and the border populations in East Sussex
  • staffing challenges and how these can be addressed
  • acknowledgement of the concerns raised about the future of hospital services in both Canterbury and Thanet

Patricia Davies, Director of Acute Strategy for the Kent and Medway Sustainability and Transformation Partnership said, “We are naturally very pleased that councillors endorsed and commented on what they felt to be a high quality public consultation – we worked hard to ensure as many people as possible heard about the stroke proposals and could share their views through in a range of ways if they wanted to. We listened carefully to the comments made by the Joint HOSC members on Thursday and noted the areas where they had questions or clarifications. We also noted they would like to be reassured on rehabilitation services and travel times. Our next steps over the summer and into the autumn are to consider the responses to the consultation alongside the agreed evaluation criteria, and all the other available information, evidence and data that the review has gathered in order to reach a preferred option. I would encourage those who want to keep up to date with the review to ensure they have subscribed to the Kent and Medway NHS bulletin via our website at www.kentandmedway.nhs.uk/subscribe.”

Background information

Find out more about the Joint Health Oversight and Scrutiny Committee formed to scrutinise the review of Kent and Medway urgent stroke services at https://democracy.kent.gov.uk/mgCommitteeDetails.aspx?ID=909

The next steps of the process will include:

  • Summer to early autumn:detailed consideration of the consultation responses and establishing whether any viable additional options have been put forward to evaluate in detail, agreeing the approach to the evaluation of the shortlisted options, meeting with the Joint Health Overview and Scrutiny Committee, evaluation workshops
  • Autumn:identifying a preferred option, development of the ‘decision making business case’, including discussion with the South East Clinical Senate, NHS England and NHS Improvement and the Joint Health Overview and Scrutiny Committee
  • Winter:final assurance process with NHS England and NHS Improvement, and the Joint Committee of CCGs meeting to agree the preferred option for implementation

Formal public consultation began in February 2018 on proposals to implement ‘hyper acute stroke units’ (HASUs) in Kent and Medway.

The consultation was run by the eight clinical commissioning groups in Kent and Medway – Ashford CCG, Canterbury and Costal CCG, Dartford, Gravesham and Swanley CCG, Medway CCG, South Kent Coast CCG, Swale CCG, Thanet CCG and West Kent CCG – along with Bexley CCG in south east London and High Weald Lewes Havens CCG in East Sussex.

The CCGs were consulting on proposals to establish three hyper acute stroke units and to locate acute stroke units and 7-day transient ischemic attack (TIA or mini-stroke) clinics alongside the hyper acute stroke units. Five possible three-site options for hyper acute and acute stroke units were included in the consultation, these were:

A: Darent Valley, Medway Maritime, William Harvey

B: Darent Valley, Maidstone, William Harvey

C: Maidstone, Medway Maritime, William Harvey

D: Tunbridge Wells, Medway Maritime, William Harvey

E: Darent Valley, Tunbridge Wells, William Harvey

The public consultation ran for 11 weeks from 2 February to 20 April 2018 and comprised the following key questions:

  • Do you think there is a clear case for changing the way we deliver stroke services?
  • Do you think there should be hyper acute stroke units in Kent and Medway?
  • Should acute stroke units and transient ischemic attack (TIA or mini-stroke) clinics be located alongside these units?
  • Do you think that three hyper acute stroke units would be the right number for Kent and Medway?
  • Do you have a preference for any of the five options?
  • Are there any other options or any other factors that we should consider?

To encourage and enable as many residents as possible to take part in the consultation, within the available budget, and to get a broad and representative range of views, a variety of different methods of collecting views were used:

  • Telephone surveys
  • Postal and online surveys
  • Listening events, public meetings and attending meetings and events held by others
  • Outreach engagement (amongst ‘seldom heard’ groups)
  • Focus groups (amongst those not engaging in other consultation activities)
  • Social media activity – Twitter and Facebook
  • Letters/emails via dedicated Freepost address and email address.

Further details can be seen in the full report via the link above.