Issue 1:  July 2019 

In this issue

 

  • Latest on implementation phasing and planning development 
  • Rehabilitation workstream progress 
  • Update on the legal challenges and referral to the Secretary of State

Welcome to the first issue of what will be a regular update on the stroke services review for staff, patients and the public, partners and stakeholders. The update will contain the latest news and developments on the implementation of the new hyper acute and acute stroke units for Kent and Medway, work to improve and standardise rehabilitation services and plans to enhance stroke prevention programmes. 

Rather than sticking to a rigid publication schedule, we will issue the update when there is news to share (we expect to send you an update on how our work to improve services is progressing every six to eight weeks) – that way you will know it’s worth your time to read. We will aim to keep the content short and to the point, but let you know where you can find more information if you want it. We hope you find the update useful. We’d love to hear your feedback, and suggestions for future issues. You can email us at km.stroke@nhs.net with any comments.

Rachel Jones

Director for Acute Strategy and Senior Responsible Officer for the Kent and Medway Stroke Services Review

Implementation update: Joint Committee agree two-phased approach plus timeline update

William Harvey Hospital in Ashford will need a new build to be completed before its new hyper acute stroke unit (HASU) can go live, and this will take around a year longer than the estates work needed at Maidstone and Darent Valley hospitals. The decision making business case for the stroke review explained that the Stroke Clinical Reference Group had recommended a two-phased approach to implementing the new HASUs, with Maidstone and Darent Valley going live at the same time, followed by William Harvey when the building work is completed. The rationale for this recommended approach is to ensure as many people as possible benefit from the new HASUs as soon as possible. This two-phased approach is possible because there are clearly defined catchment areas for the new HASUs, with patients from Medway, north and west Kent flowing to either Maidstone Hospital or Darent Valley Hospital, and patients from the east of Kent flowing to William Harvey Hospital. This makes it relatively simple to ‘switch on’ a new service and ‘switch off’ the old services first in the west and then in the east, so that it is clear for ambulance crews to know where to take patients with a suspected stroke.

At the decision-making stage we agreed to test this recommendation with a wider group of stakeholders, to ensure we had explored the pros and cons of the two-phased approach. A workshop was held on 30 May 2019, attended by around 40 colleagues from provider and commissioning organisations, local GPs and stroke consultants, local councillors and Healthwatch. The workshop used an ethical framework to discuss the different possible approaches to implementation. There was unanimous agreement that the two-phased approach would allow as many people as possible to benefit as soon as possible from an improved service.

The Joint Committee of CCGs agreed the recommendation for a two-phased approach at their meeting on 13 June 2019. The Stroke Review Team is now focussed on the real detail of implementation planning, working closely with provider colleagues at each of the three new HASU sites to develop detailed project plans. We will share updates on these plans as they progress over the coming months.

Timeline

At the time of the decision making meeting in February 2019 the draft implementation timeline anticipated that, if the two-phased approach was approved, the earliest the HASUs at Maidstone and Darent Valley could go live was early spring of 2020 with the HASU at William Harvey following approximately a year later. Since that time two factors have come into play which are impacting on this timeline:

  • The legal challenges and the referral to the Secretary of State for Health (see below for more information): while there are no guarantees, we hope these challenges will be resolved by the autumn. In the meantime, the legal advice we have is that we can and should continue with implementation planning, but we should not take any irreversible decisions. This means that the vast majority of our implementation work continues for example workforce and IT planning, and the development of detailed policies and operating procedures to support new ways of working in the HASUs. The only irreversible decisions are linked to the new build at William Harvey Hospital which requires significant financial investment and it would not be right to spend public money on these building works until we know the outcome of the legal proceedings.
  • Working with NHS England and Improvement to agree the release of capital funding needed to implement the new HASUs

Once we have a clearer picture of the timelines for the legal challenge and referral to the Secretary of State, and the capital funding has been released, we will be able to give a clearer picture of the implementation timeline.

Rehabilitation workstream update

The rehabilitation work continues apace, with a clear ambition to ensure that improved stroke rehab services are in place across the whole of Kent and Medway to coincide with the opening of HASUs. More consistent and comprehensive rehabilitation is essential if we are to deliver better patient outcomes and reduce lengths of stay in the HASUs and ASUs.

The Stroke Rehabilitation Working Group is now well established, with strong clinical leadership from acute and community partners. The Working Group is supported by a number of ‘task and finish’ groups who are charged with delivering key elements of the improvement programme such as agreeing the way we will measure benefits and agreeing the operational details to support the new pathways.

Key achievements so far include:

  • widespread patient engagement to get a better understanding of what is important to stroke survivors and their families and carers
  • completing three audits of current service provision
  • agreeing a new model of care (what services will be available) for rehab and a new patient pathway (how and when patients will access the services available)
  • agreeing an outcomes framework (what improvements and benefits we expect patients will get) that will help us measure the impact of the new service

Our priorities over the coming months include:

  • work to scope the number of inpatient rehab beds needed
  • working with CCGs around opportunities for personal budgets
  • discussions with Kent County Council about social care support
  • finalising details of the expected financial benefits of improved rehab care
  • producing a draft business case on the new service by the end of August

 Judicial review and referral to the Secretary of State

Two separate requests have been made for a judicial review of the Joint Committee of CCGs decision to implement hyper acute stroke units for Kent and Medway. In addition, Medway Council have referred the decision to the Secretary of State for Health and Social Care.

You can read more about the difference between a judicial review and a referral to the Secretary of State on our website. In summary, a judicial review is a legal challenge against the decision. The request for a judicial review is made to the courts and a judge will decide the outcome. A referral to the Secretary of State is made by local councils and is a request for a review of the decision by an independent panel of experts.

Judicial reviews

We have submitted our response to the two judicial review challenges with the court. A judge will now consider whether to grant permission for a judicial review. We expect that permission will be granted, although we maintain that the review process was robust, fair and legal. We have asked the courts to expedite the hearing, if permission is granted, as there is an urgent need to reach a conclusion so that we can minimise any delay to implementing the new HASUs, as described above, we hope to have a resolution by the autumn of 2019.

Secretary of State referral

The Secretary of State for Health and Social Care has asked the Independent Reconfiguration Panel to review the referral by Medway Council contesting the Joint Committee decision to establish HASUs at Darent Valley, Maidstone and William Harvey Hospitals. Medway Council are not questioning the benefits of or need for HASUs, but they do not agree with the three hospital sites chosen. The role of the Independent Reconfiguration Panel is to:

  • give expert advice to ministers on proposed NHS reconfigurations or significant service change in England
  • base their advice on whether the proposals will provide safe, sustainable and accessible services for the local population, taking account of:
    • clinical and service quality
    • patient choice
    • future referral needs of local GPs who commission services
    • national health strategy and policy

We are currently waiting for confirmation of the exact timescale for the review process, however we expect it to be completed within a few months.