The NHS in Kent and Medway have today published two reports arising from the recent consultation on changes to urgent stroke services, describing the consultation activity that was delivered and summarising the key themes from the responses received.
Urgent stroke services across Kent and Medway don’t consistently meet national quality standards and outcomes for people who have had a stroke aren’t always as good as they should be, despite the hard work of dedicated staff.
Earlier in 2018 the NHS in Kent and Medway, along with some parts of East Sussex and south east London held a public consultation on the future organisation of urgent stroke services in Kent and Medway.
Following the consultation, the NHS is publishing two reports today, one describing the consultation activity that was delivered and one detailing the responses to the consultation:
- Consultation activity report: This report sets out how the formal consultation on urgent stroke services was delivered across Kent and Medway and with neighbouring areas in Bexley and High Weald Lewes and Havens. It describes the range of activity undertaken but does not describe the responses received.
- Consultation response report: DJS Research, an independent research consultancy, analysed all consultation responses to develop a report on the themes emerging from the public consultation
The consultation activity report shows that the public consultation activity was comprehensive, reaching in excess of 2 million people, and generating over 5000 responses. The responses to the consultation have been independently analysed to identify a number of key themes. These themes include:
- The majority of people who took part in the consultation activity – regardless of whether they ‘self selected’ to get involved or were approached to take part in a telephone survey/focus group or other formal research – agree that hyper acute stoke units should be established in Kent and Medway.
- People generally think that the two most important questions to ask about the proposals are whether they will improve access to care and whether they will improve the quality of care.
- Whilst many people understand the reasoning behind having three proposed units in the area, and specifically the argument that it would be difficult to staff more than three units in the area, some feel that staffing should not drive such decisions, and that more should be done instead to improve recruitment and retention of staff.
- The location of hyper acute stroke units, and travel times to the proposed units, are the key area of concern, with particular concern for people living in Thanet.
- Many feel that the geography of the area means that four units would be better in order to provide fair and equal access to all residents.
- Whilst the consultation was not positioned nor intended as, a vote or referendum but rather as a chance to gather views and feedback on the proposals, the most preferred option amongst those who responded to the questionnaire was Option A (Darent Valley, Medway Maritime and William Harvey Hospitals), closely followed by Option B (Darent Valley, Maidstone and William Harvey Hospitals).
- Key reasons given for preferring these options were that they have potentially the greatest reach and accessibility. Many acknowledged that they chose the option with their preferred hospital, usually the one closest to where they live.
- Many people within the CT postcode area (which covers the largest part of East Kent, less Faversham and Ashford) did not feel any option is suitable and expressed a desire for Kent and Canterbury Hospital or Queen Elizabeth the Queen Mother Hospital to be re-considered as part of the short-listed options.
- There was also a particular concern over whether after care, including rehabilitation services and care in the community is being considered as part of the review, and the impact that hyper acute stroke units will have on these services.
- Respondents also wanted to make sure that there was a good focus on preventing stroke as well as treating it.
The extent of consultation and engagement activity undertaken during the consultation period, the number of responses received, and the consistency of the themes coming through from the feedback gathered means the themes arising from the consultation can reasonably be relied upon to be a fair representation of the views of the impacted population across Kent and Medway, Bexley and High Weald Lewes Havens.
Speaking about the response, Patricia Davies, Director of Acute Care for the Kent and Medway Sustainability and Transformation Partnership, and Senior Responsible Officer for the Stroke Review, said, “We would like to thank the thousands of people who took the time to contribute to the consultation. We welcome the many and varied responses and feedback received and the richness of conversation and debate about what we know is a complex and often emotive subject. We certainly all want the best for ourselves and our loved ones. We acknowledge and understand the range of views, and in some parts concerns, expressed from many different parts of Kent, Medway, south east London and East Sussex. The views we have gathered will play an important part of the next stage of decision making. Our next steps are to consider the consultation responses 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”
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
Although there is a desire to make changes as soon as possible in order to improve care and outcomes for people who have had a stroke, implementation will take some time after a decision has been made. We will continue to update staff, stakeholders and local people on our progress around this.
To keep up to date on the progress of the stroke review please subscribe to our bulletin at www.kentandmedway.nhs.uk/subscribe
- A 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 consultation 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?
- The public consultation ran for 11 weeks from 2 February to 20 April 2018.
- In order 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 and public meetings
- 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