Please note: the consultation has now closed. Information on the decision making process.
Stroke consultation challenges
This page lists some issues or challenges which have been raised about our stroke consultation; which we believe are misleading. We have provided a short response to each issue. We have grouped them into general themes and will update this page during the remainder of the consultation.
Options exclude Thanet
Thanet is being excluded and stroke services removed.
Some people have commented that Thanet is being excluded because none of the options include a stroke unit at the Queen Elizabeth the Queen Mother Hospital in Margate.
We believe that everyone in Kent and Medway, including residents of Thanet would benefit from the creation of hyper acute stroke units. We will however consider all the consultation feedback stating concerns about increased travel times and loss of local services as part of the final decision making following consultation.
Deprivation of areas like Thanet hasn't been considered in developing the options.
Some comments have said that the deprivation in Thanet should have been given greater consideration and a location in Thanet included in the options.
There are pockets of deprivation across all of Kent and Medway. The impact of the proposals on deprived communities has been extensively reviewed as part of the integrated impact assessment. Work has been done to develop and propose mitigation strategies for deprived communities who may have difficulty accessing services whichever option is chosen.
Further work will be done on this as part of the development of the Decision Making Business Case following the consultation.
The proposals put some people outside the "Golden hour" for receiving treatment.
Some comments are quoting a concept called the Golden Hour which suggests stroke treatment must start within one hour.
The study which the “golden hour” comes from was carried out in America nine years ago and is not based on up to date evidence.
As the NHS, we work to the National Clinical Guideline for Stroke, which is the definitive source of how stroke care should be delivered in the UK to give the optimum outcomes. This national guideline says that patients should get clot-busting drugs, if they need them, as soon as possible, ideally within 3 hours of symptoms starting (and at most within 4.5 hours of stroke). Between 10 and 20 per cent of stroke patients may need clot busting therapy (thrombolysis).
In the south east we have set ourselves the more stringent target of giving clot busting drugs to those who need them within 2 hours of making a 999 call. However, at the moment we do not consistently meet best practice standards for stroke care in Kent and Medway. We believe consolidating stroke services will enable us to deliver the standard of care patients should be able to expect.
Longer travel times contradict the FAST campaign.
It has been highlighted that the national public health stroke awareness campaign (FAST) is contradictory to increasing travel times for some stroke patients in Kent and Medway.
Our proposals complement the advice given in the FAST campaign. When dealing with stroke the most important thing is to get the person to the right place as quickly as possible. We support and endorse the FAST advice which is to call 999 as soon as people spot the symptoms of stroke.
After that, what makes the difference is having the first 72 hours of care delivered by a specialist team (that are available 24/7) and getting clot-busting treatment as soon as possible, and at most within 4.5 hours, if it is needed.
In the south east we have set ourselves the target of giving clot busting drugs to those who need them within 2 hours of making a 999 call.
Keeping travel time to a minimum is the most important thing.
Some comments say it is essential to keep travel time for stroke patients to an absolute minimum.
Evidence shows that patients treated in hyper acute stroke units have better outcomes, and that deaths and disability are reduced. It is important to get stroke patients to specialist services quickly. However, travel times are just one factor in ensuring people have the best possible outcome after a stroke. We know that it is the totality of the care given in the first 72 hours after a stroke that makes a difference. However, at the moment we do not consistently meet best practice standards for stroke care in Kent and Medway.
We want best practice care to be available to everyone in Kent and Medway. Our proposals aim to balance the benefits of specialist hyper acute stroke units, equipped and staffed 24/7 to give the best stroke care, with reasonable ambulance travel times. We believe consolidating stroke services will enable us to deliver the standard of care patients should be able to expect.
Quality of stroke services
Stroke services are fine now, there is no need to change.
Some people have commented that the service available at the existing six stroke units is good and there is no reason to change.
We know the staff at all of the current stroke units work extremely hard and many people do receive good quality care. However, performance is not consistently meeting national standards which shows there is a need to find better ways of delivering stroke services in Kent and Medway.
We believe consolidating stroke services will enable us to deliver the standard of care patients should be able to expect.
All stroke services across England provide regular performance information to the Sentinel Stroke National Audit Programme (SSNAP), run by the Royal College of Physicians.
They publish data quarterly and annually. Their website has interactive maps and easy read reports by region. The following links may be of interest:
- Regional reports https://www.strokeaudit.org/results/Clinical-audit/Regional-Results.aspx
- Interactive maps https://www.strokeaudit.org/results/Clinical-audit/Maps.aspx
To see Kent and Medway data select South East SCN from the regional filter options.
Costs and funding sources
The proposals could lead to privatisation.
Some people believe the objective of Sustainability and Transformation Partnerships (STPs) is focused on cost cutting and privatisation of the NHS.
There is absolutely no privatisation agenda with our stroke proposals. The only providers being considered are NHS Hospital Trusts. We are not aware of any private providers of acute stroke care in England.
Whilst there are financial savings plans linked to the wider work of the sustainability and transformation partnership these proposals for stroke involve up to £40 million of extra investment into the services and recruitment of more staff.
The proposals are about saving money.
Some people have commented that reducing the number of stroke units is about saving money rather than improving patient care.
The proposals to centralise stroke services in three hyper acute stroke units serving all of Kent & Medway is driven by a need to improve the current performance of stroke services. The proposals would mean an investment of around £40 million to create the hyper acute stroke units, employ more staff and a £1 million investment for ambulance services.
The proposals are not focused on delivering savings, however, we would expect better stroke care to reduce the number of people left with disabilities and the severity of those disabilities; which would reduce the costs of ongoing care for people with stroke related disabilities.
More staff could be employed to have more units. You could train nurses. Stroke is no longer a specialist service.
Some people have suggested that stroke is now a standard service that all local hospitals should offer and that we could simply employ more doctors and train up nurses so we could have more than 3 units.
There are currently significant shortages of stroke doctors, nurses and therapists, both nationally and in Kent. The likelihood of being able to fill all the roles we would need to run hyper acute stroke units in Kent and Medway has been a key part of evaluating options for how many units we should have.
It is wrong to suggest that stroke care is a routine service that could be delivered as effectively by non-stroke specialists. Stroke clinicians, nurses and therapists are highly skilled and experts in treating this serious condition. It is not a quick process to train staff to a specialist level, if it were, we would not see the staffing challenges that do exist across the country.
It is important to remember that at the moment we do not consistently meet best practice standards for stroke care in Kent and Medway. We believe consolidating stroke services will enable us to deliver the standard of care patients should be able to expect.
The public meetings have been undemocratic.
Some comments have said our use of table discussions at listening events is undemocratic and the format should just be an open question and answer session; and that more time should be given for people to ask multiple questions.
We are using a mix of open question and answer sessions and smaller table-based group discussions. This is good practice in engagement events and gives people who are less comfortable speaking in public the opportunity to give their views. It also means we can capture more comments within the time of the meeting. We have been asked by some people to include round table discussions and have had positive feedback from where they have been used.
Our aim is to hear as broad a range of views from as many people as possible. Depending on the size of the audiences in different meetings we have sometimes limited the number of questions from individuals; but this is managed on a meeting by meeting basis to hear from a range of people.
The questionnaire is biased and limits options people can choose.
Some comments have said our consultation questionnaire is biased and does not give room for views opposing the options we are presenting.
Our questionnaire has been approved by a research company that complies with industry standards to make sure that bias isn’t introduced in the questioning. The questionnaire uses a mix of tick-box ranking questions (allowing responses from strongly agree to strongly disagree) and open text comment boxes. We have a specific open text question asking if people think there are other options that we should considered.
There is more detail in the supporting documents about the evaluation method used to get to the shortlist of options being consulted on; in particular see appendix M and N.
There hasn't been enough publicity about the consultation.
Some comments have called for more publicity about the consultation and public meetings taking place.
An extensive communications and engagement plan is underway to seek views from a wide range of people. There is general publicity as well as specific work to gather views from people less likely to respond to public consultations. The engagement plan has been reviewed and approved by the Health Overview & Scrutiny Committees for Kent, Medway, Bexley and East Sussex councils.
However, in response to comments, we have added additional public meetings, run more press adverts and sent a flier about the consultation to 98,000 homes in some of the areas most affected by increased travel times if the proposals go ahead. We have used paid for advertising in newspapers, radio and social media in a targeted way to balance raising awareness with the costs of such advertising.
Areas outside Kent and Medway should not be getting the same voice in the consultation.
Some comments have challenged why we are including people living in Bexley and parts of East Sussex in the consultation.
The proposals are focused on changes to stroke units in Kent and Medway, but some of the options would affect residents and hospitals in neighbouring areas. Bexley and High Weald, Lewes, Havens Clinical Commissioning Groups concluded that the potential impact on their residents was enough to mean they should join the formal consultation. Parts of Rother and Hastings are also being informed about the changes and invited to respond to the consultation.
The consultation is not a referendum or a vote. All feedback will be considered and will help inform final decisions. The consultation geography covers those who may use Kent and Medway hospital services. We believe it is important to include people living in neighbouring areas.