Medway Liberal Democrats urge best outcome for Kent in Stroke services consultation

Kent and Medway Clinical Commissioning Groups are urged to retain critical NHS stroke care in the Medway Towns and Mid Kent.

Responding to the consultation on proposed changes to stroke treatment and recovery in Kent, Medway Liberal Democrats offer qualified support for the principle of hyper-acute units offering specialised stroke care. There are clear benefits from patients having greater access to brain imaging, highly-specialised staff and quicker access to drugs and other surgical treatments following admission. There is little variation in cost between the options, so the decision must be based on quality of patient care and access times to hospital.

Option D offers the best possible patient care through investment at Medway Maritime, Tunbridge Wells and William Harvey hospitals. Medway Maritime already treats over 500 Stroke patients a year, investing in improved facilities would help ensure this busy facility can offer even better care. Based on their previous assessments, the three hospitals in this option would offer the most advanced treatments which could save lives and significantly reduce brain damage.

In describing the Medway Lib Dem preference for Option D, Martin Rose said: this would ensure the greatest proportion of Kent's population is within a 30-45 minute travel time of a hyper acute unit. Reaching hospital as quickly as possible can save lives and reduce the long-lasting effects of stroke. Option D represents the most equitable geographic distribution, recognising hospital catchments and road links.

For any of these options to work, we need confidence that ambulance crews can reach patients in the shortest time possible. The NHS needs to ensure that ambulance stations are properly resourced around the county. It is critical that paramedics reach patients within the first few minutes of a suspected stroke.

The urgent care they administer can buy time and offset the longer travel times to the more specialised hyper-acute units. Investment in the ambulance service to reduce travel times will benefit everyone in Kent.

Complementary services

The review highlights that hyper acute stroke treatment units perform better when other complementary services are available at the same site. Examples include the availability of a trauma unit offering vascular surgery (surgery carried out on blood vessels) and interventional radiology units offering mechanical thrombectomy - more information below. Medway Maritime and William Harvey Hospitals perform much better in this regard, as well as Tunbridge Wells Hospital. Maidstone and Darent Valley Hospitals do not currently offer such a wide range of other services. The Kent and Canterbury Hospital, like Maidstone Hospital, has in recent years experienced a reduction in the variety of services available, this further reduces the options for investment in hyper-acute stroke treatment in East Kent.

Advanced treatments

All three hospitals will be able to offer the most highly-specialised care, including mechanical thrombectomy - which is considered to be 2.5-3 times more successful at opening up blocked blood vessels than traditional treatment methods with "clot-busting" drugs. It has been successfully employed in France and Germany, NHS England is now aiming to roll the treatment out across the country.

The procedure is needed within six hours of the stroke's occurrence in order to be successful. Mechanical thrombectomy involves the insertion of a tube and then a stent to remove the clot from the brain. Around 10% of stroke victims would be eligible for the treatment.

It can reduce damage to brain tissue and therefore significantly reduce the chance of permanent disability following stroke, and may potentially save lives. Each procedure has been estimated to cost £12,000 but could save thousands of pounds by avoiding the need for rehabilitation and enabling some stroke survivors to live more independently than if they had sustained more significant damage. In their review the joint clinical commissioning groups conducting the survey determined that it may not be possible to offer this treatment at Maidstone or Darent Valley hospitals. In our view this reduces the case for investment at those sites.

Geographic distribution and road network access

This option also ensures that investment is focussed on the most densely-populated areas of North and Mid-Kent. A facility at Tunbridge Wells would ensure coverage in the High Weald and Sussex border where road links are poorer.

Distribution of acute stroke units and clinics to treat Transient Ischaemic Attack (TIA)

Whilst all options include investment at the William Harvey Hospital in Ashford, we believe further consideration should be given to the spread of "acute" stroke units for recovery and rehabilitation, as well as clinics for the treatment of Mini-Strokes.

Current proposals would see these co-located with the "hyper-acute" treatment centres. A higher number of acute recovery units, spread around Kent would reduce the inconvenience and cost of travel for patients recovering from stroke, especially in the East of the county.

In the North West of the county, option D also makes optimal use of facilities which are currently available at the Princess Royal Hospital in Farnborough (Orpington). Conversely, leaving no stroke unit between Maidstone and Eastbourne would lead to unacceptably high travel times for patients in the High Weald and other areas in the west of Kent and East Sussex border area.