It may seem the Kent and Medway Stroke Programme has been a little quiet of late. As we all know, the past six months have been an unprecedented time for the NHS. Covid-19 has meant that while our frontline stroke services continued to treat stroke patients as usual, non-clinical members of the central Stroke Programme team were re-deployed from their jobs to support the pandemic response. The team members have now returned to their usual roles and we wanted to provide an update on key elements of our work.
We were pleased to receive notification from the Court of Appeal that permission has been refused for both applications for appeal against the judicial review ruling on the stroke services review.
These decisions from the court draw a line under the legal process challenging the decision to implement three hyper acute stroke units as there are no further legal routes available to the claimants.
The judges considering the applications ruled that there were no permissible grounds for an appeal against the judicial review ruling made in February 2020. As you will recall, the judicial review found entirely in favour of the NHS on all eight of the grounds bought by the claimants.
The need to improve stroke services in Kent and Medway is as urgent as ever however, and while this decision brings us closer to being able to move forward with the implementation of evidenced-based hyper acute stroke units, which will in turn reduce death and disability from stroke we are still awaiting the decision from the Secretary of State on the referral for an independent review of the process. We hope this can now be expedited so we can make improvements to acute stroke services for our population.
It has always been recognised that the loss of key staff from stroke units which will not become HASUs is a significant risk to the services in those units, particularly in the transition period from agreement to implementation of a new model of care. We also understand that the ongoing uncertainty for all stroke staff in Kent and Medway about the location of acute stroke services is a risk given that bordering counties have all implemented HASUs and can offer roles delivering a high quality model of care.
Over the last 12 months there have been two temporary emergency changes to acute stroke services provided by Maidstone and Tunbridge Wells NHS Trust (MTW) and Medway Foundation NHS Trust (MFT) related to a lack of specialist stroke nurses. The acute stroke service at Pembury Hospital in Tunbridge Wells was transferred to Maidstone Hospital in October 2019, and the acute stroke service provided by MFT was transferred to Maidstone Hospital and Darent Valley Hospital in July 2020.
In both cases the changes were made to ensure patient safety. While these moves are emergency temporary transfers of services, it seems unlikely that they will return to their original sites before the implementation of the new HASUs. Fragility of acute stroke services in Kent and Medway and their ability to meet national clinical quality standards related to staffing remains one of the key drivers for change. In addition, as part of the Covid-19 response, East Kent Hospitals temporarily moved the acute stroke services from William Harvey Hospital in Ashford and QEQM Hospital in Margate to the Kent and Canterbury Hospital on 1 April. This was a direct response to the pandemic designed to free up hospital beds to care for patients with coronavirus at William Harvey and QEQM hospitals, and to keep vulnerable stroke patients as safe from infection as possible, in line with national guidance.
As Covid-19 is still with us, the service will remain at Kent and Canterbury Hospital for the immediate future. However, it is important to note that this temporary move is separate to the implementation of HASUs for Kent and Medway patients.
As part of the national NHS response to Covid-19, NHS England agreed a six-month subscription to an artificial intelligence (AI) tool called Brainomix. Brainomix is able to ‘read’ brain scans of potential stroke patients and help consultants make a faster and more accurate diagnosis.Tools like Brainomix allow high quality brain scans to be shared digitally so doctors could review them remotely. Images are securely sent straight to computers or smartphones and the AI tool identifies potential diagnosis for clinicians to confirm, speeding up the time it takes to make appropriate treatment decisions. This use of AI is not just helpful during the pandemic, stroke specialists and best practice guidelines recommend that AI tools become common place in stroke services. The Kent and Medway Stroke Network will be evaluating the six-month trial of Brainomix to better understand how AI will benefit the new HASUs once implemented.
Integrated Stroke Delivery Networks (ISDNs) were first described in the NHS Long Term Plan, published in January 2019. The new ISDNs will be multi-agency networks tasked with ensuring optimal stroke pathways and supporting the delivery of the NHS’s seven-day standards for stroke care; delivering safe and effective treatments to stroke patients.
ISDNs will involve all services from pre-hospital through to early supported discharge and community with specialist stroke-skilled rehabilitation and life after stroke, as well as commissioners.
The Kent and Medway ISDN will officially come into being on 1 April 2021. The key success factors of the ISDN will be:
- Improved access to and discharge from services at the right time
- Improved operating consistency
- Improved outcomes for patients (fewer deaths and less disability)
- Increased productivity
The Kent and Medway ISDN will be led by a Programme Board that will oversee and manage a collectively agreed plan of work that will aim to:
- Ensure effective clinical flows and care pathways through the system with clinical collaboration and coordination between providers
- Take a whole system collaborative approach to ensuring the delivery of safe and effective services across the patient pathway
- Improve cross-organisational multi-professional clinical engagement and patient/carer engagement
- Enable the development of consistent provider guidance and improved service standards, ensuring consistent patient and carer experience
- Focus on quality and effectiveness through facilitation of comparative benchmarking and auditing of services, with implementation of required improvements
- Fulfil a key role in assuring providers and commissioners of all aspects of quality as well as coordinating provider resources to secure the best outcomes for patients across the area
- Support capacity planning and activity monitoring with collaborative forecasting of demand and matching of demand and supply.
Our work on the rehabilitation business case continues, and we expect it to be finalised and approved by December. We remain committed to improved and equitable stroke rehabilitation services being in place when the new HASUs go live.
Work has been completed to analyse current services, to design and agree new model of care, and establish the resource requirements for the new service. We are continuing to secure inpatient rehab facility in Thanet and this work is progressing well.
Covid-19 has highlighted some helpful lessons such as the importance of befriending services and vocational rehab alongside the clinical aspects of rehab, and we are working to build these in to our stroke recovery offer. The pandemic has also reinforced the need to eliminate “handoffs” between acute and community services to deliver seamless services. We will enable this by designing and introducing new, innovative staff roles and ways of working so that staff 'follow the patient' across the pathway with staff being known to the patient from acute care to life after stroke.