UPDATE : Staff shortages no excuse for closures

Attendees of the Margate Listening Event (Stroke Review) last week might be surprised to read this… The Stroke Association, whilst supporting the implementation of HASUs (Hyper Acute Stroke Units), do not support staffing gaps being used as an excuse to limit the number of acute units, as stated explicitly in their document ‘What We Think about Reorganising Stroke Services’ report, from 2017. This is exactly what Kent and Medway NHS execs are doing – justifying the centralisation of acute stroke services from 9 to 3 units, due to a lack of specialists.

STROKE ASSN staffing gaps
The Stroke Association states:
‘While there is good evidence that reorganisation has produced good results in some parts of the country, we recognise that it may not be appropriate everywhere. Reorganisation should only happen where it can be demonstrated that stroke patients will benefit. Those wanting to reorganise need to fully engage with patients and set out how it will happen and how services will improve. If we are satisfied that services will improve as a result of reorganisation, we will support the process in local areas. Reorganisation should certainly not be used as a way to plug staffing gaps.’
It does seem to be rather a back to front argument, to state that all of Kent’s acute stroke services must be reorganised, including the closure of six acute units, to deal with what ought to be a temporary staffing shortage. There is a lot of concern that Thanet and Herne Bay will be facing dangerously long ambulance journeys (40 miles to Ashford), which will jeopardise the chance of patients being seen within the ‘golden hour’. Also QEQM hospital’s current stroke unit is better that the national average for achieving rapid stroke diagnosis (imaging within one hour), and all the hospitals in East Kent that have a stroke unit currently already have out-of-hours access to a consultant for thrombolysis assessment* (thrombolysis ; dissolution of a blood clot on the brain by use of clot-busting drugs).
So why the need to consolidate all of Kent’s acute stroke care into just three HASUs? Kent and Medway STP (a group of senior NHS managers and clinicians) say that they cannot attract the staff, they are losing staff to jobs in London which is more attractive due to the number of job opportunities available, and a national shortage of stroke specialists.
Save Our NHS in Kent (SONIK) not do agree with the argument that a reduction of the units in Kent is the correct solution to this difficulty. Here’s why:
  1. Staff shortages must be dealt with urgently; the upskilling of existing staff and training new ones must be a national priority for the NHS. But citing staff shortages as a reason to close units is just accepting failure without attempting to find solutions. Shortages of this kind should never be used as a justification to cut or centralise services.
  2. We asked Dr David Hargroves (Lead Clinician on the Stroke Review, Kent and Medway STP) if it would be possible to train existing nurses to administer thrombolysis, in order to increase the number of specialist nursing staff. He avoided giving a direct answer, saying ‘that is not currently done anywhere in the UK’. We pushed for a full response, asking ‘Is it possible’, but could not get a sufficient answer.
  3. Regarding the shortage of consultants, we asked if consultants could be attracted here from abroad. We also asked if stroke specialists of all kinds (speech and language therapists, physiotherapists) could be recruited and retained with better incentives, such as improved pay and conditions. No sufficient answer has been given for this.
  4. On the topic of London and its environs being more attractive to specialists because of the wider availability of job and promotional prospects (career development). By reducing the number of units and accepting that we can only have a limited number of FTE roles for specialists, aren’t we just reducing that job and career development pool even further in Kent? If we accept that it is not possible to have the 24 consultants required to staff four HASUs, then aren’t we just accepting failure, abandoning certain sections of Kent (who pay their National Insurance just like everyone else) to poorer care, and growing the chances of career bottlenecks that could drive experienced consultants away to London?
In conclusion, the reduction of stroke units to just three must be contested. In particular, the closure of QEQM hospital in Margate is a proposition that defies common sense given the elderly population and levels of deprivation in Thanet. How can temporary staff shortages – that should be addressed as a matter of urgency – be used to remove a stroke unit dangerously far away from the area of Kent with the highest incidence of stroke** in the county?
Carly Jeffrey
Save Our NHS in Kent
With thanks to Debbie Marriott, Dr Coral Jones, Helen Whitehead, Rebecca Gordon Nesbitt, Candy Gregory, Liz Milne, Ian Venables, Maria Pizzey, Dr Tim Winch, Angela Curwen and Margaret Hay for research.
* Figure 7, page 38 of Kent and Medway STP’s Pre Consultation Business Plan.
** Figure 4, page 34 of Kent and Medway STP’s Pre Consultation Business Plan.