CF supported the reconfiguration of stroke services in Kent & Medway to improve patient outcomes. We established an initial case for change, facilitated clinicians to define the proposed new clinical model, and developed a shortlist of options for where Hyper Acute Stroke Unit(s) should be located. Following public consultation, we supported leaders to agree unanimously on a preferred option.


  • Robust business cases achieved endorsement and support by regulators, the South East Coast Clinical Senate and the local government Health Overview and Scrutiny Committee
  • Successful public consultation reaching a population of 2.2m
  • A unanimous decision reached by Clinical Commissioning Group on a preferred option for location of Hyper Acute Stroke Units, which was successfully defended at judicial review
  • Reduction in deaths and disability from stroke expected following implementation.

Issue: Slow progress on reviewing underperforming stroke services

Healthcare leaders and clinicians in Kent and Medway had been struggling to make progress in reconfiguring their stroke services for two years before CF’s involvement despite the urgent need; stroke care in Kent & Medway was amongst the worst in the United Kingdom. The Sustainability and Transformation Partnership had no designated Hyper Acute Stroke Units (HASUs) and was underperforming against many quality measures. This pointed to many cases of avoidable deaths each year.

Outcome: Unanimous decision on the location of HASUs and support for business cases

CF supported the Kent & Medway team to evaluate the reconfiguration options for their stroke services to reach a unanimous agreement of locating HASUs at Darent Valley Hospital, Maidstone General Hospital, and William Harvey Hospital. External stakeholders of regulators, the South East Coast Clinical Senate and the local government Health Overview and Scrutiny Committee all supported the associated business case.


We brought together a multidisciplinary team incorporating financial, legal and NHS assurance expertise to deliver high quality, accurate work that would stand up to the high level of scrutiny required by the reconfiguration process. Supporting strong clinical leadership and engagement was central to our approach:

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Case for Change
  • Case for change: we developed a case for change narrative summarising our analysis of the issues with the region’s stroke services and their impact on the health and care of patients. We engaged with the local population on the case for change which was crucial in ensuring buy-in for the proposals.
  • Developing the clinical model: with our help, local clinicians developed a new clinical model for stroke. We facilitated the process and provided best practice evidence from across the UK with insights CF partners who led the ground-breaking London Stroke reconfiguration programme.
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  • Pre-consultation Business Case development and system engagement: we supported the system to move from the full list of potential options for the location of the HASUs to the final list using a rigorous process (see below). We then summarised this into the Pre-Consultation Business Case. Evaluation of the options was enabled by our comprehensive modelling of catchment, activity and beds; finance and capital; and workforce. The system was engaged throughout to ensure the modelling outputs were robust and had full ownership by stakeholders.
  • Public consultation: we supported the development of the public consultation plan and material, which far exceeded the original target for reach.
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Final Evaluation Matrix
  • Decision-making business case: following the public consultation, we conducted further modelling to evaluate the options for location of the HASUs as summarised below. The evaluation process culminated in a workshop designed and facilitated by CF and attended by members of the ten involved Clinical Commissioning Groups (CCG). A single preferred option for implementing HASUs was agreed by all CCGs, in a timescale the client had not originally thought possible.
  • Implementation planning: with a preferred option agreed, CF co-ordinated the development of an integrated implementation plan and worked with clinicians to identify a set of metrics against which the full benefits of the reconfiguration would be monitored. We then designed a reporting and governance system to support them. Finally, all findings and plans were synthesised into the Decision-making Business Case.

Results: Approval to implement and improved patient outcomes

The robust business cases achieved endorsement and support by regulators, the South East Coast Clinical Senate and the local government Health Overview and Scrutiny Committee allowing Kent and Medway to move forward to implementation. As a result of the HASU, a reduction in deaths and disability from stroke is expected.


“CF is a refreshingly different form of consultancy, using a range of very skilled professionals who have worked within and across real services. They are responsive to feedback, deliver to tight timescales and provide great quality, ensuring an overall outstanding experience. Most importantly, there is compassion and a real understanding of why services need to change and improve. The philosophy is about facilitation, evidence, challenge and most of all support and appreciation of the staff delivering the change and respect and inclusion of the public voice. The attention to detail and expertise has been pivotal, alongside the very real passion to land the best services for the Kent and Medway community.”

Patricia Davies
Director of Acute Strategy, Kent and Medway STP