CF was commissioned to support the reconfiguration of stroke services in Kent & Medway to improve outcomes for the population. In phase one 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 a period of public consultation, we then supported the leaders in Kent & Medway 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
  • Reduction in deaths and disability from stroke expected as a result of implementation.

Underperforming stroke services

Stroke care in Kent & Medway is among the worst in the United Kingdom. The Sustainable Transformation Partnership has no designated Hyper Acute Stroke Unit (HASU) and is underperforming against all quality measures. For example, standards indicate that all eligible patients should receive thrombolysis treatment within 60 minutes, however, none of the hospitals in Kent & Medway currently meet this standard. This points to many cases of preventable deaths each year.

Healthcare leaders and clinicians had been struggling to make progress on the stroke review for two years before CF’s involvement. 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.

Case for change

The first part of our process to accelerate Kent & Medway’s stroke review was completing a rapid analysis of issues involved in stroke service across the region and their impact on the health and care of patients. We synthesised our findings into a case for change narrative and engaged with the local population on this which was crucial to ensuring buy-in for the proposals.

Developing the clinical model

The next step was working with clinicians to agree on the outline of a new model, informed by the best practice evidence we gathered from across the UK and the practical experience of our accountable partner, who led the ground-breaking London stroke reconfiguration programme.

Robust modelling

Having identified site-specific options, we carried out comprehensive modelling to determine a shortlist for the location of Hyper Acute Stroke Units. This involved catchment, activity and bed modelling; finance and capital modelling; and workforce modelling.

All modelling work was conducted with broad engagement with the system, to ensure STP the outputs were robust and had full ownership by stakeholders.
We supported providers and commissioners to understand the financial impact of the reconfiguration and helped estates directors to identify the implications on estates and to assess deliverability. We also engaged with areas outside of Kent and Medway to ensure the full impact of any potential change was understood.

Business case development and public consultation
We prepared the pre-consultation business case (PCBC), which we supplemented with robust financial analysis. In addition, we supported the development of the public consultation plan and material, devising an approach that far exceeded the original target for reach. 

Decision-making business case
Our second phase of work built on the public consultation process and involved further robust modelling to evaluate the shortlist of options for the location of Hyper Acute Stroke Unit
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Agreeing a preferred option

Determining a preferred option involved assessing against a number of criteria, including each Trust’s ability to deliver on proposals. To do this, we devised and ran a deliverability panel chaired by the regional director of NHS England, with other panel members including an independent clinical expert and a stroke survivor.

The culmination of the evaluation process was a workshop which was designed and facilitated by CF and attended by members of the ten involved Clinical Commissioning Group (CCG) governing bodies. A single preferred option for implementing HASUs in Kent and Medway was agreed by members of all affected CCGs, in a timescale the client had not originally thought possible.

Programme planning

With a preferred option agreed, CF convened an operational planning group to co-ordinate the development of an integrated implementation plan. This addressed the requirements for estates, finance, workforce, clinical service development, communications, information management and telecommunications, and a project management office. 

Ongoing impact and monitoring

As a result of the HASU implementation, a reduction in deaths and disability from stroke is expected. CF worked with clinicians to identify a set of metrics against which the full benefits would be monitored. Expertise was drawn from the national clinical lead for stroke and an independent academic to ensure that the metrics chosen were the most appropriate and fit for purpose. We designed a reporting and governance system to support them.