Dear Kent and Medway Stroke Review Team / Rachel Jones,

In light of your (oddly timed) December 11th announcement that the opening of the new HASU units would be delayed, can you please answer these questions:

A) Please can you provide a full explanation of all the reasons for the planned HASU stroke unit openings being delayed
B) Can you explain in full why the delays vary in different areas?

C) Are the closures also delayed?

D) When are you expecting the decision from the referral back of your stroke plans (actioned by Medway Council) to be made public?

Also, you made this statement to the press “we introduced a recruitment and retention incentive for newly recruited stroke nurses earlier this year at all hospitals in east Kent, including QEQM” (Isle of Thanet News, 11/12/2019), but we cannot find any references to this in the public domain that give details. Can you please provide further information on this and on the current staffing situation, as follows:

1. When did this ‘recruitment and retention incentive’ begin?
2. What is being offered? Please provide comprehensive details.
3. Why are only newly recruited stroke nurses being offered this, when we know from the arguments made during the stroke consultation that retaining experienced stroke staff is essential to running a best practice, high quality stroke unit?
4. Why are other stroke specialist staff not being offered this – the SLTs, the Physios, Occupational Therapists and the doctor/consultant roles? Specialist staff in these areas are also essential for a top class stroke care, which is your aim, so the decision to limit retention incentives only to newly recruited nurses seems rather odd.
5. Immediately following the closure (which is temporary, but “unlikely …[to] be reversed”) of the acute stroke unit at Tunbridge Wells Hospital due to unsafe staffing numbers, SONIK contacted EKHUFT (East Kent Hospitals University Foundation Trust) and the STP (Kent and Medway Sustainability and Transformation Partnership) asking that retention premia (pay incentives) be put in place to allow specialist stroke staff to remain in their jobs in this period of uncertainty, knowing that they would be cushioned by the extra pay if their jobs were suddenly scrapped. In August 2019, we also set up an online petition. EKHUFT gave no reply whatsoever to this question; your Stroke review Team confirmed they would not be doing so. Why was it not mentioned at that time that the ‘recruitment and retention incentive’ recently referred to was in place at all hospitals in Kent? Why instead was there a refusal to provide pay incentives to prevent skilled staff from leaving?
6. From the HSJ, we understand that there are two consultant vacancies across the WHH and QEQM hospitals. Can you clarify if those are specialist stroke consultant roles? When did the roles become vacant (we know that at the time the plans were initiated, there was no stroke consultant vacancy at QEQM).
7. From the HSJ (“Controversial Streak Plans Delayed”, Alison Moore, 11th December, 2019), we understand that East Kent Hospitals Trust has “only had 76 per cent of the substantive nurses it needed in the unit at QEQM”. What is meant by ‘substantive’ in this context? Is the 24% shortage of specialist stroke nurses, or does it pertain to a different category? What is the shortfall figure in numbers rather than a percentage?
8. How many specialist stroke nurses are there currently in each of Kent and Medway’s NHS hospitals, and what is the shortfall in each?
9. The statement (in the HSJ article) also says “We currently have sufficient stroke nurses, doctors and therapists to run stroke services in east Kent”; can you explain how this fits with the 24% shortage in ‘substantive nurses’ mentioned in the same article?
10. QEQM was missing an SLT (Speech and Language Therapist) for a period of time (one of the main reasons that it achieved lower SSNAP scores that would be desirable). Now it appears that QEQM has an SLT. When was the SLT recruited?

Please let it be noted that at the current time, as far as we are can tell from the limited information provided, both Medway Foundation Trust and the Kent and Medway Stroke Review Team have decided not to offer retention premia (pay incentives) to avert the possibility of a disaster at QEQM and Medway Maritime Hospitals. The CEO of East Kent Hospitals did not given any response at all when asked about this. The new HASU centres will not open until 2021/2022, therefore staff at the units earmarked for closure MUST BE PROPERLY INCENTIVISED TO REMAIN IN POST in the interim. The Stroke Review Team clearly state (see attachment) that staffing at all the stroke units is ‘fragile’. If specialist stroke staff decide to leave their (currently very unstable) jobs in the coming year, and it results in early closures of the existing acute units, it will be the responsibility of the senior decision makers with the local NHS infrastructure; they will be to blame.