Changes to Yeovil stroke services ‘make no financial sense’

The NHS Somerset integrated care board voted in late-January to approve plans to remove Yeovil Hospital’s hyper-acute stroke unit (HASU), meaning the most urgent stroke patients will be transported to either Dorchester or Taunton for treatment.

Chris Loder, who was first elected as Conservative MP for West Dorset in 2019, has laid out his concerns about the proposed changed in a letter to NHS Somerset’s chief executive, claiming the changes were based on a flawed business case and would lead to worse health outcomes.

NHS Somerset says its business case is sound and patients and the public would be kept closely informed as the changes were gradually implemented.

Stroke services are categorised by the NHS into two camps – hyper-acute (where emergency treatment is required within the first 72 hours) and acute (where the stroke is less life-threatening).

Under the agreed reforms, Yeovil will retain its acute stroke provision but all hyper-acute stroke patients will be transported to either Musgrove Park Hospital in Taunton or Dorset County Hospital in Dorchester, whichever is closer.

NHS guidelines currently advise that any hyper-acute stroke unit should be staffed by at least six qualified consultants and should operated between 8am and 8pm seven days a week, seeing a minimum of 600 patients a year.

The changes are expected to cost around £4m out of Somerset’s health revenue budget (i.e. day-to-day spending) – which includes £1.9m for additional staffing at pay at Musgrove Park Hospital, £1.8m for similar costs at Dorset County Hospital, £100,000 for similar costs at Royal United Hospital in Bath, and £100,000 for “repatriation transport”, where patients are taking back to Yeovil’s acute stroke unit after receiving treatment from the relevant HASU.

Around £1.8m of capital funding will be provided to ensure Dorset County Hospital has sufficient capacity for the additional patients.

Mr Loder – who is standing for re-election at the general election on July 4 – presented his case to the NHS Somerset integrated care board (ICB) when it met in Frome on May 23, before parliament was officially dissolved.

Following this meeting, he released a letter to NHS Somerset chief executive Jonathan Higman, outlining the following concerns he had with the business case for the stroke unit proposals:

1. The business case measures the average ambulance journey time as recorded at 3am, which is “not in line with the expected majority” of call-out times, and could hurt patients’ chances of being treated in good time
2. The case does not take account of any additional costs that will be borne by the South Western Ambulance Service NHS Foundation Trust
3. The additional journey times for ambulances could lead to longer waits for less urgent patients – something which is “unacceptable” given that some patients are already waiting eight hours or more
4. The case does not provide clarity on how many people will benefit from the changes – or what will happen to the 25 per cent of stroke patients who self-present at Yeovil Hospital for treatment
5. Most Yeovil patients needing a HASU will be sent to Dorchester rather than Taunton  – with the most serious possibly needing to go be directed all the way to Southampton for specialised treatment
6. Recruitment may prove more difficult in Dorchester than in Yeovil due to high property prices and rent levels
7. The needs of Dorset residents “have not been adequately considered”, with a lack of consultation over the border until the initial decision had been made
8. The ICB has “underestimated” public opposition to the changes, as demonstrated by an online petition signed by more than 10,000 concerned residents
9. Dorset Council Hospital does not currently have a HASU, and the risks of building and then staffing one within 18 months are not adequately considered”

Mr Loder added: “The public cannot understand how the taxpayer will be paying an extra £4.2m a year, when Yeovil Hospital’s HASU will be closed – and neither can I.

“The assumptions for ambulance journey times are based on 3am call outs, when most stroke responses are in the middle of the day.

“There is a huge disparity in a basic assumption that is totally unacceptable on which to base a case of such importance to life.”

NHS Somerset said that considerable work had gone into ensuring that the business case was sound and said patients would be kept constantly updated about the implementation of the changes.

In a statement published on its official website following the ICB meeting, it said: “We have now started to implement the plans, which were developed by clinicians, people working in stroke services, key stakeholders and people with lived experience of stroke.

“We have been considering how to keep key stakeholders involved in the implementation phase so we will be setting up a stroke stakeholder reference group that will receive regular updates on the implementation of the changes, and will advise on ways to best engage with local communities to respond to concerns they may have.

“The changes will mean better emergency treatment, reduced disability, in fewer deaths and better recovery for stroke patients.

“A considerable amount of work has gone to make these improvements, including hugely valuable input from clinicians, staff, stroke survivors and their loved ones.

“The review of urgent stroke services in Somerset has always been about improving the quality of care and outcomes for patients. These changes will see a significant investment in local stroke services.

“We will see improvements to patients’ diagnostic and treatment times, with quicker CT scans and thrombolysis, meaning patients will recover better and have an improved experience.

“All patients, no matter where they live in Somerset, will benefit from being admitted to a unit that is able to provide excellent stroke care 24 hours a day, seven days a week.

“Our NHS colleagues in Dorset have been active members of our steering group and we continue to work closely together to implement these changes over the coming 18 months.

“The process will make sure that the services needed at Musgrove Park Hospital and Dorchester County Hospital will be ready to go, before emergency stroke services at Yeovil move.”