Agenda item

Graham Venables, Clinical lead for Stroke work stream provided a presentation relating to a review of hyper acute stroke services across South Yorkshire, that had been undertaken over the past 18 months.

 

Consultation had been undertaken with doctors, nurses and healthcare staff in hospitals, NHS staff who commission hospital and GP services and data and clinical experts about what the future for critical care stroke patients might look like in the region.

 

The Committee learnt:-

 

·       If HASU centres admit less than the best practice minimum of 600 per unit but over 1,500 then there is a risk of burn out.

·       Doctors, nurses and healthcare staff all agree that the way critical care for stroke patients is provided across the region won’t meet their high standards in the future – this needs to change.  There were currently unsustainable medical rotas.

·       More stroke doctors and nurses to run the services were required – there were not enough locally or nationally

·       There is low QUALITY of care (SSNAP data) across 4/5 hospitals

·       Patients need GOOD care for the first 72 hours (hyper acute stage)

 

The Committee was provided with details of the appraisal process and preferred options for moving the service forward over the next 5 years.

 

It was recommended that the services change by adopting a system wide solution, working together better for the benefit of every stroke patient in South Yorkshire and Bassetlaw and North Derbyshire.

 

Based on feedback from doctors, nurses and regional and national clinical experts, the following option would allow this, with further work being carried out to consider the second option in the future.

 

A number of options had been discounted by the working group leaving two preferred options:

 

OPTION 1

 

The proposal is that if you live in South Yorkshire and Bassetlaw and North Derbyshire and have a stroke, you would receive hyper acute stroke care in:

 

•Chesterfield Royal Hospital

•Doncaster Royal Infirmary

•The Royal Hallamshire Hospital, Sheffield

 

This would mean that Barnsley and Rotherham hospitals would no longer provide hyper acute care for people who have had a stroke.

 

Chesterfield was not a part of this review as it is sited within the East Midlands region.

 

 

OPTION 2

The proposal is that if you live in South Yorkshire and Bassetlaw and North Derbyshire and have a stroke, you would receive hyper acute stroke care in:

 

•Doncaster Royal Infirmary

•The Royal Hallamshire Hospital, Sheffield

 

This would mean that Barnsley, Rotherham and Chesterfield hospitals would no longer provide hyper acute care for people who have had a stroke.

 

Chesterfield was not a part of this review as it is within the East Midlands region and so this element is subject to decision elsewhere.  However, we will need to talk to people about this possibility as part of our consultation process.

 

It was stressed that stroke care was divided into three phases:

 

1.     Every person enters the acute critical care unit where the physical status is monitored; 

 

When they are stabilised they move into:-

 

2.     Rehabilitation in hospital;  and

 

3.     Phased return to home.

 

It was stressed that to deliver a sustainable stroke response service the following support was required Consultant, training staff, nurses, continence advisers and social workers.  Early assessments were essential

Following the presentation, Councillors undertook discussion on the following areas:

 

Staffing, funding and skills shortage

Concern was expressed that many doctors could train for Acute stroke care however there was not the funding in place for them to do so.

 

It was highlighted that one of the reasons to consolidate the Hyper Acute Stroke Units was to address the skills shortage, which was increasing year on year.  It was reported it was not just a local issue but a national problem and the position had been forwarded to the Department for Health as a real worry. 

 

The proposals for the next five years would provide security for the region with staff, for example in Rotherham staff would be offered to undertake skills they have learnt in high functioning teams and trained for, in Sheffield or Doncaster hospitals.

 

The service was reviewed to plan a future model, with week on week intense provision and workforce challenges no one could be certain of the exact requirements.  Sometimes staff could be difficult to recruit in Yorkshire but this was due to personal issues rather than medical issues.  There was a lot of attraction for medical staff in stroke care provision towards the end of people’s careers.

 

It was recognised by professional bodies who work in the health field there was a shortage of funded opportunities for stroke positions. and that some of the funded training posts in London could not be filled and the money was transferred to the Yorkshire region.

 

It was reiterated that there were no proposals to change the number of consultants but for them to move to different locations across the region.Proposals would provide a much more sustainable service and provision.

 

First 72 hours of care

 

It was noted that to reduce the number of stroke patients dying with pneumonia, a swallow test must be undertaken immediately.  Early intervention with such a test stops incidents of this nature.

When a person has a suspected stroke the first responder does an initial assessment before a patient is transferred to hospital, with times and standard that have to be met.  Ambulance staff undertake informal assessments to ensure the information is available for clinicians on arrival at hospital.  Once a patient arrives the meet and greet team take them from the ambulance direct to the CT scan area.

In response to queries raised, Aspirin was not administered in the ambulance and it was noted that Newcastle hospital were currently investigating use of this treatment.

 

Travel times to hospital/repatriation to local area and home

 

In response to questions and concerns raised by the Committee, it was explained that the worst case scenarios of travel time by ambulance have been considered and meet the 45 minute deadline taking into account variable with travel/road conditions and weather.  It was explained that someone from Bassetlaw would be transported to Doncaster within the 45 minute and in reality could reach Leeds in this timeframe.

At this point some Members highlighted that there had been difficulties with ambulance response times and how this would impact on the 45 minute time frame. 

 

The Committee expressed concern that generally people who had strokes were older, meaning relatives would have to travel a long distance to undertake visits.  The proposals would provide initial treatment for patients at one of the three or two hospitals for the first 72 hours following which, they would be repatriated to the area where they live for the recuperation period.  During pre-consultation stage outcomes were clear that people would be willing to travel the distance to the proposed hospital sites.

 

Members fully understood that from a clinical point of view it was more advantageous for a patient to be transferred to strengthened Hyper Acute Stroke dedicated hospitals for the first 48 to 72 hours, and were assured that they would not be moved unless their condition was stable and allowed the patient to be transferred.

 

It was explained that if a patient from the Barnsley area was treated initially at Sheffield, for recuperation they would not be transferred to a ward at Sheffield, but back to Barnsley hospital.

 

With regard to returning home following treatment, the Committee highlighted that good partnership working needed to be in place.

 

Treatment that could be provided by a Hyper Acute Stroke Unit

 

With two or three centres one of the treatments provided could be blood clot sucking undertaken via a catheter via the artery to brain.

 

Consultation

 

The Committee was assured that when consultation was provided to members of the public it would give details of all options for discussion.

 

Standard of care

 

It was noted that the time it takes for a stroke patient to be properly assessed has not changed in the last 7 years, and that was not acceptable.  There have been areas and standards of improvement but these would be difficult to sustain and it was stressed that nobody in the Stroke service provision arena would accept low standards.

 

Cross Boundary issues

 

Members stressed there could be cross boundary capacity issues and stressed that full consultation be undertaken to ensure all parties were aware of the current situation.

 

Issues relating to Pinderfields and Chesterfield Royal Hospitals were raised by Members but it was noted that this was outside the jurisdiction of this collaborative to discuss the position.

 

RESOLVED:- that the above discussion, progress of the work and implications for moving forward through NHSE Level 2 Assurance and towards public consultation for the options in October, be noted.