Agenda item

This item was introduced by Adrian Stokes, Accountable Officer for Warwickshire North and Coventry & Rugby CCGs. The aim of the proposals was to improve stroke services, which were part of both CCG plans and the health and care system improvements identified under the previous item. It had been shown that current local stroke services could achieve better health outcomes for patients and more effective and efficient services. The analysis of current services showed considerable unwarranted variation and inequity.

Options for the future delivery of stroke care had been co-produced and appraised through a process involving extensive professional, patient and public engagement. Adrian Stokes referred to this engagement over the last four years and the current public consultation process underway on the proposed future stroke pathway. Detailed clinical engagement had also taken place and clinicians were in attendance. The report stated that the preferred future stroke pathway would improve the quality of outcomes and clinical care and remove the current variation in access to care. This proposal was for a whole stroke pathway improvement. He also referred to the bed modelling and service delivery in the home. A lot of work had been undertaken on the preventative aspects. Mr Stokes referred to the plans for a hyper acute stroke unit (HASU) and the subsequent rehabilitation support. It was believed this review was the best solution for the whole stroke pathway. He outlined the learning from the earlier engagement phases and the changes to the proposals, especially for additional ambulance support and workforce aspects.

The Pre-Consultation Business Case (PCBC) was submitted to NHS England and its panel granted provisional assurance, subject to some minor amendments. These amendments had subsequently been completed and the consultation document had been signed off by all local CCGs. The consultation document had been provided as an appendix to the report. The financial implications were reported. This proposal represented an investment of nearly £3.1 million. He outlined how the public consultation would be undertaken between now and 21 January 2020, with a formal pause over the Christmas holiday period. Dr Gavin Farrell outlined his involvement in the review as a clinician over the last five years. He referred to the work on early discharge and support in the home, with the excellent outcomes from this initiative in terms of reduced disability for patients and social care cost savings. The proposed review had been clinically led and sought to design the best outcomes from stroke in both the acute and community phases of the pathway.

Questions and comments were submitted, with responses provided as indicated:

• There was recognition of the extensive consultation undertaken to date and the investment being made in stroke services.

• An earlier concern was how the predicted reduction in the number of stroke cases had been modelled and further information was sought about the proposals for community based atrial fibrillation (AF). Early access to the HASU and AF were both stated as ways in which the number of strokes would be reduced.

• There would be some public concerns about transport and accessibility to the HASU at UHCW, especially for relatives wanting to visit a patient. The concerns for relatives and visitors was acknowledged, but it was considered this would be offset by bedded rehabilitation being closer to home.

• It was noted that investment had been made to commission additional services from West Midlands Ambulance Service (WMAS). Members questioned how well WMAS had been engaged in these proposals and they had been involved extensively and would be present at the public consultation events. The additional funding was to ensure WMAS could achieve the required response times.

• Where patients were in hospital with another condition and then suffered a stroke, it was questioned how they would be treated and whether they would be relocated to the HASU. If a patient suffered a stroke whilst in hospital, their treatment would be prioritised on the basis of the dominant condition. There would still be stroke physicians at both Warwick and George Eliot Hospitals, as these would be bedded rehabilitation sites.

• An assurance was sought that ambulance response times and access to the UHCW site could be achieved. Access for WMAS via School Lane was referenced particularly. Adrian Stokes would ask WMAS to provide a formal response to give this assurance to members. He added that there was a streamlined approach at UHCW so when the patient arrived, they were transferred to the HASU as soon as possible. Some patients were already being transferred to UHCW within four hours for treatment. Access to the site was much better following the introduction of revised parking arrangements.

• The rotation of specialist staff across the sites was discussed. The recruitment and retention challenges were acknowledged especially for acute stroke consultants. The model proposed was an exemplar and it was hoped this would be attractive to staff. Good training and rotation across sites were proposed as part of the vision and this should assist with staff retention.

• If the proposals were approved, there would be implementation of the community services first, to ensure that the modelling, bed numbers and patient flow were correct, before the acute centralisation took place.

• The decision on acute centralisation would be subject to further consultation as part of a staged and monitored process. This clarity was welcomed to avoid any rumours developing that services were being reduced.

• With regard to the report’s recommendations, it was not yet possible for the joint committee to provide its formal response. There were some minor aspects to resolve and members would need to see the consultation feedback before submitting their views. It was confirmed that each council’s health scrutiny body would review the proposals in detail, before reaching a conclusion at a further JHOSC meeting.

• The WMAS transfer times were a crucial aspect and there were differences between the city of Coventry and a predominantly rural county like Warwickshire, it being questioned if the timescales could be achieved. A meeting with WMAS was required. It was confirmed that WMAS would be involved in the consultation meetings.

• The location and timing of the consultation meetings was raised and these needed to be easily accessible so people could contribute to the review.

Resolved

That the Joint Health OSC:

1. Notes the pre-consultation business case and consultation documentation.

2. Provides its formal response to the consultation following the further discussion of the issues raised above.