Agenda item

Andrea Green, Coventry and Rugby Clinical Commissioning Group (CCG) will report at the meeting

The Board received a report from Andrea Green, Coventry and Rugby Clinical Commissioning Group (CCG) on the proposals for the redesign and improvement of stroke services.

The report referred to the establishment of a project in April, 2014 by Coventry and Warwickshire CCGs to improve local stroke services for those who have had a stroke or a transient ischemic attack (mini stroke). In due course the proposals were expanded to include improvements to acute services, specialist rehabilitation and primary prevention of strokes. Reference was made to the project governance structure including the Project Stakeholder Board and an expert Patient and Public Advisory Group.

The report set out the case for change as follows:

Access to Service is time critical both to saving lives and reducing disability

Local gaps in timelines for people who stroke

Local TIA (mini stroke) service variation

Workforce gaps – Stroke Specialist Consultants

Unwarranted variation and inequality in stroke specialist rehabilitation services.

The Board were informed of the engagement with patients, carers and key stakeholders. A pre-consultation engagement programme was undertaken in the initial stage of the project to understand the views of key stakeholders and local people about the potential scenarios for a new stroke pathway in order to shape the future of stroke services in Coventry and Warwickshire. The aims of the discussions were to ensure everyone had a clear understanding of the services delivered currently, the evidence base and rationale for change and what scenarios were being discussed. Four possible scenarios for the future of acute stroke care were put forward. Key themes received from the early engagement with stroke survivors, carers and the public were related to transport issues, communication difficulties, compassion and dignity, staffing and discharge support. Following engagement, the following proposals were developed:

·  Having one specialist stroke team based at UHCW, made up of experts in stroke services. They will treat people in the important first few days after a stroke

·  A community support service for people who are recovering at home

·  Closure of the specialist stroke services at Warwick Hospital and George Eliot Hospital

·  The provision of hospital beds for people who need to be in hospital while they recover at Leamington Hospital and George Eliot Hospital.

Following treatment at Hyper Acute and the Acute Stroke Unit on the UHCW site, patients would be referred to one of five settings to meet their rehabilitation or ongoing needs:

·  Home with Early Supported Discharge Service

·  Cared for in a nurse led stroke ‘bedded’ rehabilitation service at a local hospital

·  Home with the Stroke Community Rehabilitation Service

·  Home with a package of care

·  Nursing or residential care for those with more complex needs.

Attention was drawn to the support from the West Midlands Clinical Senate of national experts on Stroke Care for the model.

It was anticipated that improvements would be a reduced number of people who stroke; a reduction in deaths from stroke; a reduced disability from those who suffer a stroke; and improved cognitive function for people after a stroke.

Further information was provided on the four week public and patient engagement on the proposals. Appendices to the report detailed the consultation questionnaire and the four engagement events to be held during July. NHS England would then need to complete their assurance process before any consultation commenced.

Members raised a number of questions in response to the report, matters raised included:

·  The anticipated average length of stay at Leamington or George Eliot hospitals

·  The importance of providing the public with a consistent message being clear on the benefits of the proposals during the engagement and consultation stages

·  The requirement to tighten up on communications ensuring the message was all about better patient outcomes as oppose to saving money

·  The importance of all the partners supporting the redesigned and improved stroke services.

RESOLVED that, having reviewed the proposals to improve stroke services, it be noted that the CCGs are:

a) Completing a further phase of engagement as the scenarios for improvement have now been translated from the feedback from patients, the public and clinicians into proposals attached at Appendix A

b) Have commissioned another integrated impact assessment of the proposals

c) About to enter the final stage of assurance with NHS England.