Agenda item

Report of Adrian Stokes, Interim Chief Executive, NHS Coventry and Rugby and NHS Warwickshire North Clinical Commissioning Group (CCG) who has been invited to the meeting for the consideration of this item along with the following representatives:

Gavin Farrell, Consultant Clinical Neuropsychologist,  South Warwickshire NHS Foundation Trust

Claire Quarterman, Clinical Lead for Early Supported Discharge Team and Community Neuro Rehabilitation Team, Coventry and Warwickshire Partnership NHS Trust

Mark Docherty, Director of Clinical Commissioning and Strategic Development/Executive Nurse, West Midlands Ambulance Service

Rose Uwins, Senior Communications and Engagement Manager, NHS Coventry and Rugby and NHS Warwickshire North CCG

The Board considered a report of Adrian Stokes, NHS Coventry and Rugby and NHS Warwickshire North Clinical Commissioning Groups (CCG), concerning the proposed new clinically and operationally sustainable model for stroke services across Coventry and Warwickshire. Copies of the pre-consultation business case and the consultation documentation were set out at appendices to the report. The submission of the report formed part of the current public consultation on the proposals. Adrian Stokes attended the meeting for the consideration of this item along with Gavin Farrell, South Warwickshire NHS Foundation Trust, Claire Quarterman, Coventry and Warwickshire Partnership NHS Trust, Mark Doherty and Pippa Wall, West Midlands Ambulance Service, and Rose Uwins, NHS Coventry and Rugby and NHS Warwickshire North CCGs.

Adrian Stokes introduced the report which indicated that the aim of the proposals were to improve stroke services, which were part of both CCG plans and the health and care system improvements identified by the Coventry and Warwickshire Health and Care partnership. Comparisons of the performance and outcomes of current local stroke services against best practice standards and the achievements of other health systems in England, showed better health outcomes could be achieved for patients and more effective and efficient services.

The Board were informed that options for the future delivery of stroke care had been co-produced and appraised through a process involving extensive professional, patient and public engagement. The resultant Pre-Consultation Business Case (PCBC) described the process and outputs in detail, proposing the implementation of a new service configuration that would see:

·  Removal of the current inequities in service provision across Coventry and Warwickshire

·  Prevention of c.230 strokes in 3 years by bringing anticoagulation prescribing to best practice levels

·  Centralisation of hyper-acute and acute care at University Hospitals Coventry and Warwickshire (UHCW)

·  The provision of 2 sites for bedded rehabilitation at George Eliot Hospital and Leamington Rehabilitation Hospital for the 30% of the population experiencing a stroke who cannot go home with Early Supported Discharge or Community Stroke Rehabilitation

·  The provision of new community services to deliver consistent Early Supported Discharge and Community Stroke Rehabilitation services at home for 70% of stroke patients, enabling them to return directly home after hyper acute and/or acute care.

This preferred future stroke pathway and delivery model would create services that met the NHS Midlands and East Stroke Service Specification and would enable providers to deliver an “A” rating on The Sentinel Stroke National Audit Programme (SSNAP) performance targets for stroke care. Extensive public and patient engagement and co-production to help inform and shape the proposed pathway had taken place over the last 4 years and a public consultation process on the proposed future stroke pathway was currently underway.

The report highlighted that it was unusual to develop a PCBC that only proposed one option to achieve the improvements, however this was a proposal for a whole stroke improvement and not just a business case for a single service improvement. The complexity and interdependencies of handover of care, and need for an integrated workforce approach across the pathway, had led to the proposed option and pathway.

An NHS England Panel review meeting had taken place on 15 August 2019. The Panel had granted provisional assurance for the PCBC against the five assurance tests in the NHS England Planning, Assuring and Delivering Service Change for Patients, subject to minor amendments. These amendments had been completed, and the resulting consultation document had been signed off by NHS Coventry and Rugby Clinical Commissioning Group, NHS South Warwickshire Clinical Commissioning Group Governing Body and NHS Warwickshire North Governing Body in preparation for consultation.

The consultation went live on 9 October 2019. Following the announcement of the General Election, the Clinical Commissioning Groups became subject to pre-election guidance. The consultation had remained open, and respondents had continued to feed back on the proposals via the website and postal responses. The public events which were due to be held in November and December had been postponed until January, and the new dates were reported at the meeting.

The report detailed the financial implications associated with the proposals which represented an investment of nearly £3.1m into the Coventry and Warwickshire Health System.

Mark Doherty provided assurances that the West Midlands Ambulance Service were fully supportive of the approach for stroke services and Claire Quarterman informed of the staffing proposals and therapy offer for patients.

The Board questioned the representatives on a number of issues and responses were provided, matters raised included:

·  Clarification about how the ambulance service responded to emergency calls relating to potential stroke victims or other illnesses

·  Details about the ambulance hub in the city

·  Further information on the improvements anticipated from the new proposals

·  Details about staff training

·  How the service coped when patients presented with language barriers

·  A request for improved public transport for patients attending the rehabilitation centres and for visitors who played an important role in the recovery process.

·  An acknowledgement of the potential savings to social care by providing better outcomes for people who suffer from strokes and a reduced likelihood of dependency

·  Support for the proposals for the new stroke pathway and delivery model

·  A concern about the implications for the potential cessation of gp home visits. 

RESOLVED that:

(1) Having reviewed the pre-consultation business case and consultation documentation, the changes to the dates of the consultation due to pre-election guidance be noted.

(2) Support be given to the proposals for developing the new clinically and operationally sustainable model for stroke services across Coventry and Warwickshire, from a Coventry perspective, and this response be referred to the Coventry and Warwickshire Joint Health Overview and Scrutiny Committee on 22nd January 2020.

(3) The existing report about transport issues from the CCG be circulated to Board Members.