Agenda item

(Further Papers to Follow)

Mr Roche, Medical Director (South East Coast Strategic Health Authority). Ms  Evans, Head of Business Planning and Strategy,  and Mr Reynolds, Head of Business Development,(South East Coast Ambulance Trust were present for this item.

(1)       The Chairman welcomed health colleagues to the meeting and invited them to introduce each of the care pathway areas and to answer questions from Members.

Cardiac

Dr Mishra, Clinical Lead Cardiology and Ms Andrews CBE, Director of Nurses and Director of Infection Prevention and Control, Ms Hiscox - Lead Commissioner Cardiovascular (NHS Eastern and Coastal Kent), Mr Wheat, Director of the Cardiac Network, Ms Stewart, Senior Service Improvement Project Manager ( Kent Cardiovascular Network) and Mr  Lawson, Patient Representative were present.  

(2)       Mr Wheat set out the current treatment pathway for a suspected heart attack following a 999 call.  He referred to the new treatment which was being rolled out nationally which would reduce admission time for patients. 

(3)       Dr Mishra stated that the way that heart attacks were treated was changing, nationally 47% of people who had heart attacks had primary angioplasty compared to 6% in Kent it had taken time to get this service developed.  It was hoped that by April 2010 Kent would have 100% of heart attack patients going to the Heart Centre and having balloon angioplasty rather than drug therapy.

(4)       Mr Daley commended the upward trend in good outcomes and asked if there were plans for angioplasty to be carried out more locally in east Kent.   

(5)       Mr Wheat explained that over the past 5 years five cardiac catheter laboratories had been opened at various locations across Kent and Medway so that patients could be treated closer to home. The first was at the William Harvey Hospital, Ashford in 2004 and the latest had opened in Maidstone at the end of 2008. 

(6)       Dr Mishra stated that the reason it had been decided to concentrate on one Heart Centre was the need to have a certain number of patients coming through to maintain the expertise both for the unit and the operators.   It had been decided to base this at Ashford as it was the first cardiac catheter laboratory and therefore had a high volume of patients.  In future if it was found that there is a high enough demand consideration would be given to locating a second centre in East Kent.

(7)       In response to a question from Mr Smith, Mr Wheat explained that whenever he designed a care pathway he argued that decisions regarding where a patient was taken for treatment was for the clinician from the ambulance service who was with patent.

(8)       Mr Tolputt asked whether all ambulance staff were now trained in administering thrombolytic drugs.   Mr Reynolds explained that the care pathway had moved away from using thrombotic drugs and now a paramedic would attend all 999 calls for heart pain, even if they were not the first to attend, and following an ECG would decide if it was a heart attack and deal with it appropriately.

(9)       In response to a question from Councillor Blackmore on the comparative length of stay in hospital following treatment, Doctor Mishra explained that currently if a patient was admitted to hospital with a heart attack they were likely to stay seven days (or longer if it was over a weekend), with the new treatment the patient should be able to go home on the third day and after that have their rehabilitation at a local hospital. This saved 3 to 4 overnight stays in expensive beds.  She acknowledged that there was a financial as well as a health benefit to this change in practise.  In relation to rehabilitation, as patients were spending less time in hospital there was a danger that they would not recognise the seriousness of what had happened to them, therefore part of the rehabilitation was convincing them of this.

(10)     In relation to transfer time, from call to balloon angioplasty, Dr Mishra stated that  the national prescribed limit was 150 minutes and the Trust were aiming for 120 minutes and were hoping to get below that.

 (11)    Mr Ferrin expressed the view that there was too much emphasis placed on travel time and that patients would be prepared to go to the hospital that gave them the best chance of a good outcome.  Dr Mishra explained that it was only possible to have cardiac intervention at high volume centres and that all of the Trust’s cardiac consultants also worked in London.  Therefore it was the doctors that were travelling to and from London rather than the patients.

Stroke

Ms  Hunt, Director of Nursing and Quality (NHS West Kent), Mr S Duckworth, Stroke Network Director (Kent Cardiovascular Network) and Ms Hiscox - Lead Commissioner Cardiovascular (NHS Eastern and Coastal Kent) were present.

(12)     The Chairman invited health colleagues to introduce this item and to take questions from Members.

(13)     Ms Hunt gave some background to the service and stated that a couple of years ago the service was poor in patches compared to the rest of England.  Rapid improvements had been made over the last 18 months particularly in relation to hyper acute stroke services.  Two years ago there were not any acute stroke services in Kent now there were acute stroke services in all hospitals in Kent and Medway and all could provide acute thrombolysis. They had worked with the ambulance trust in relation to response times and acute strokes were now regarded as a medical emergency.  It was not possible for ambulance staff to administer thrombolysis, therefore patients needed to get to hospital as soon as possible so that they could be treating with three hours of the symptoms.

(14) Ms Hunt explained that there were currently different approaches to treatment in East and West Kent.  In East Kent patients could be taken to any acute hospital for assessment and treatment remotely by a consultant, this was facilitated by telemedicine equipment.  In West Kent there was currently a rota with the service always available at one acute hospital at least, ambulances would take patients to this hospital for initial treatment and when they were stable they would be transferred to their local hospital.   The Network had recently received an innovation award from the Strategic Health Authority which would enable them to purchase telemedicine equipment for West Kent and Medway so that patients in those areas could also be taken straight to their local acute hospital and would be able stay in the same hospital throughout.

(15)     In response to a question from Mr Kendall, Ms Hunt confirmed that currently clinical outcomes were equally good in East and West Kent.  The introduction of the telemedicine equipment in the summer would just provide a logistically better service. 

(16)     Mr Daley referred to the increase in public awareness of the importance of acting quickly in the case of a stoke for the best outcomes.

(17)     Ms Hunt agreed that the public awareness campaign had been very helpful in enabling the public to recognise a stroke and the importance of getting help as quickly as possible. Also if the patient was within the 3 hour timeframe a stroke team would be waiting at Accident and Emergency to receive them and if appropriate arrange for thrombolysis to be administered by either a consultant or a specialist nurse. In East Kent the time from a patient arriving at hospital to treatment being administered had been reduced to 40 minutes.

(18)     Mr Duckworth explained that it was not possible to give thrombolysis to all patients who had a stroke, however, even for those patients who could not have it if they got onto a dedicated stroke pathway they would have better outcomes.  Therefore, the thrombolysis service improved processes and outcomes for all stroke patients even those were not able to receive this treatment.

(19)     Mr Duckworth confirmed that the time of day the stroke occurred made no difference to the outcome and that the current mortality rate was 12%. 

(20)     Regarding the care pathway for a transient ischaemic attack (TIA), Mr Duckworth explained that people who were regarded as a high risk were seen within 24 hours and were given treatment if necessary.  Anyone of a lower risk would be seen within seven days. Two years ago the average waiting time for a TIA appointment was 4 – 5 weeks.  Approximately 50% of patients go on to have stroke following a TIA within the first few weeks, therefore waiting weeks for an appointment not appropriate.  He highlighted the great progress that had been made in this area.

(21)     Mr Roach emphasised the importance of having a comprehensive package for all stroke patients even those who do not have thrombolysis.  He also mentioned the advertising campaign which was a national success story.  Real progress had been made in this area by colleagues who were passionate about the service provided to these patients.

Trauma

Ms Thomas, Director of Service Redesign (NHS West Kent) and Andrew Cole, Head of Commissioning Urgent and Continuing Care (NHS Eastern and Coastal Kent) were also present.

(22)     Mr Roche referred to the major trauma report that had today been issued by the National Audit Office. Major trauma was not currently a success story, the UK was just starting to look at major trauma services.  In Kent one of the issues was logistics, in 2008 66 people in Kent died in road traffic accidents, and most of these were in the coastal area away from the major road network.  Patients with complex trauma need to be rapidly assessed by ambulance crews.  Approximately 60% of those with complex trauma had head injuries.  Many patients from Kent were taken to King’s College Hospital, London.  However King’s could not accept transfers by air ambulance at night.   It was recognised that there was a problem with trauma treatment in Kent and a review had already been commissioned across the Strategic Health Authority area.  Trauma Leads had been appointed in Brighton and Kent who would form the basis of a trauma board.  The message was that major trauma patients like heart attack patients needed a 24/7 service available with senior staff and urgent access to further services if necessary.  He stated that he was determined to come back to the Committee in the future with a success story for trauma.

(23)     The Chairman stated that he was encouraged that Mr Roche had approached this Committee at this early stage to seek the Committees our as representatives of the layperson.

(24)     In relation to a question from Councillor Blackmore seeking clarification on the air ambulance and night flying, Mr Roche explained that only police pilots could fly at night, but another issue was the affect of adverse weather on the air ambulance.  Accidents involving major trauma were more likely to occur in poor weather conditions.  

 (25)    Councillor Lyons asked whether there were likely to be a number of dedicated centres in Kent or whether there would be a shared facility with Sussex.   Mr Roche explained that 600 – 700 patients a year were needed to support a fully equipped trauma centre.  It was anticipated that Kent would produce less than 100 patients a year and therefore it was very unlikely Kent could host a centre.  In Kent the issue was logistics and there was a need to ensure that patients were assessed, any immediate problems resolved and then were able to access good pathways to appropriate care in a timely manner.  It was then necessary to repatriate and properly rehabilitate these patients.   This needed to be put in place across Kent to ensure the best outcomes for the patient.  

 (26)    In response to a question from Mr Cooke, Mr Roche confirmed that the most significant number of road deaths in Kent occurred outside of the M25 and M20 corridor, along class “A” roads and in the coastal areas.  The aim was to provide the best possible service and not disadvantage people because of where they lived or where an accident occurred.

(27)     Mr Daley asked whether when Pembury Hospital was open it would be able to deal with aspects of the major trauma services that patients currently had to go to Brighton or London to receive.  Mr Roche replied that patients with brain or chest injuries would still need to go to other centres.  He stated that Kent was to be congratulated in centralising its heart treatment, which had been done by clinicians working together to provide a service that was best for patients and he was keen that the same principle would drive the reconfiguration of acute trauma.

(28)     In response to a question from Mr Lyons,   Mr Roache confirmed that the trauma leads would inform him of relevant organisations to seek views from, However, the service would be developed around the benefits to the patients and not any vested interests.

(29)  In answer to a question from Mr Kendall, Mr Roache stated that very few cyclists were killed in Kent but that there was evidence from America that the use of helmets reduced injuries for cyclists.

RESOLVED That the Committee supports the developments taking place in emergency care pathways and heath colleagues be thanked for bringing the paper on trauma to this Committee to enable Member to have an input at an early stage.