Agenda item

Corrine Stewart (Senior Service Improvement Project Manager, Kent Cardiovascular Network) and Clare Boggia (Cardiology Matron, East Kent Hospitals University NHS Foundation Trust) were present for this item.

(1)       The Kent Cardiovascular Network led on the work to establish a coordinated pathway of care around a 24/7 emergency primary angioplasty service being established for Kent and Medway at William Harvey Hospital, Ashford.  Corrine Stewart and Clare Boggia were able to provide an overview of the first six months of the system in operation. A formal 6-month review was being undertaken, and this would be shared with the Committee once it had been completed.

(2)       Ambulances attending cases of suspected heart attacks were able to carry out electrocardiograms (ECGs) and transmit the results to William Harvey Hospital, where nurses were able to interpret the results to decide whether primary angioplasty was appropriate. Of 2255 ECGs transmitted, 476 patients were taken by ambulance direct to William Harvey Hospital, which equates to around 15 each week. Around 75% of those admitted received primary angioplasty. Some received thrombolysis for clinical reasons or because of patient choice. 5% are transferred to London for “cabbage” (coronary artery bypass graft surgery, or CABG). William Harvey Hospital works on an 8 am to 6 pm day and 60% of patients are admitted during these hours. The length of stay has been reduced to an average of 3.79 days, and the target is 3.5 days. Some patients are repatriated to hospitals closer to home where possible. In terms of geographical spread, 44% patients were from the NHS Eastern and Coastal Kent area, 34% from NHS West Kent and 22% from NHS Medway.

(3)       It was stressed that the primary angioplasty service at William Harvey was an emergency service only. The service was only appropriate for patients suffering from a type of heart attack called ST-elevated myocardial infarction (STEMI). This means that not every patient experiencing a heart attack would be sent to William Harvey or receives angioplasty.

(4)       The target is for 75% of patients to experience a call-to-balloon time of 150 minutes and this means the time from when medical help was called for to the time the angioplasty balloon is first inflated. Performance has been improving against this target since the service began and is now achieving the 75% target. The service was designed around a maximum travelling time of 75 minutes, but in practice the maximum time was 60 minutes from the furthest points in Kent. In response to a specific question from a Member, the time from Edenbridge was given as 50 minutes. As services in neighbouring areas like Surrey achieve the required standard, it may be that in the future the best option for patients in some areas of Kent would be to go to a different centre outside the county.

(5)       In terms of local factors which may affect travelling time, such as Operation Stack, it was explained that there was a memorandum of understanding with the police which would mean there was a police escort available for ambulances in these circumstances.

(6)       Members accepted that high levels of patient satisfaction were reported, but some expressed concerns about the existence of only one centre and the problems this could cause for patients and their families. The attendees were able to refer to clinical evidence that demonstrated centralisation in the case of this service did deliver better outcomes. A practical demonstration of this was that there were 12 cardiac specialists in the county able to perform the procedures, and to deliver a 24/7 service, this meant the consultants only had to work an out of hours shift 1 night out of every 10 and this delivered better quality of care. The relevant national mortality figures were 5.2%, whereas for the county the figure was 3.7% for the first six months. It was explained that the review currently underway should help answer a Member’s question as to whether the benefit of the service was felt equally across the county. 

(7)       Both the hospitals at Medway and Tunbridge Wells were able to carry out angioplasty, and the service’s contingency plan was for patients to be diverted to Medway. This arrangement held for when contingencies were planned for, such as equipment maintenance, but also the occasional time when there was an unplanned contingency such as equipment failure. To reduce the number of times when the service was disrupted for these unplanned reasons, a business case for a second resilience laboratory was currently being finalised. If approved by the Board of East Kent Hospitals University Foundation Trust, it would require 40 weeks to be built.

(8)       There was positive discussion around the role that public education could play in improving the service, through first-aid training in schools and businesses and through educating the public that if they were showing the symptoms of a heart attack calling an ambulance was more appropriate than presenting themselves at their local Accident and Emergency Department.  

(9)       One challenging area was extending the service to prisoners. The numbers were few, but formed a disproportionately high number of the access problems faced by South East Coast Ambulance Service. This was due to accessing high security prison grounds. The Network was working with the Sheppey Prison Cluster and was looking at the feasibility of putting telemetry equipment in the prisons to speed up the process.