Agenda item

Oena Windibank (Programme Director, Kent & Medway Specialist Vascular Services Review, NHS England), Ian Ayres (Accountable Officer, NHS West Kent CCG) and Dr David Hargroves (Clinical Lead - Stroke, South East Strategic Clinical Network) were in attendance for the item.

(1)       The Chairman welcomed the guests to the meeting.  Mr Ayres began by stating that the CCGs were committed to improve current performance and outcomes for Kent and Medway stroke patients. The CCGs were looking to develop a Kent and Medway solution to the hyper acute and acute pathway. He stated that the hyper acute pathway related to the first 72 hours and the package of critical interventions and monitoring particularly within the first four hours.  He highlighted the centralisation and consolidation of stroke services in London where patients were admitted to one of eight units for the first 72 hours. He stated that the Kent and Medway CCGs had identified very few county wide service configurations with the exception of stroke and vascular services. He noted that major trauma, paediatric surgery and cancer had already been configured.

(2)       Dr Hargroves explained that he was the Clinical Lead for Stroke in the South East Strategic Clinical Network. The Clinical Network had worked alongside the CCGs throughout the process. He noted that the stroke workforce in Kent and Medway was passionate about and fully supportive of the review. He stressed the importance of access to a specialist unit within four hours and clot busting drugs to improve patients’ outcomes. He acknowledged that it was very difficult to deliver stroke services across all seven admitting units in Kent and Medway; performance was variable across the county.  He noted that only one site had a seven day unit and workforce levels were low. He stated the CCGs and providers were committed to improving outcomes for Kent and Medway stroke patients.

(3)       A number of comments were made about ambulance transfers and travel times. Ms Windibank advised that South East Coast Ambulance Service NHS Foundation Trust (SECAmb) were part of the Clinical Reference Group. Travel times to each unit had been mapped and key issues such as Operation Stack and city centre traffic had been identified. Dr Hargroves stated that brain imaging was an absolute requirement for effective treatment but at present could not be delivered from an ambulance. He highlighted a pilot in East Kent where stroke consultants had a telelink with the ambulance to monitor the patient. The ambulance transfer was also used to take a history which saved time on admission to hospital. Dr Hargroves reported that access to a specialist unit had the most benefit within 4 – 5 hours; all patients in Kent and Medway were transferred by ambulance within this time scale.

(4)       In response to a specific question about stroke prevention and rehabilitation services, Dr Hargroves explained that prevention was key. He stated that the risk of a stroke was increased by genetic and lifestyle factors including diet and nutrition; physical activity; smoking and alcohol. Mr Ayres stated that rehabilitation services were not part of the review and that the CCGs would be happy for the Committee to scrutinise these services separately. He noted that finance and workforce would be central to the next part of the review. He acknowledged that the stroke review may be subject to a Joint Health Overview and Scrutiny Committee with Medway Council.

(5)       RESOLVED that the report be noted and Kent and Medway CCGs be invited to submit an update to the Committee at its September meeting.