Agenda item

OenaWindibank (Programme Director, Kent & Medway Stroke Review, NHS England) and Ian Ayres (Accountable Officer, NHS West Kent CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the meeting. Mr Ayres began by outlining the scope of the review; he explained that the focus of the review was hyper acute services - the treatment that needed to be given within the first 72 hours of a patient having a stroke. He advised that once the hyper acute pathway had been established, each health system in Kent would then review their acute and rehabilitation pathway and present their proposals to the Committee. He stated that the CCGs considered the proposals to be a substantial variation of service and would require formal public consultation. He noted that the Medway HASC had determined the proposals to be substantial and if the Kent HOSC also considered the changes to be substantial, a joint HOSC would need to be established.

(2)       Ms Windibank explained that the review was being overseen by a Review Programme Board which included representatives from all Kent and Medway CCGs, NHS England, South East Cardiovascular Network and a Clinical Reference Group. She noted that a number of clinically led modelling groups had been developed to look at travel and access; patient profile and capacity; workforce and value for money.  She stated that 10 public listening events had been held; additional events were being arranged in conjunction with the Stroke Association and Healthwatch Kent. Phase two of the engagement process would include stakeholder involvement with option development and appraisal. She stated initial consideration had indicated that one or two site configurations would not be viable.  A range of potential configurations were being developed from three to seven sites. A public consultation was planned for early next year.

(3)       Members of the Committee then proceeded to ask a number of questions and make a number of comments. A Member enquired about financial planning and the impact on the public health budget. Mr Ayres explained that it was not a financially driven review; the aim was to ensure the delivery of clinically sustainable and high quality hyper acute stroke services.  He noted that the consideration of cost came after quality, access and workforce. He stated that there was no additional money available to fund changes to hyper acute services and if an expensive configuration was chosen the money would have to come from another service.  He confirmed that the review was only considering the NHS funded services; preventative services provided by KCC were separate. Mr Scott-Clark explained that a cut to the public health budget would be set out in the Autumn Spending Review; it was not known if it would be a one-off or continuous reduction to the budget. Mr Scott-Clark stated that stop smoking services, NHS health checks and the promotion of physical exercise were key preventative services provided by Kent County Council. He noted that public health services would not meet the needs of the entire Kent population; its focus would be on a small cohort of the population who found it difficult to remain healthy particularly in areas of deprivation.

(4)       In response to a specific question about modelling demographic change, Ms Windibank explained that there were 35,000 patients registered with a GP in Kent who had had a stroke. In 2014/15 2559 patients in Kent & Medway were confirmed to had had a stroke. Mr Scott-Clark noted that the hyper acute services would be commissioned using an evidence base provided by Public Health; a number of demographic variables would be taken into account. Mr Ayres stated that any proposed configurations would also include capacity for people who presented with a suspected stroke, known as a stroke mimic.

(5)       RESOLVED that:

(a)       the Committee deems the  stroke proposals to be a substantial variation of service.

(b)       a Joint HOSC be established with Medway Council, with the Kent HOSC receiving updates on the work of the Joint Committee.