Oena Windibank (Programme Director, Kent and Medway Vascular Services Review, NHS England South (South East)) and Julie Van Ruyckevelt (Principal Associate, South East CSU)) were in attendance for this item.
(1) The Chairman welcomed the guests. Ms Windibank began by outlining the case for change which established the need to review and remodel hyper acute (first 72 hours) and acute (remaining acute stay) across Kent and Medway. She explained that primary prevention and rehabilitation services were not part of the review; the review would make recommendations to the individual CCGs where those areas required further exploration. She stated that there were a number of concerns about the performance and sustainability across the seven hospitals currently treating stroke patients including access to diagnostics, specialist assessment and intervention; specialist workforce treating the minimum number of patients; and 24 hours, seven day specialist stroke services cover. She reported that none of the current services met the national strategy and guidance.
(2) Ms Windibank stated that eight clinical options had been identified; models ranged from one to seven sites plus the status quo. She explained that the Stroke Review Programme Board had identified that the single, two site model and status quo were not sustainable. On 22 December 2015 the Stroke Review Programme Board considered the feedback from the People’s Panel; and the Review’s Clinical Reference Group and agreed that a detailed appraisal, workforce risk assessment, travel heat maps, public health incidence growth and equalities impact assessment for a five, four and three site model should be undertaken. She reported that the number of strokes was levelling out nationally and the number of strokes in Kent and Medway were expected to increase by 650 annually. She noted that following the successful FAST campaign, the number of patients transferred to hospital with stroke like symptoms had increased; 30 – 40% of patients who attended their local Accident and Emergency department were not admitted with a stroke or transient ischaemic attack (TIA) which needed to be considered as part of any reconfiguration. She stated that the recommended options for public consultation would be presented to the Committee on 26 February 2016.
(3) Ms Van Ruyckevelt gave an overview of the communication and engagement activity. She stated that ten Listening Events were held across Kent and Medway to share the Case for Change and raise awareness with the public; 110 participants attended including stroke survivors, families and carers of stroke survivors, voluntary sector and residential care providers. 220 participants attended 15 Focus Groups which were held in partnership with the Stroke Association and 285 participants completed the online survey. Three deliberative events were also held in November and December which tested out the criteria used in the options appraisal process and the emerging options. The events included representation from members of the public, patients, carers, the Stroke Association, stroke champions, Public and Patient Involvement leads and JHOSC members. She reported that feedback included support for the Case for Change, a recognition that the required standards were not being met and an understanding of the pressures regarding workforce; the Public Panels voted for either a four or five site option. She noted that the Review was built upon and superseded the work of Maidstone and Tunbridge Wells NHS Trust, Healthwatch Kent and East Sussex carried out in December 2014. She stated that Healthwatch Kent, Healthwatch Medway, Healthwatch Bromley and Healthwatch East Sussex were part of the Communications Sub Group.
(4) The Chairman invited Mr Inett to speak. Mr Inett began by endorsing the engagement work carried out as part of the Review. He stated that deliberative events had built participants’ knowledge and confidence and involved them in the decision making. He noted that he was a member of the Stroke Review Programme Board which he had found to be open and transparent.
(5) Members of the Committee then proceeded to ask a series of questions and make a number of comments. A Member expressed disappointment that a deliberative event had not been held in Medway. Ms Van Ruyckevelt stated that a range of engagement activities had been arranged to involve as many participants as possible. She noted that a Focus Group was held in Medway and 34 people from Medway had responded to the online survey. She explained that the three deliberative events had been held in central locations with a range of 21 participants at each event. Another Member stated that out of the two main road networks in Kent and Medway the A2/M2 and A20/M20 both events had been held on the A20/M20 route. Ms Windibank stated that there would be further focus groups and events as part of the next phase of the review. Attendees who had attended the Public Panels and requested additional information were being provided with this. She also noted that the Equalities Impact Assessment would identify population groups to specifically target.
(6) Members enquired about rehabilitation, attracting workforce, current performance by providers and involvement with social care services in Kent and Medway. Ms Windibank stated the variability of rehabilitation services was not consistent; the Review had taken this on board and would be making recommendations to the CCGs. She noted that the acute model would only work if a successful pathway was in place. Ms Windibank explained that there were different models for Hype Acute and Acute Stroke services; in London patients were admitted to one of 8 hyper acute sites for the first 72 hours before being transferred to a local acute site for the remainder of their acute stay. She reported that combined hyper acute and acute sites in Kent would be much more attractive for specialist workforce including nurses and therapists. Ms Windibank stated that the decision making would not be based on current performance; providers would be judged on how they would deliver the service going forward. Ms Windibank explained that Public Health were part of the Stroke Programme Review Board and fed back to Social Care and CCGs; she noted that they would be more actively involved in the next phases and once the final recommendation had been made, the Programme Review Board would morph into a mobilisation group.
(7) RESOLVED that:
(a) the Kent and Medway Stroke Review Programme Board be requested to note the Committee’s comments and take them into account during the detailed options development and appraisal.
(b) Kent and Medway CCGs be requested provide details of travel infomation at the next meeting of the Committee.
(c) Kent and Medway CCGs be requested to present an update including options for public consultation to the JHOSC Committee on 26 February 2016.