Oena Windibank (Programme Director, Kent and Medway Vascular Services Review, NHS England South (South East)), David Hargroves (Chair, Stroke Clinical Reference Group) and Lorraine Denoris (Public Affairs and Strategic Communications Adviser, NHS Dartford, Gravesham and Swanley CCG and NHS Swale CCG) were in attendance for this item.
(1) The Chairman welcomed the guests to the Committee. Ms Windibank began by updating the Committee on the option appraisal process. She explained that detailed appraisals had been undertaken for a five, four and three site model and had been reviewed against a set of red flag criteria. The red flag criteria were agreed by the Review Programme Board and aligned to recommendations within the national stroke configuration guidance. She noted that workforce was the key limiting factor to providing seven day cover. She reported that a five site model was most challenging in terms of workforce and there were concerns about the capacity and sustainability of a three site model; more detailed work was being undertaken including the review of alternative clinical models. She stated that a five, four and three site model had been reviewed against the financial envelope determined by the standard tariff for stroke; if best practice guidance was met an enhancement would also be paid.
(2) Members of the Committee then proceeded to ask a series of questions. In response to a specific question about the consultants’ letter, Dr Hargroves explained that the process embarked upon had been transparent and engaging; all clinicians had been invited to participate with variable levels of involvement. He stated that the letter had been received at a late stage. The Clinical Reference Group had responded and addressed each of the concerns raised in the letter including frail and elderly patients, alternative models of delivery and the use of technology; the Group had also reflected on the information it provided to the Review Programme Board and had concluded that it was robust and adequate. Ms Windibank noted that the consultants had been invited to raise any outstanding concerns before the next Review Programme Board.
(3) A number of comments were made about the public perception of travel times and the provision of rehabilitation facilities. Ms Windibank explained that safe travel times would be included as part of the public consultation; she noted that the review was not yet at the stage to go out for public consultation. She explained that the focus of the review was the acute pathway for patients but acknowledged the importance of rehabilitation. She stated that as the model was developed, pathways for rehabilitation were also being identified and the CCGs were being made aware of areas which worked well and where there were gaps. She noted that the new acute model would only work if sustained investment was made by the CCGs into rehabilitation services and the Review Programme Board would be making recommendations to the CCGs about rehabilitation. She reported that she would feedback concerns about rehabilitation facilities for patients with brain injury to the CCGs.
(4) A number of questions were asked about the aim of the review, engagement with highways and weighting of journey times in the decision making. Dr Hargroves explained that the aim of the review was to improve clinical outcomes, care and quality for patients. He reported that the provision of services was variable across Kent and Medway. He noted that the review was not looking to establish a single centre of excellence in Kent and Medway, as the centre would be inefficient for the expected volume of patients. Ms Windibank explained that the review had used ambulance travel times provided by SECAmb and bed usage by CCGs for journey times. She stated that KCC Highways had been approached for data but a response had not been received. She noted that the Review Programme Board was proposing to put forward a request to KCC Highways to prioritise access for medical staff during Operation Stack. She reported that mapping was underway to assess private travel time by car and public transport. She explained that in terms of weighting, priority would be given to a 24/7 specialist service with adequate staffing levels. She noted that the review was working with providers to mitigate costs and travel times for visitors using public transport.
(5) RESOLVED that:
(a) the Kent and Medway Stroke Review Programme Board be requested to take note of the Committee’s comments and take them into account during the detailed options appraisal;
(b) the Committee note the three options for a five, four or three site model and make no further comment at this stage;
(c) Kent and Medway CCGs be requested to present an update to the Committee including the final options for public consultation.