Agenda item

An update on the Hyper Acute Stroke Pathway from Paul Willcoxon, Lead Clinician, Stroke Services, Darren Fletcher, Senior Operational Manager and Neil Wilson, Head of Partnerships and Alliance, York & Scarborough NHS Foundation Trust.

Considered – A presentation from Paul Willcoxon, Darren Fletcher and Neil Wilson, York and Scarborough NHS Foundation Trust.

Paul highlighted the following points;

·       data on journeys to York, specifically from a Filey base;

·       patient and families support;

·       outcome data;

·       priorities for the future;

·       transfer and repatriation;

·       a golden hour explanation;

·       rehabilitation at home;

·       recruitment and retention;

·       international recruitment and the challenges currently being faced by the Trust.

There then followed a discussion raising the following questions and discussion points:

Change occurred within the Trust from 2015 onwards when 3 Consultants retired simultaneously, the priority then becoming how to provide better care for a large number of patients.

It was asked whether Paramedics were able to successfully identify stroke symptoms and deal with patients effectively ?

Ambulance crews have an 80% positive detecting with the relevant tools and are then able to spend more time assessing patients. Approximately 1,000 patients a year are admitted at York, with approx. another 500 patients presenting with symptoms initially but then subsequently not diagnosed with a stroke.

It was raised that the length of travel time from Scarborough to York is concerning and the possible delay in handover time once the ambulance arrived.

It was reiterated that ambulance crews rarely have issues getting from Scarborough to York and there is no handover time as the hospital staff are waiting and prepared,  ready for the ambulance to arrive.

Councillor Rich Maw had previously presented a question that had been forwarded to the Trust which was

“The NHS England target time for transport to a HASU is 30 minutes, 1 hour at the very outside - and EVERY patient should access a stroke unit in under 4 hours.

NICE go further and recommend 'brain imaging immediately' in many cases and thrombolysis treatment 'as soon as possible' and at least 'within 4.5 hours of onset of stroke symptoms'.

What is the current national Standardised Mortality Ratio for East Coast stroke patients?

Figures from SNAP gave the mortality rate from April 14 – March 15 when there was an HSU in Scarborough as 1.26 and then  from 17/18, 18/19 and 19/20 as 0.86, 0.96, 0.80 respectively, when the service moved to York. The best care for patients was paramount and it was noted that 30 patients died in 1 year, of which 9 were from Scarborough.

The current national Standardised Mortality Ratio (SMR) is 1.05.

Councillor Maw referenced a letter he had received which the Chair agreed to circulate after the meeting.

It was asked if other outcomes were measured on recovery levels ?

Other measurements used to measure recovery were time metrics, the amount of physiotherapy required and occupational therapy amongst others. All stroke patients will have a 6 month follow up examination. Ambulance response times could also have an effect on mortality figures.

It was also confirmed that all stroke patients would be taken to York, if the diagnosis was subsequently not a stroke, patients would be returned to Scarborough.

It was asked whether there were staffing issues that related to the length of stay being around 22 days ?

There were no specific issues relating to this figure and no staffing issues. The priority is to discharge patients wherever possible, but home care and community care remain the biggest struggle as it is adult social care generally.

A question was raised in relation to the practicalities of family support when patients were in Hull or York.

It was agreed that family support is crucial to recovery and wellbeing and when offered a place of care most patients chose to stay in York. A family room in York is being refurbished and this will be reintroduced to facilitate family support to patients.  

Resolved – The Chair thanked the representatives from Scarborough and York NHS Foundation Trust for their presentation and the useful discussion with Members and suggested they return to a future Committee meeting with an update.

Due to time restraints of presenters and the Committee overrunning on the previous item the Chair agreed to take item 8 before item 7, allowing the presenters to leave for a previously agreed appointment.