Agenda item

This item is ‘To Follow’.

Considered – a presentation by Simon Cox of the North Yorkshire Clinical Commissioning Group (CCG) and Neil Wilson of the York Teaching Hospital NHS Foundation Trust on the reconfiguration of stroke services provided by York Teaching Hospital NHS Foundation Trust at Scarborough.

The key points from the presentation are as summarised below:

·         There is documented evidence of the improved patient outcomes associated with the centralisation of specialist hyper acute stroke services

·         National clinical guidance suggests that hyper acute stroke units should see a minimum 600 patients per year to provide the appropriate level of workforce expertise and critical mass of resources

·         There have been persistent shortages in staff at Scarborough hospital, which has impacted on the ability to provided specialist stroke services there

·         The ‘drip and ship’ model was introduced at Scarborough hospital in 2015.  This meant that people with a suspected stroke were first assessed at Scarborough hospital, stabilised and then transferred to York hospital

·         In 2020 a direct admission model was put in place, replacing the ‘drip and ship’ model

·         The direct admission model results in quicker access to specialist treatment at the Hyper Acute Stroke Unit (HASU) at York hospital (known as ‘door to needle’ time and so better long term patient outcomes

·         The Humber, Coast and Vale Integrated Care System (ICS) conducted a formal review of hyper acute stroke services in the area in 2020/21.  The review found that the direct admission model was safe, efficient and able to deliver better outcomes than the previous ‘drip and ship’ model. These findings were verified by regional and national stroke leads in the NHS

·         The community-based rehabilitation services for people who have suffered a stroke are being reviewed to improve patient outcomes and enable earlier, planned and supported discharge from hospital

·         There is a renewed focus upon prevention and there is a key role for primary care in the identification and management of risk.

Simon Cox asked the committee to formally endorse the direct admission model.

There followed a discussion, the key points of which are as summarised below:

·         Stroke is a preventable disease and there needs to be a greater focus in primary care upon identification and early intervention

·         There will need to be more joint work between health and social care in managing the rehabilitation of people who have suffered a stroke and been discharged from hospital.  In particular, around speech and language therapy

·         Paramedics are key in making the first assessment when someone presents with a suspected stroke.  They need to be trained appropriately and supported.

County Councillor Liz Colling asked whether the change from the ‘drip and ship’ model to the direct admission model, which the committee were being asked to endorse, was going to be a permanent change.

In response, Simon Cox said that this would be a permanent change as there was no other viable alternative.  In line with NHS guidance, no formal public consultation is required as there is no viable alternative to what has been in place since 2020.  The final decision would be made at the next meeting of the York Teaching Hospital NHS Foundation Trust Board.

Ryedale District Councillor John Clark thanked staff at York hospital for the excellent care and support that had been given to a friend who had suffered a severe stroke.  He said that the challenge was now around discharge and rehabilitation services in the community that help ensure positive long term outcomes.

County Councillor John Ennis summed up and said that in view of the information, data and analysis that had been considered by the committee over the past 18 months, the similar and successful changes made at Harrogate hospital to stroke services, the outcome of the regional review of hyper acute stroke services and the views expressed by the committee members that the direct admissions model be endorsed for permanent adoption.

Resolved:-

1)    That the permanent adoption of the direct admission model for hyper acute stroke services is endorsed, as there is no other viable alternative

2)    That an overview of what stroke services are in place for the population of North Yorkshire is given at the committee meeting on 17 December 2021

3)    That an update on outcome data is provided at the committee meeting on 17 December 2021.