Presentation by Simon Cox (Director of Acute Commissioning, North Yorkshire Clinical Commissioning Groups).
A presentation by Simon Cox (Director of Acute Commissioning, North Yorkshire Clinical Commissioning Groups) advising of the background to changes made to stroke services at Harrogate Hospital in 2019, the impact of Covid, future work, and future engagement with the Area Constituency Committee.
Key issues within the presentation were:-
· Stroke services for the Harrogate area had been reconfigured in 2019. This had followed wide engagement and national research which had identified the mortality benefits of having Hyper Acute Stroke Units (HASUs) to provide specialist intervention during the first 48-72 hours of a stroke, and greater focus on providing therapy and rehabilitation to patients in their own homes. As part of the reconfiguration, Harrogate District Hospital had moved away from providing the hyper acute phase of stroke care and instead patients were transported directly to their nearest HASU which, for the majority of the Harrogate population, was at Leeds, and, for others, was at York. For the majority of patients, once the hyper acute phase was finished, they were transferred back to Harrogate District Hospital for rehabilitation.
· Simon Cox advised that, at this stage, two years on, ideally he would have wanted to provide a detailed analysis of figures and patient numbers. However, this was difficult because Covid issues had tended to skew some of the numbers. For example, nationally, during 2020, the numbers of patients presenting with stoke, had significantly reduced, which was worrying. (Consequently, the NHS was putting out the message that anyone having stroke-like symptoms must telephone 999 or go to hospital.) One of the other problems arising from Covid-19 was that hospitals had had to change how they organised themselves to make themselves Covid-safe, such as separate Wards for quarantining. This had made analysing some of the data around stroke in Harrogate difficult. Simon Cox suggested that, in a year’s time, he should bring to Members a full set of data to look at the Stroke Admission Pathway. In the meantime, a lot of work was continuing about stroke care, both nationally and in North Yorkshire, including through the “Getting It Right First Time” (GIRFT) programme and the Sentinel Stroke National Audit Programme. Simon Cox advised that he wanted to continue to work with stakeholders to assess things like patient satisfaction, do surveys, and get patient experiences of the Stroke Admission Pathway, and to share that with communities to evaluate the changes. He was keen to engage with the Area Constituency Committee to obtain patient experience around changes to flex or support how NHS services were changed to make them better for patients.
Members asked Simon Cox questions and received responses. The issues which arose during discussion included the following:-
· It was confirmed that Harrogate patients would continue to be taken to either the Leeds HASU or the York HASU, and this would not be impacted by the changes to the Integrated Care Systems in 2022.
· Simon Cox undertook to obtain the latest breakdown figures showing the number of people from Harrogate who had gone to the Leeds HASU, and the number who had gone to the York HASU, and to send these to Ruth Gladstone for forwarding to Committee Members. Simon Cox emphasised that these figures would not be representative due to Covid.
· In response to expressions of disappointment from some Members that more data was not available today about the impact of the greater time spent travelling the longer distances to Leeds and York, Simon Cox offered to attend another meeting of the Committee later in 2021 to provide data regarding the previous 12 months, although such data would be heavily caveated because it was difficult to say, due to Covid, whether that data was a true reflection of the outcomes of changes which had been made to the Service.
· Regarding prevention measures, it was acknowledged that the promotion of good nutrition was one aspect in respect of which the NHS worked with partners, such as local authorities and schools. Simon Cox added that, similarly, a lot of work was being undertaken to tackle blood pressure, atrial fibrillation, obesity and smoking. However, it needed to accepted that, in reality, some preventative measures eg blood pressure, were age related and significant illness could be deferred, but not avoided completely. Simon Cox offered to arrange for a Dietitian colleague to attend a future meeting of the Committee to have a more detailed discussion about nutrition. County Councillor Paul Haslam expressed support for this suggestion because he felt that the NHS, in partnership with other organisations, could do more preventative work around nutrition.
· County Councillor Jim Clark advised that he had been, and continued to be, supportive of the Hyper Acute Stroke Units and that the reconfiguration of stroke services in Harrogate had been the correct thing to do. He added that Harrogate residents received tremendous service from Harrogate District Hospital and asked for his view to be placed on record.
· County Councillor Michael Harrison commented that he would prefer to be taken to the best place to deliver the best clinical outcome, regardless of where that was located. He also commented that, where the clinical outcome prediction demonstrated a best clinical outcome, it was the responsibility of elected Members to support Health partners when they wanted to make such changes.
(a) That Simon Cox be thanked for attending this meeting and his excellent presentation.
(b) That the following arrangements be made with Simon Cox:-
(i) Simon Cox to provide a copy of the slides used during his presentation to Ruth Gladstone (Principal Democratic Services Officer) for forwarding to Committee Members.
(ii) Simon Cox to obtain the latest breakdown figures showing the number of people from Harrogate who have gone to the Leeds HASU, and the number who have gone to the York HASU, and send these to Ruth Gladstone (Principal Democratic Services Officer) for forwarding to Committee Members, recognising that these figures will not be representative due to Covid.
(iii) Simon Cox to attend another meeting of the Committee later in 2021 to provide the previous 12 months’ data regarding the impact of the greater time spent travelling the longer distances to Leeds and York, recognising that this data will be heavily caveated because it is difficult to say, due to Covid, whether that data is a true reflection of the outcomes of changes which have been made to the Stroke Service.
(iv) Simon Cox to bring to elected Members, in a year’s time, a full set of data to look at the Stroke Admission Pathway.
(v) Simon Cox to arrange for a Dietitian colleague to attend a future meeting of the Committee to have a more detailed discussion about nutrition.