monday 20 june to sunday 11 september 2011 a public consultation on proposed changes to hyperacute...
TRANSCRIPT
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Monday 20 June to Sunday 11 September 2011 www.haveasay.org.uk
A public consultation on proposed changes to hyperacute stroke services in County Durham and Darlington
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Welcome and introduction
David GallagherDirectorNHS County Durham and Darlington
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Introduction to consultation
• We are now in a formal 12-week consultation process
• Scope of consultation includes:- Hyperacute stroke services in County Durham and Darlington- Durham and Darlington hospitals - No other services
• The organisations involved are:- NHS County Durham and Darlington- County Durham and Darlington NHS Foundation Trust
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Today’s public meeting
• One of eight public meetings in the formal consultation
• Will last 90 minutes including group discussions and a Q&A session
• Introduction to panel members
• All views will be fed into consultation process
• We are audio recording all comments made today
• A transcript of today’s public meeting will go on www.haveasay.org.uk
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Housekeeping
• No fire drill is expected
• Please switch mobiles off or to silent mode
• Hearing loop system available
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Why review hyperacute
stroke services?
Ben ClarkHead of Strategy and PlanningNHS County Durham and Darlington
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Some key facts about stroke
• Major cause of death and disability across County Durham and Darlington
• 1,100 people in the region suffer a stroke each year
• More common locally than in other parts of the UK
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Useful definitions
HYPERACUTE STROKE SERVICES
• Needed when a patient is at their most seriously ill
• Covers the period of time from the onset of stroke to the first 48/72 hours of care afterwards
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THROMBOLYSIS
• Use of drugs to break up a blood clot
• Essential part of hyperacute stroke services
• Given no more than four and a half hours from start of symptoms
Useful definitions
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TELEMEDICINE
• Enables patients to be assessed remotely by specialist clinicians based elsewhere
• Uses a video-link
• Relatively new but safe way of working
Useful definitions
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TRANSIENT ISCHEMIC ATTACK (TIA)
• Known as a ‘mini-stroke’
• Temporary stroke symptoms, usually lasting minutes
• Risk of more severe stroke
Useful definitions
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Drivers for change – key quality standards
• Accelerating stroke improvement programme
• Local strategies and policies
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Patients should:• Have 24/7 access to hyperacute stroke services and be
directly admitted to specialist stroke unit• Be assessed by expert stroke clinicians within 24 hours• Have a brain scan within 24 hours• Have results interpreted by a stroke specialist• Have thrombolysis treatment if needed• Have the ability to swallow tested • Be monitored 24/7 in a high dependency bed• Receive 24/7 care from range of specialist clinicians• Receive seven-days a week TIA service
Drivers for change – key quality standards
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The story so far…
• Review of full stroke pathway
• Role of Stroke Strategy Implementation Group (SSIG)
• Stakeholder event in December 2010
• Hyperacute services were where the most immediate difference could be made to patients
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The current situation and why this needs to change
Dr Bernard EsisiSpecialist Stroke ConsultantCounty Durham and Darlington Foundation Trust
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Current situation
University Hospital of North
Durham
• Hyperacute stroke services• Monday-Friday 08.00-18.00• Alternate weeks out-of-hours• Vascular surgery for carotid disease
Darlington Memorial Hospital
• Hyperacute stroke services• Monday-Friday 08.00-18.00• Alternate weeks out-of-hours• Vascular surgery for carotid disease
Bishop Auckland Hospital
• Centre of excellence for rehabilitation• 7-day stroke rehabilitation • Physiotherapy, occupational therapy, speech therapy
Five-day TIA serviceThree clinics at Bishop Auckland Hospital
Two clinics at University Hospital North Durham One clinic at Darlington Memorial Hospital
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Why the current situation cannot continue
• Staffing and recruitment pressures
• Not enough direct admissions to stroke units
• Need to provide seven-days a week TIA service
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Staffing and recruitment pressures
• National shortage of expert stroke physicians
• National shortage of therapists and specialist nurses
• Optimum number of full-time consultants for a two-site hyperacute stroke service is six
• Only two full time stroke consultants in County Durham and Darlington and two part-time consultants
• Delays in assessment and treatment of stroke patients
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There are not enough direct admissions into stroke units
• Most stroke patients spend time in Accident & Emergency or Medical Admissions Units • Small number directly admitted to stroke units
• Delays in specialist assessment and treatment
• Unnecessary longer stays in hospital
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Need for 7 days a week TIA service
• Currently provided five days a week
• Difficulties with staff being split between three sites (inc. Bishop Auckland Hospital)
• Enables TIA patients to be seen within a 24-hour time period
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Benefits of hyperacute services on single site
• Consistent access to specialist stroke consultants, including out-of-hours
• Direct admissions to a stroke unit
• Immediate assessment by specialist stroke consultant
• Access to seven-day TIA service with assessment in 24 hours
• Thrombolysis given in a more timely manner following arrival at hospital
• More patients receiving thrombolysis
• Access to seven days a week therapy service
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Doing nothing is not an option
• We cannot continue to provide hyperacute stroke services at two hospital sites
• Fast, safe access to specialist stroke services is essential to survival and recovery
• All patients in County Durham and Darlington deserve the best possible treatment
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The options appraisal process
Rachel Emery Commissioning lead for strokeNHS County Durham and Darlington
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The Stroke Strategy Implementation
Group (SSIG)• Set up to enable the implementation of recommendations highlighted within the Stroke Strategy (2007) and improve stroke services across County Durham and Darlington
• Membership includes a stroke consultant, stroke clinicians, a consultant in public health, carers of stroke patients, the Stroke Association (representing patients), social care, regional cardiovascular network managers, and commissioners
• The SSIG asked a sub-group to carry out a case for change options appraisal for hyperacute stroke service configuration
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Options considered
• Long list of options reduced to shortlist of eleven
• Two site 24/7 hyperacute model - one option
• Single site 24/7 hyperacute model - three options
• Two site hyperacute model plus out-of-hours diversion to single site 24/7 hyperacute - two options
• Two site + transfer including telemedicine plus single site 24/7 hyperacute model - two options
• Single site 24/7 hyperacute model plus collaboration for transfer with neighbouring Trusts - two options
• CDDFT not to have a hyperacute service - regional model - one option
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Benefits Criteria
• Clinical quality - the best for patients
• The service must be sustainable and flexible
• All patients must have fair access to services
• Must be an efficient service
• Must enable better workforce planning
• Functional suitability
• Acceptability to the Trust
• Cost effectiveness
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Weighting of criteria
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How scores were determined
Could hardly be better 10
Excellently 9
Very well 8
Well 7
Quite well 6
Adequately 5
Somewhat inadequately 4
Badly 3
Very badly 2
Extremely badly 1
Could hardly be worse 0
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ResultsRegional modelsTwo site + transfer modelSingle site models
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Darlington Memorial Hospital
Criteria Score Weight Weighted score
Clinical quality 9 17 153
Sustainability/flexibility 10 16 160
Equity of access 7 15 105
Efficiency 8 14 112
Workforce 8 14 112
Functional suitability 7 11 77
Acceptability 6 8 48
Cost-effectiveness 8 6 48
Total weighted score 815
University Hospital of North Durham
Criteria Score Weight Weighted score
Clinical quality 9 17 153
Sustainability/flexibility 10 16 160
Equity of access 8 15 120
Efficiency 8 14 112
Workforce 8 14 112
Functional suitability 8 11 88
Acceptability 6 8 48
Cost-effectiveness 8 6 48
Total weighted score 841
Current two site model
Criteria Score Weight Weighted score
Clinical quality 5 17 85
Sustainability/flexibility 4 16 64
Equity of access 10 15 120
Efficiency 6 14 150
Workforce 4 14 56
Functional suitability 5 11 55
Acceptability 9 8 72
Cost-effectiveness 4 6 24
Total weighted score 590
Scores for single site model vs. current two site model
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What were the differences in the top two scores?
• Equity of access
• Functional suitability
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The preferred option for hyperacute stroke services in County Durham and Darlington
Dr Mike LavenderConsultant in Public Health MedicineNHS County Durham and Darlington
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Bishop Auckland Hospital: 7-day stroke rehabilitation service
University Hospital of North Durham
• 24/7 hyperacute stroke services
• 20 stroke beds
• Full range of intensive and critical care facilities to support hyperacute stroke service
Our preferred option
Darlington Memorial Hospital
• Assessment of self-presenting stroke patients by stroke specialists via telemedicine
• Use of intravenous drugs to stabilise patients before transfer to University Hospital of North Durham
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Between the hours 9am – 5pm patients with a suspected stroke will be taken to the nearest A&E department. These patients will be assessed and then transferred onto the hyper-acute stroke unit.
Current in-hours pathway
Stroke ward
Stroke ward
Darlington
Darlington
Durham Durham
Bishop Auckland
Rehabilitation
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Outside of 9am – 5pm, patients will be taken to the site with the open hyper-acute unit for that week. This alternates between UHND and DMH on a weekly basis.
Current out-of-hours pathway
Stroke ward
Stroke ward
Darlington
Darlington
Durham Durham
Bishop Auckland
Rehabilitation
1st week
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Outside of 9am – 5pm, patients will be taken to the site with the open hyper-acute unit for that week. This alternates between UHND and DMH on a weekly basis.
Current out-of-hours pathway
Stroke ward
Stroke ward
DarlingtonMH
Darlington
Durham Durham
Bishop Auckland
Rehabilitation
2nd week
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In the preferred future option, all patients suffering a suspected stroke would be taken to the single site and directly admitted onto the hyper-acute ward without waiting for assessment in A&E.
Slight increases in journey times would be offset by this reduction in delay with the direct admission.
Preferred future pathway
Stroke ward
Durham Bishop Auckland
Rehabilitation
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In the preferred option, patients self-presenting with a suspected stroke at UHND would go straight up to the hyper-acute unit. Patients self-presenting at DMH would be seen by an Acute Physician who would use “tele-medicine” linked to UHND to assess and treat the patient. Once stable, the patient would transfer to UHND.
Stroke ward
Durham
Darlington
Bishop Auckland
Rehabilitation
Preferred future pathway - self presenting
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• Shorter travel times
• More people suffering a stroke in County Durham
• Essential ultrasound, CT and MRI diagnostic facilities more readily available
Why Durham? Important information which supports our preferred option
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Shorter travel times
• Information from the Development and Assessment of Services for Hyperacute stroke (DASH) research project, carried out by Newcastle University
• Analysis of average ambulance travel times for suspected stroke patients taken to Durham and Darlington hospitals between Jan-Dec, 2010
Durham 16 mins
Darlington 17 mins
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• Analysis of suspected stroke incidences between Jan-Dec, 2010
• Number of patients from North Yorkshire treated in County Durham and Darlington: 9
• Patients in East of County Durham treated in Sunderland and Stockton
More stroke cases in County Durham
University Hospital of North Durham 925
Darlington Memorial Hospital 683
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More stroke cases in County Durham
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• More capacity at University Hospital of North Durham for ultrasound, CT and MRI scanning
• Patients can access essential tests sooner
• Enables quicker diagnosis
• Supports swift access to urgent surgery if needed
More access to diagnostic facilities
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• Shuttle bus runs between three hospital sites
• £2.50 per journey
• Bus pass holders travel free after 9.30am
• Staff travel free
• Inconvenience minimised – 48-72 hour hyperacute period
• Clinical benefits of specialised care make excess
travel worthwhile
Transport implications and solutions
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• Delivers a balance between specialised care and care closer to home for the majority of patients
• Not about saving money
• The preferred option will lead to improved recovery rates for patients
• Safeguards stroke hyperacute service for County Durham and Darlington patients
Preferred option summary
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The consultation process
Rachel EmeryCommissioning lead for strokeNHS County Durham and Darlington
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Your views are equally important
Four tests for proposed service change:
Support from GP commissioners
Strengthened patient and public
engagement
Clinical evidence base
Consistency with patient choice
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• Take part in public meetings such as today
• Complete the online questionnaire at www.haveasay.org.uk
• Email us at [email protected]
• Write to us
• Complete the paper questionnaire in consultation documents
• Request more information or a dedicated consultation session for your group/organisation on 0191 374 4253
How you can get involved
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• Do you agree the current split-site model for stroke hyperacute services cannot continue?
• Do you agree our single site hyperacute stroke service is the best model?
• Is specialist care more important to you than care closer to home?
• Do you agree our preferred option of the University Hospital of North Durham the best option?
• If you don’t agree with the preferred option, what alternatives, if any, would you like to see implemented and why?
What we want to know
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Your chance to have your say: group discussions and Q&A session
David GallagherDirectorNHS County Durham and Darlington
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Group discussions: 20 minutes
• Is a single site the best option?
• Is our preferred option of University Hospital of North Durham the best model?
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Feedback from group discussions
One key point per group
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Questions for the panel
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The next steps
• NO DECISION HAS BEEN MADE
• Consultation closes 11 September 2011
• All views and comments independently collated, analysed and reported
• Final report considered by NHS County Durham and Darlington Joint Board
• Responses and outcomes reported to both council health scrutiny committees
• All feedback and final report made available on www.haveasay.org.uk
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Thank you for your contribution
www.havesay.org.uk
Hyperacute Stroke ConsultationFREEPOSTRRXK-CZGR-TJJAUnit GLumley CloseThirskYO7 3TD
To request more information or arrange a dedicated consultation session for your group/organisation contact us on 0191 374 4253