Agenda item

The Committee received a report and presentation from Dr Steve Kirk, Long Term Conditions Lead, Newcastle Gateshead CCG and Jane Mulholland, Director of Delivery and Transformation, Newcastle Gateshead CCG on the proposals for the future of the acute stroke services in Gateshead. Councillors were reminded that this was an engagement session and not a consultation session.

NHS Newcastle Gateshead Clinical Commissioning Group has been reviewing the current Gateshead model of acute stroke care to ensure it is compliant with evidence based best practice and national guidance. In addition there are capacity issues at the Queen Elizabeth Hospital (QEH) that reflect the national picture.

When a patient presents with suspected stroke they need rapid assessment, diagnosis and treatment by specialist staff. The team at the QE is depleted, carrying vacancies they have been unable to fill.  Currently the team is supported by their colleagues in South Tyneside and Sunderland out of normal working hours. This support is delivered remotely using telemedicine, however, changes in treatments now mean that a face to face assessment is considered the gold standard for treatment and delivers the best outcomes for patients.

National policy is driving change in how stroke services are arranged locally. NHS England advocates a new model for stroke services which involves services being delivered through a Hyper-Acute Stroke Unit where patients are transferred for specialist rehabilitation, usually 2-3 days after their stroke following their initial treatment and stabilisation.

Along with the national recommendations the Local Stroke Network (North East and Cumbria) has produced a paper summarising how ideally we can meet these standards and recommends that there is a maximum of 6 Hyper Acute Stroke Units supported by acute stroke units. Importantly, there are not the numbers of stroke consultants available to be able to provide the extended hour’s emergency cover for acute stroke patients under the current configuration.

There has been a vacancy in one of the two stroke consultant posts at the QEH since April 2014 which the Trust has been unable to fill. There is also a stroke consultant vacancy in South Tyneside NHS Foundation Trust, which provide out of hours cover for Gateshead. This is causing an additional strain on the stroke service in Gateshead.

All of these factors have put pressure on the Stroke Service in Gateshead and in 2014 the QE approached the CCG to ask if we would consider a new stroke pathway moving the initial care of stroke patients to a larger unit based at the RVI.5

The Committee were advised that the current situation is no longer sustainable. The QE unit has 2 consultant posts, 1 of which has been vacant for over 12 months despite several attempts to recruit. The QEH clinical and management team have approached the CCG and suggested that they would like to work in collaboration with Newcastle Hospitals to update and improve the Stroke Services.  With this in mind three options have been considered in order to meet national and regional guidance on stroke services:-

1) Gateshead Stroke Unit continues to receive hyper-acute strokes

2) HASU at City Hospitals Sunderland with acute stroke unit in QEH

3) HASU at RVI with Acute Stroke unit at QEH

The CCG and Foundation Trusts believe Option 3 described above would best meet the challenges that have been highlighted and improve the care for patients suffering a stroke. The RVI in Newcastle will assess and treat all patients suffering a stroke. The RVI in Newcastle will assess and treat all patients from Gateshead in the acute phase of their illness. For those patients who are well enough to go directly home from the RVI, they will be supported by Gateshead community teams. For those patients who require a longer stay in hospital, they will be transferred to the QEH acute unit and will be supported through their rehabilitation and re-ablement by the specialist team who are based there before being discharged home when they are well enough.

It is anticipated that the benefits of the proposed model would:-

•         At least 3 fewer deaths from stroke each year in Gateshead

•         Improvement in quality standards measured by the Sentinel Stroke

National Audit Programme (SSNAP)

•         Patients will be admitted to a unit that meets the recommended

standards of

both national and local stroke networks

•         Patients will have access to the most up to date treatments

•         The service will be sustainable and robust

•         Patients will have access to new treatments such as thrombectomy

•         Patients will benefit from access to research programmes which are

trialling the latest advances in stroke medicine

•         The new service will be a 24/7 service

•         Average length of stay in hospital is expected the reduce by 2 day as a

result of these changes.

With this in mind the CCG plans, with its partners, to engage with patients and the public to explain what these proposed changes mean for them, hear their concerns and understand issues affecting patients and their carers. The CCG will then ensure that these issues are addressed during implementation.

RESOLVED -  that the information be noted.