Agenda item

Aaron Cummins, Senior Responsible Officer for the stroke programme and
Chief Executive of Morecambe Bay Hospitals, Cath Curley, Clinical Director of the Integrated Stroke and Neuro Delivery Network (ISNDN) and Stroke Consultant Nurse, Elaine Day, Manager of the Lancashire and South Cumbria ISNDN, Anthony Gardner, Director of Planning and Performance, Hayley Michell, Interim Stroke Programme Director, Sharon Walkden, Project Manager, Stroke Programme, and Phil Woodford, Chair of the Patient and Carer Stroke and Neuro Assurance Group attended to present the report and answer queries from the committee.

Comments and queries from the committee were as follows:

·  In response to member's concerns about lessons learned it was noted that the model was adopted by Manchester and London a few years ago and national data from the Sentinel Stroke National Audit Programme (SSNAP) for those areas helped to identify key outcomes.  A key outcome at specialist centres was that staff became experts as they saw more patients and had more experience with procedures. The Lancashire stroke team learnt that on those sites where there was not a front-door team, there was a requirement to have an established team within the hospital to take calls from the ambulance, A&E or from the wards to attend to the patient straight away, diagnose the urgency and identify next steps. Other lessons learnt from the Manchester and London models was a requirement to up-resource community teams.

·  To ensure the 24/7 service, staff were recruited as part of a three-year investment plan and workforce plan. The local NHS worked with the local universities and set up different courses along the pathway. The stroke centres have been considered good places to work, therefore recruitment was successful, new unblended roles were introduced, and services were future proofed. Succession plans were put in place for the staff already in place and this supported retainment. Digital services also supported staff to do their jobs more efficiently, they did not need to be onsite to access test results. 

·  The team visited individual hospitals for thoughts and feelings of the staff and to gather if there was any resistance to change. This was followed up with regular workshops, where staff contributed to the case for change, so that there would be no surprises with the new model of care.

·  It was clarified that the hospitals would not lose their acute stroke units, but would be strengthened, with staff supported in their training and development.

·  It was confirmed that there had not been any involvement with Trade Unions or professional bodies, as it had been perceived from staff that there was no need. However, they were aware of a forum which they could attend. Further information on trade union and professional body engagement could be provided to the committee.

·  It was noted that the local NHS had a strong relationship with UCLAN, courses were also available in Manchester and Liverpool, and it was expected that where students train, they would stay to work close-by. There was a phased approach across the region due to the number of staff required, therefore staff were upskilled on each acute site and apprentices were recruited. Funding was secured for a regional role which supported speech and language therapy training and there was collaborative work done with Edge Hill around carers assessments.

·  In terms of concerns regarding travel times in particular from the north Lancashire area, a strengthened front-door allowed more efficient assessment before suitable patients would be transferred to Royal Preston Hospital. Where there were traffic issues, the air ambulance was used. It was noted from the patient perspective, that they were happy to attend the general hospital to be stabilised and then transferred to the acute stroke centre to receive specialist treatment. The team continued to work closely with the North West Ambulance Service (NWAS) on modelling travel times. It was explained that when the business case was considered by the Joint Committee of Clinical Commissioning Groups, they asked for more work to be done with NWAS regarding travel times and access points which included scenario planning using technical mapping software.

·  It was confirmed that Blackpool Victoria Hospital would remain an acute stroke centre, but Royal Preston Hospital would be the main hub for Thrombectomy.

·  Data from the Equality Impact Assessment relating to main risk factors for stroke and equality protected groups in particular ethnicity and gender could be shared with the committee. On preventative measures, it was noted that there had been a number of community projects carried out this year including GP practices supporting people to self-monitor. One of the benefits of the proposed model was to ensure that there was no variation in access to services and treatments. The Patient Carer Assurance Group was currently looking at methods to increase their diversity to be representative of different communities.

·  The New Hospitals Programme was seen as an opportunity to receive investment for improvement but was still at an early stage of development. There was some assurance provided that clinical models that were changed based on best practice and national guidelines, would not be changed and the stroke pathway was set, and that pathway would be included in any development through the programme if successful.

The Chair thanked members of the local NHS for the presentation and information provided. In considering whether the proposal represented a substantial variation, there was a consensus from the committee that on balance it did not meet any of the characteristics likely to increase defining the proposal as substantial. However, it was felt that further assurances were required in relation to travel times, engagement with trade unions and professional bodies and recruitment and training. It was suggested that the Health Scrutiny Steering Group be asked to seek assurances on these matters at its next scheduled meeting on 9 February 2022.

Actions:

·  The local NHS to provide members with Equality Impact Assessment data relating to the equality protected groups.

Resolved: That;

  i.  The Enhanced Network Model of Acute Stroke Care and Rehabilitation in Lancashire and South Cumbria proposal did not represent a substantial variation; and

  ii.  The following matters be taken forward by the Health Scrutiny Steering Group at its meeting scheduled on 9 February 2022:

a.  Travel times modelling and contingency plans for the north Lancashire area;

b.  Engagement activity with Trade Unions and professional bodies; and

c.  Recruitment and training.