Meeting: Health Scrutiny Sub-Committee (County Hall, Durham - Committee Room 2 - 03/07/2006 10:00:00 AM)
Item: A6 Coronary Heart Disease and Stroke Services
3 July 2006
Coronary Heart Disease and Stroke Services - Review of Responses
Report of the Head of Overview and Scrutiny
Purpose of Report
1. To explain the responses which have been received about the Coronary Heart Disease and Stroke Services report.
Background
2. A copy of the Coronary Heart Disease report was widely circulated. The following comments have been received:-
Tees, Esk and Wear Valleys NHS Trust
3. This Trust welcomed the report and drew attention to the importance of heart issues in relation to those with mental health and learning disability problems. The Trust points out that with the ageing population, heart conditions will be increasingly an issue. Furthermore, in relation to people with learning disabilities, their health needs are often greater than the rest of the population and they are more prone to stroke and heart disease as they become older.
4. This new Health Trust is seeking to be proactive by identifying and seeking to manage obesity in adult in-patients and becoming smoke free by the end of 2006.
5. In relation to staff, an occupational health nurse was available as a trained smoking cessation adviser. A blood pressure event has taken place in which staff were offered a blood pressure test. Discount gym membership is also one of the staff benefits.
Durham Dales PCT
6. The Dales PCT drew attention to the fact that blood pressure did not need to be regularly checked just by GPs. Nurses, pharmacists and occupational health services can also carry out blood pressure checks.
7. It was also pointed out that cholesterol testing is available at some local pharmacists.
8. The Trust indicated the need to educate the population about the risk of coronary heart disease particularly for those with established cardiovascular disease, people with diabetes and apparently healthy individuals at high risk of developing cardiovascular disease over the next ten years.
9. With regard to stroke, the Trust indicated that plans are well developed for an initial stroke unit at Bishop Auckland General Hospital.
County Durham and Darlington Acute Hospital Trust
10. A copy of the detailed response from the Acute Trust is attached as an appendix. The Trust has been asked to clarify whether a clinical lead has yet been appointed in respect of stroke services. Further clarification has also been sought about compliance with the National Service Framework for Stroke at the University Hospital North Durham and Bishop Auckland Hospital.
Members of Parliament
11. Responses have been received from The Rt. Hon. Hilary Armstrong MP and John Cummings MP
Durham County Council
12. The County Council’s Cabinet has considered the report. The acquisition of a defibrillator for County Hall is being pursued. The Council is also considering the health position of its own staff.
Summary
13. The Chairman of the SubCommittee recently led a publicity campaign about the Scrutiny report and, in particular, the importance of regular blood pressure tests. This has produced some interest. Perhaps the strongest message from the report is publicity about prevention. A report about the simple ways that premature heart disease can be avoided recently appeared in the County Council’s newsletter ‘Countywide’ and the City of Durham Council newsletter ‘City News’.
14. The establishment of a specialist stroke service for each of the County hospitals is a key issue and the Sub-Committee may wish to continue to monitor the position.
Recommendation
15. The Sub-Committee is asked to note the responses to the Sub-Committee’s report and to monitor progress to achieve compliance with the National Service Framework for Older People in relation to stroke services in the County’s hospitals.
Contact: Ian Mackenzie
APPENDIX 1
19th June 2006
Mr. I. McKenzie, Head of Overview and Scrutiny, Durham County Council, County Hall, DURHAM. Co. Durham.
Dear Ian,
HEART ATTACK AND STROKE REPORT
Thank you for forwarding this comprehensive document, which the Trust has been heavily involved in. The document has been circulated around the organisation and comments have been received from a number of our Physicians.
As you are aware, there is a huge amount of work going on in this area both within PCTs and the acute Trust. We acknowledge the time and effort that has been put into providing this comprehensive assessment of services by members of the Health Scrutiny Committee. We are also grateful for the way in which the members conducted themselves when visiting our services and we trust that the ability to talk to patients has given an insight into the importance of acute care for these patients.
In drawing up this report Health Scrutiny has undertaken quite a difficult piece of work joining together both heart attack and stroke. From the primary care and health promotion point of view there is a significant link between heart attack and stroke however when it comes to the acute management of patients who have suffered from either of these conditions they are extremely different and services that we run in the acute Trust are both very different. The importance of stopping smoking, of regular exercise and the healthy diet as recommended cannot be over emphasised and are significant for many conditions not just those of heart attack and stroke.
With regard to the coronary heart disease services run by the acute Trust we have as you are aware some excellent examples of care; we have reduced the waiting times for coronary angiograms significantly since the opening of the two labs in North Durham and in Darlington and we have the potential to develop those services further should our Commissioners wish to do so. Coronary care units on all of our sites work to a very high standard we always achieve the door to needle time for thrombolysis for heart attack victims. There is room for improvement around the call to needle time once the patient makes their call to the Ambulance Service.
Cardiac rehab teams functioning across all sites also have excellent services and they evaluate very well with the patients. They use the recognised programmes for cardiac rehab and the service is extremely well received. Therefore we believe that from an acute point of view the coronary heart disease service that we provide are very good and whilst there is always room for improvement they meet the standards of the NSF for coronary heart disease.
Stroke services vary again across the organisation. Since your visit to the University Hospital of North Durham we have continued to develop the stroke unit and Ward 2 is functioning well with the multi-disciplinary team with Dr. Earnshaw as the lead clinician. The availability of specifically trained staff, excellent accommodation with a gym on site and dedicated therapy staff makes the service achieve many of the standards of the NSF.
The stroke unit in Bishop Auckland meets the standards of the NSF and the development of the thrombolysis trial that Dr. Mehrzad has been involved in has made that service one of the best in the area.
The key issue for the Health and Scrutiny Committee around stroke, I am sure is to address the recognition of stroke within the community. The Stroke Association’s campaign for FAST recognition of stroke is very important for the future. If patients are to have the opportunity for thrombolysis they must be in hospital within three hours of a stroke event taking place. It is therefore important that they recognise when a stroke happens and take appropriate action to get faster care. We believe that the Health Scrutiny Committee will have a significant role to play in raising the profile of early recognition of stroke.
Once again, thank you for the way in which this study has been completed and we look forward to working with you again on further reviews of this kind.
Yours sincerely,
LAURA ROBSON Director of Nursing
Attachments