Minutes:
The Committee received a presentation from the Chief Executive, County Durham and Darlington NHS Foundation Trust (CDDFT) that provided an update of the review of stroke rehabilitation (for copy see file of Minutes).
The Chief Executive was accompanied by the Lead Stroke Consultant, Commissioning & Development Manager, and the General Manager of CDDFT together with the Director of Commissioning for DDES CCG.
The Commissioning and Development Manager highlighted the following information from the presentation:-
· Key Facts about Stroke
· Scope of Service Review
· Current Pathway
· Current Discharge Pathways
· Drivers for Change
· Case for Change – Quality of Care
· Case for Change – Workforce
· Next Steps – doing nothing is not an option
· Engagement & our commitment
· Timescales
The Chairman thanked officers for the presentation. He asked for assurances that this was not linked to changes to the regional vascular services and The Chief Executive provided that assurance.
Councillor Crute referred to early supported discharge and asked how the service would know that people received the same level of support at home as they would in hospital. The Lead Consultant advised that early discharge was was not available at present countywide however a small team based in Easington were involved in setting this up.
The Chairman referred to the previous changes to hyper-acute stroke services moving from Darlington to Durham and he expressed concerns about these further changes in respect of the viability of services provided at University Hospital North Durham and Bishop Auckland Hospital. He requested evidence to provide the assurances about the future of these hospitals. The Chief Executive referred to the changes made to hyper-acute services and the recognised significant improvement outcomes as a result. She advised that the key aspect was to have early supported discharge as a commissioned service as this would make a big difference. She referred to opportunities around Bishop Auckland Hospital to enhance the assessment services for frail patients.
The Lead Consultant added that there had been no complaints about patients being in the wrong place following the changes to the hyper-acute services. referring to community services he said that patients did want to be in their own homes and that we needed to make best use of the facilities available. He added that it was important for patients to receive continuity of care and by putting services in place would ensure that happened. Referring to Bishop Auckland Hospital he commented that this was a great facility and was an aspiration to have this as a centre of excellence for elderly care.
The Director of Commissioning explained that there was not a direct link between stroke services and the rest of the services taking place at Bishop Auckland Services. She would share the list of services available at Bishop Auckland Hospital following the meeting with the Committee. She assured the members that Bishop Auckland Hospital was thriving.
Referring to early supported discharge Mrs Hasson expressed concerns about those people leaving hospital where a good service was not available within the community. The General Manager advised that other services were being developed in relation to discharge to assess. The Director of Integration added that discharge to assess was only carried out when safe to do so.
Councillor Patterson welcomed the advantages of centralisation and was pleased to hear about the aspirations for Bishop Auckland Hospital however she was concerned about transport for patients and their families. She agreed that the best care for patients was to receive that locally however, it had also been noted that in the recent CQC inspection, there were a lot of areas that required improvement. She went on to ask what an acceptable sample size was for public engagement.
The Director of Commissioning assured members that this was not about the centralisation of services, that was the view expressed by the Lead Consultant.
The views of patients would also be sought together with those of clinicians. She added that it would be difficult to say what the sample size would be but said that they would be talking to people who had suffered from a stroke together with their families. They would not receive a 100% response rate but would share who they had talked to and what the response rate was at the end of the engagement exercise.
The Chairman suggested that a special meeting of the committee be arranged whereby evidence could be presented from patients. He believed that this was a significant change to the service and would like to view the evidence to back up the ideas for change. Referring to the slide on the workforce, he asked what had caused the deterioration across the board. The General Manager explained that recruitment to Bishop Auckland Hospital and UHND had been difficult. Retaining therapists had also been problematic due to not delivering the best outcomes. The Chairman asked if this would be improved and was advised that staff would be consolidated in teams and a named clinician would follow the patient into the home or community where teams around the patient would take over.
The Chairman asked a question on behalf of Councillor Smith relating to stroke and mortality figures and was advised by the Lead Consultant that all of the North East Stroke Units have average mortality rates but that it did vary according to postcodes. He assured members that they were not experiencing an increase in mortality rates and added that regular reviews took place whereby clinicians were presented with data.
Councillor Patterson re-iterated her point about travelling and the costs associated with transport and car parking not only for patients but for their families. The Director of Commissioning explained that this was one of the reasons why the service were supportive of discharge to home and this wold also make it easier for families. Their views would be sought.
Councillor Darkes asked if the centralisation reaction was due to staff shortages and he asked for a scheduled plan of where the staff would be recruited from and how they would be recruited. The Director of Commissioning confirmed that they were not preparing to centralise as development plans and options had not yet been proposed. She again referred to the views of the Lead Consultant.
Councillor Darkes commented on the reduction from 9 to 6 units and was advised that this was in relation to the hyper-acute unit and those changes had already taken place.
The Lead Consultant commented that a national directive, led by Professor Tony Rudd on hyper-acute treatments, was about trying to get the size of the units right. He added that in Durham a lot of consultants had been recruited and would hopefully be retained. Referring to the comments made about centralisation he said that it was not only his view but that of his team and something that the therapists would like to see happen.
On answering a question from Councillor Darkes about finding additional staff, the Director of Commissioning advised that they did have a recruitment plan and patients would still have the choice as to whether they wanted to accept the service. The General Manager added that once they had spoken to patients they would have a better understanding of who wanted to be at home receiving treatments.
The Chief Clinical Officer, DDES CCG said that there was evidence to support the restructure in one area. He said that 27 days in hospital was too long and that patients should be in their own homes. He added that investments into the service were much better and he believed that this would help to recruit staff. There had been concerns about the speed of getting patients from home to hospital but with further investments into NEAS from the CCG it was expected that they would deliver.
With reference to the hyper-acute unit Councillor Temple said that the changes had produced a much better service. However, further evidence was needed in relation to early supported discharge as he was not convinced by the arguments put forward. He did agree that to do nothing was not an option but was concerned about what the losses would be as a result of the proposed changes.
Councillor Chaplow was concerned that many patients would say that they wanted to go home and then refuse the help and support when they leave hospital. Her view was that in hospital patients would get the care they required and believed that we had a really good system in place.
Councillor Patterson agreed with Councillor Temple’s point that we couldn’t do nothing but she added that these changes were due to a shortage of staff as the NHS was heavily under funded.
Resolved:-
(i) That the report be noted.
(ii) That the proposed review of stroke support services across County Durham be added to the Committee’s 2018/19 work programme.
(iii) That a special meeting be arranged to discuss options for future stroke rehabilitation services across County Durham and for evidence to be presented to that meeting which demonstrated the case for change and also set out the views of patients in respect of the existing stroke rehabilitation services.