Minutes:
The Committee received a presentation by representatives of County Durham Clinical Commissioning Groups and County Durham and Darlington NHS Foundation Trust regarding the Review of Stroke Services in County Durham (for copy see of Minutes).
The Senior Service Manager, CDDFT gave a detailed presentation highlighting the following-
· Scope of improvement – how services would be delivered in future
· Context and best practice
· Current state for stroke rehabilitation
· SSNAP performance – August to November 2017
· Reporting periods
· Summary of key issues identified
· Engagement activity
· Proposal on best way forward – review best practice, engage and feedback responses
The Senior Service Manager added that there was a supported discharge team located in the Easington area. She would report back to the Committee in September 2018 with the feedback received on the changes.
Mrs Hassoon asked if the under performance in occupational therapy was due to staff shortages and was informed that there were some gaps in speech and language and that it was difficult to service multiple sites. The service also had difficulty recruiting staff. There was a national shortage of therapy staff across the County.
Councillor Bell was concerned that if someone was discharged from Bishop Auckland Hospital and the care was not available for them out in the community. He said that the care available in that patch was uneven and asked what outcomes the CCG were looking for with these changes.
Councillor Smith understood that staying too long in hospital was not best practice but she too was concerned about community services not being available, making recovery difficult for some patients. She asked if there would be a more systematic approach that focused on the patient group.
In response, Dr Pai, Consultant Stroke Physician and Clinical Lead, CDDFT, that better outcomes were seen at three months from a patient having a stroke and this was used as an evidence base. This would depend on the category of the stroke as sever strokes can see a patient in hospital for six weeks plus rehabilitation treatment. Minor strokes tend to see improvements after two to three weeks. He said that there was a concern about the lack of community services available from GPs and consultants. He added that most patients did recover better in their own home with familiar surroundings with much better outcomes.
Councillor Smith commented that the bottom line was that there were not enough robust community services in place to give patients the best outcome.
The Director of Commissioning advised that the therapies were diluted with acute rehab being carried out in Durham and longer intensities at Bishop Auckland. With the proposed changes, staff at Bishop Auckland would be freed up to be available in the community. She added that it was important to talk to patients about their stroke recovery and that this would help to improve communication.
Councillor Smith believed that this was a hidden agenda to remove stroke services from Bishop Auckland and move them to Durham.
With regards to shorter stays from Bishop Auckland for patients choosing to go home, Councillor Quinn asked for a breakdown of those numbers.
The Stroke Manager for CDDFT assured the Committee that anyone who opted to go to Bishop Auckland Hospital would be able to go there. Early supported discharge was available in Easington however there were different levels of rehab available in other parts of the County which could be delivered through the Teams around Patients and Community Hubs.
Councillor Wilkes said that so many other services had been drawn into the University Hospital North Durham, he believed at the expense of the rest of the County. This had an impact on staff and he was horrified to see even more services being pushed into this hospital as the capacity was already difficult with a lack of parking.
With regards to accessibility and parking, Councillor Bell agreed that this was a huge problem in Durham. He said that it was difficult for people to get from the Dales into Durham and felt that there had been a contradiction in the information given as on one hand officers had said that there was not enough of a specialist resource to provide care in hospital but that there was also not enough resource out in the community.
Mr Taylor-Gooby was advised that North Durham CCG had led on the engagement. He was assured that the AAPs had been involved in the process and went on to say that engagement should be a continuous effort with peoples concerns being fed in to the process. The Senior Service Manager responded that this was a priority for the CCG and so it would be resourced. She added that they used all of the networks and processes that they already had available to help with the engagement, including the AAPs.
The Director of Commissioning explained that they had the same number of patients from Bishop Auckland attending UHND as patients from the Durham area attending Bishop Auckland Hospital. She added that best practice would be for people to be out of hospital and in their own homes which would help aid their recovery. Therefore the best services for people would be in the community with rehab available to offer support required.
Referring to the Easington Discharge team, the Chairman said that this was a wonderful service and that we should not lose it. The Director of Commissioning said that they wanted to replicate this good practice across the whole County.
The Chairman asked if the stroke rehab unit at Bishop Auckland Hospital was being removed. The Senior Service Manager confirmed that they were trying to understand the indicators and at the moment it was not fantastic in terms of outcomes for patients. They wanted to share good practice and therefore needed to carry out further detailed work around this. They needed to work out what was the best they could offer with the resources available. Following the period of engagement they would come back to Committee with their findings.
Resolved:
That the engagement process be noted and the Committee to receive feedback to a future meeting at the conclusion of the stakeholder engagement activity.