Agenda item

The Committee received a report from the Director of Transformation and Partnerships and presentation from representatives of County Durham Clinical Commissioning Groups and County Durham and Darlington NHS Foundation Trust that provided a range of service model options in respect of stroke rehabilitation services for public consultation and the associated communications and engagement plan (for copy see file of Minutes).

The Director of Commissioning and Delivery gave a detailed presentation that highlighted:-

·        Background

·        Vision

·        Scope of Review

·        Current Pathway

·        Quality and Performance

·        Patient and Carer Feedback

·        Clinical Case for Change

·        GIRFT – Getting it Right First Time

·        Options Appraisal

·        Proposed Future Model

·        Proposed Pathway

·        What this would mean for patients in County Durham

·        Next Steps

The Chair encouraged everyone to take part in the consultation, taking the opportunity to feed in any concerns and comments that they had.

Councillor Bell expressed concerns about transport and accessibility not just for the patient but for the visitor.  He said that there were not enough staff for both UHND and Bishop Auckland Hospital and the proposal was to move everything to Durham and have community based provision.  He asked if there was adequate staffing to do this and that this should be in place and working well before decisions were made. 

Dr Smith, Consultant for Stroke and Elderly at Ward 6, Bishop Auckland Hospital explained that the acute services available at UHND offered stroke patients 45 minutes of therapy per day.  Therapists would all be on the same site and this would allow rehabilitation to commence as soon as the patient was ready.

Councillor Smith said that these changes were going against the principle of promoting care closer to home, if the patient had to travel to Durham.  She added that transport had not been referred to and was concerned that this was very difficult from some areas in the County, such as Weardale.  The parking was also an issue at UHND with very few spaces and Councillor Smith was concerned that these changes would also add to the already overstretched resources at UHND.  She added that this seemed to be more about staff convenience than the care of patients.  Councillor Smith suggested that a third option should also be considered so that services could be retained at Bishop Auckland Hospital.

The Chair agreed that transport was a recurring theme, including difficulties for relatives.

In response, the Director of Commissioning and Delivery said that she would ensure that any proposals would take into account transport requirements.  Dr Smith added that the changes for ward 6 and the stroke rehabilitation were separate issues, as specialist services were in place for stroke patients and these patients could not be relocated easily.  The vulnerable patients would benefit from having acute care on the same site as the therapy services.  She explained that care closer to home was the preferred option however for those patients that required rehabilitation, this should be specialist service led.  She assured members that clinical staff did not feel that it was an inconvenience travelling however the time could be better spent on delivering patient care. 

Councillor Henderson agreed with the points made about parking at UHND and asked that all venues be used that are available, such as the Richardson Hospital.

Councillor Temple could recollect when stroke services were centralised in 2010 when a strong case was put forward for improving results.  However, he was not convinced of the arguments in this case and felt that the target to reduce the length of stay could result in re-admissions.  He added that a much stronger evidence base would need to be put forward for the capacity at UHND to be able to cope with the increase in services, and that details of what the space at Bishop Auckland would be used for.  He accepted that it was right to treat people in one setting but would require further evidence to support this.  He was informed that the Trust were reviewing bed capacity in Durham and Darlington for all services and the best way to utilise all beds.

Councillor Jewell commented that this report was contradictory to the previous ward 6 report, in respect to treating people in one central location to the other that was all about more locally delivered services.  He asked that better communication and understanding was given on these issues so that people were not confused with the proposed changes.  He added that it was understandable for clinicians time to be more effective treating patients rather than travelling but he asked what about the visitors when they had to travel further.

The Chair reminded members that the committee would monitor any changes.

Councillor Allen commented that all of the proposed changes had disillusioned staff members with some choosing to leave and find alternative employment.  She felt that therefore the proposals were trying to address the staff shortages rather than addressing the patients needs.  She agreed with Councillor Smith’s earlier point about having a third option and continuing to offer services from Bishop Auckland Hospital.  Councillor Allen added that Bishop Auckland Hospital was a Centre for Excellence specialising in older people’s care.  She further asked about the bed reduction and what would happen to patients during inclement weather should they not be able to travel to Durham.  She was also concerned about staff having to travel to patients.

Referring to NICE (National Institute for Health and Care Excellence) guidelines for stroke patients, Councillor Zair commented that they must have 45 minutes of rehabilitation per day and he was concerned that staff would not have all of the necessary equipment to treat at someone’s home or out in the community.  To enable a patient the best outcome he suggested that they needed to stay at Bishop Auckland Hospital and was also concerned that there would not be sufficient beds at UHND.  He was advised that in terms of therapy, the service were trying to make improvements for the patient.  Therapy would also be offered across the board whether it was in a hospital or community setting and by centralising the existing services would ensure time was used more effectively to have better outcomes.

A member of the public, Mrs Taylor spoke about her and her husband’s experiences following a stroke and the admission to UHND and Bishop Auckland Hospital.  She praised the staff at Bishop Auckland for offering a palpable service which she found to be peaceful and have a different energy from UHND.  She commented that if it wasn’t broke then you shouldn’t fix it.

Further to a question from the Chair, the Director of Commissioning and Delivery advised that separate meetings,events and presentations were in place to ensure that whilst both the Stroke Rehabilitation and Ward 6 consultations were taking place there would be no confusion between the two.

Councillor Grant thanked the Director of Operations and Delivery for explaining these difficult issues in a way that was understandable.

Resolved:

(i)           That the report be received.

(ii)              That comments on the range of service model options in respect of stroke rehabilitation services for public consultation and the associated communications and engagement plan be communicated back to the CCG.