Issue - meetings

36.1     The Committee considered a report of the Central Sussex Stroke Services Scrutiny Review Board.

36.2     The Review Board thanked the witnesses for their contributions. Ashley Scarff, Director of Strategy, High Weald Lewes Havens CCG, said that the review process had been a worthwhile and helpful exercise.

36.3     The Committee RESOLVED to

1) agree the report and its recommendations;

2) agree to submit the report to the appropriate NHS organisations; and

3) request an update on the progress of the new stroke service for March 2018.

1.1.        The Committee considered a report which provided an update on the Sussex Stroke Review, specifically relating to services provided by Brighton and Sussex University Hospitals NHS Trust (BSUH) to residents in central Sussex.

1.2.        The report was introduced by Dr Peter Birtles, Urgent Care Clinical Lead, and Ashley Scarff, Director of Strategy, High Weald Lewes Havens Clinical Commissioning Group (HWLH CCG).

Viability of other options

1.3.        HOSC asked whether the preferred option to develop a fully compliant Hyper Acute Stroke Unit (HASU) with a co-located acute stroke unit (ASU) at Royal Sussex County Hospital (RSCH) was the only viable option and whether, as an alternative, it would possible to have a service where patients are stabilised locally before being transferred to a HASU.

1.4.        Dr Peter Birtles said that all options were considered in significant detail but, taking into account a number of factors, the option being put forward was strongly favoured by clinicians because:

·         centralising stroke units provided better outcomes as evidence suggests that, even if the journey time is 10-15 minutes longer, travelling to a properly resourced HASU is likely to result in a better outcome. Although the NICE guidelines recommend treatment of a stroke patient within an hour, in terms of actual outcomes the evidence suggests it is not as time critical as that;

·         option 4 (the preferred option) would ensure that there was a stroke service caring for more than the 600 patients per year, which is the minimum number required to be able to gather sufficient clinical expertise to ensure that people have the best outcomes;

·         interventional radiology is increasingly used for treatment of strokes and RSCH has a new radiology unit under development;

·         neuro-surgeons need to be on site, and they are located only at RSCH where the intensive care unit is located – this cannot be located at two sites;

·         guidance says that the HASU should be co-located with a major trauma site like the one being built at RSCH;

·         only 50 HWLH CCG patients a year previously using the ASU at Princess Royal Hospital (PRH) would need to travel further. Patients in the east will generally go to Eastbourne District General Hospital and patients in the north will travel to Pembury Hospital.

Consideration of West Sussex stroke service proposals

1.5.        HOSC asked how the proposed HASU at RSCH would align with services provided by Western Sussex Hospitals NHS Foundation Trust (WSHFT).

1.6.        Ashley Scarff assured HOSC that HWLH CCG was working with colleagues in West Sussex CCGs and any future configuration of stroke services at WSHFT would not impact on the proposal for BSUH. However, the timing of the implementation of any WSHFT changes may be impacted.

1.7.        Dr Peter Birtles said that having a single stroke site at RSCH would mean that no matter what configuration is chosen in West Sussex, RSCH will have above the minimum threshold of patients. However, it is only if the West Sussex HASU was to be located at Worthing Hospital that a HASU at  ...  view the full minutes text for item 18

36.1     This item was introduced by Ashley Scarff, Director of Strategy, High Weald Lewes Havens CCG; and by Allison Cannon, Chief Nurse, Eastbourne, Hailsham & Seaford and Hastings & Rother CCGs.

36.2     Ashley Scarff told the committee that the stroke review is ongoing. The current focus is not on services within East Sussex, but on services at hospitals used by a number of county residents such as the Royal Sussex County hospital, Brighton; the Princess Royal hospital, Hayward’s Heath; and Tunbridge Wells hospital. Any significant service changes will be reported back to the HOSC.

36.3     In response to a question on cross-border funding, Ashley Scarff told members that a good deal of work had been done on this issue via the Sussex Collaborative, but that more still needs to be done.

36.4     Replying to questions on staffing for language therapy services, Allison Cannon informed the committee that there were long-standing issues with recruitment of some workers, particularly in terms of speech and language and of physiotherapists. It was important to think innovatively, for example, using easier to recruit lower grade staff to undertake appropriate tasks.

36.5     As well as seeking to improve stroke services and fill the gaps between services, the stroke review will focus on rehabilitation and on preventative measures.