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29.1.      The Committee considered a report about whether the decision of the Joint Committee of Clinical Commissioning Groups in relation to stroke services in Kent and Medway is in the best interest of health services in East Sussex.

29.2.      The Committee received a number of responses to its questions from the witnesses in attendance.

Number of patients affected by changes

29.3.      Ashley Scarff, Director of Commissioning Operations, HWLH CCG, confirmed that modelling by the CCGs had indicated the total number of patients in East Sussex affected by the planned changes would be approximately 50 per year. These comprise patients who currently use Pembury Hospital in Tunbridge Wells and who would in future use Eastbourne District General Hospital (EDGH).

Additional capacity at the Eastbourne District General Hospital

29.4.      Dr Adrian Bull confirmed that ESHT has modelled the likely impact of the additional patients and considers it relatively small compared to the number of patients currently served by the EDGH Hyper Acute Stroke Unit (HASU). He confirmed the additional patients could be accommodated.

Travel Times

29.5.      James Pavey explained that SECAmb is effective at identifying whether someone describing their symptoms over the phone (or the symptoms of someone else) is having a stroke. Someone suspected of having a stroke will be placed in a Category 2 response call, which has a target response time of 18 minutes. The ambulance crew will assess the patient on arrival to check that they are having a stroke and they will be then taken to the closest appropriate hospital with a stroke unit. There is a two-hour ‘call to needle’ time for patients who need to go to a stroke unit and receive thrombolysis (if it is a clot causing the stroke) and SECAmb is confident it can achieve this timescale. He added that strokes are one of the most straightforward conditions to identify clinically, which is a real advantage when determining which hospital to convey a patient to.

29.6.      James Pavey confirmed that it will depend on the individual case and will be decided on-scene, but as a general rule an ambulance would convey a patient straight to a HASU first time. An ambulance crew would not take the patient to the nearest hospital in order to have them stabilised before moving them on to a specialist centre. He explained that this was because:

• taking patients to the nearest hospital may add further delays in treatment when transferring them on to a specialist unit; and
• an ambulance crew can manage the straightforward medical needs of a patient with a stroke – such as keeping airways clear – on the way to a specialist unit, so this would not need to be performed at an intermediary hospital.

29.7.      He compared the conveyance straight to a HASU as analogous to other medical conditions where it is more important to go to the right place first time such as serious trauma cases where the ambulance will take patients to either the Royal Sussex County Hospital (RSCH) or London hospitals.

29.8.      Steph Hood, Comms and Engagement Advisor, added that there is a natural fear about the time taken to get to hospital and, although it is an important factor, the likelihood of good outcomes is more dependent on being on a specialist unit with consultant-led care for the first 72 hours.  The model developed in Kent and Medway is designed to be able to deliver this level of care 24/7.

View of the JHOSC members

29.9.      In speaking about the views of the East Sussex members of the JHOSC, Cllr Howell explained that she had initially been in favour of the two proposed options that would have ensured that stroke service remained at Pembury Hospital in Tunbridge Wells. However, in light of the evidence that it is important to get patients to the right hospital first time, and evidence that this model had worked elsewhere in Sussex, she urged the Committee to support the decision of the Joint Committee of CCGs.

29.10.   The Committee RESOLVED to:

1)    Agree that the decision of the Joint Committee of CCG to reconfigure stroke services in Kent and Medway is in the best interests of health services in East Sussex;

2)    Agree to submit the recommendations made by the East Sussex JHOSC members to the CCGs for consideration when implementing the decision; and

3)    Request a future update on the implementation of the stroke services reconfiguration. 

Cllr Turner abstained from resolution 1.