Agenda item

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 PRH would be viable in terms of numbers of patients.

Capacity at RSCH

1.8.        HOSC asked whether, in light of BSUH’s Care Quality Commission (CQC) report which raised concerns about the capacity of the RSCH site, it was feasible to set up a HASU there.

1.9.        Dr Peter Birtles said HWLH CCG considers the ongoing situation at BSUH at its monthly quality meetings. He said that most of the major problems at RSCH relate to its A&E Department and in a fully functioning stroke service patients would bypass A&E and be admitted directly to the HASU.

1.10.      The Committee RESOLVED to:

1)            note the report and its appendix;

2)            agree that the change proposed is considered a ‘substantial development or variation to services’ requiring formal consultation with HOSC;

3)            agree that a proportionate public consultation on this proposed change should be targeted at the areas particularly affected and on groups with special knowledge and interest in the issue; and

4)            request that a report be circulated by email on the current performance of the stroke services provided by East Sussex Healthcare NHS Trust.

1.11.      Cllr Mike Turner abstained from voting on whether the change proposed was a substantial development or variation to services.