Agenda item

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which sets out the Case for Change for Stroke Services and the proposed options for future services as set out within the Acute Services Review and the feedback to date from the Healthy Conversation 2019.  Dr Abdul Elmarimi, Consultant in Stroke Medicine, United Lincolnshire Hospitals NHS Trust and Dr Richard Andrew, Consultant Cardiologist, United Lincolnshire Hospitals NHS Trust will be in attendance for this item)

The Committee gave consideration to a report from the Lincolnshire Sustainability and Transformation Partnership, which set out the Case for Change for Stroke Services and the proposed options for future services as set out within the Acute Services Review and the feedback to date from the Healthy Conversation 2019.

The Chairman welcomed to the meeting Dr Abdul Elmarimi, Consultant in Stroke Medicine, United Lincolnshire Hospitals NHS Trust and Dr Richard Andrews, Consultant Cardiologist, United Lincolnshire Hospitals NHS Trust.

The Committee was provided with some background information, which made reference to the fact that there were over 100,000 people who suffered a stroke in the UK each year.  The Committee was advised of the long-term problems caused by strokes and the different types of strokes, details of which were shown on pages 44 and 45 of the report.

The report made reference to the milestones for stroke care as set out in the NHS Long Term Plan, details of which were shown on page 47 of the report.   It was noted that the national drive was to form larger Stroke Centres.

Details relating to the current model of Stroke Care in Lincolnshire; and the current position of the workforce were shown on pages 48 and 49 of the report.  The Committee was advised that clinical standards and performance standards were not consistently being met, and that there were significant workforce gaps against clinical guidelines for staffing levels, and that this had been the case for a number of years.

The Committee was advised that there were two emerging options, which were:

1.    Centre of Excellence – Stroke services at Lincoln Hospital;

2.    Strokes services continuing at both hospitals with a combined stroke rota.

The Committee was advised further that option one was the preferred option, as this option had been developed based on the national clinical guidelines for stroke published by the Royal College of Physicians.  This option also reflected the key messages and recommendations for stroke care as set out in the NHS Long Term Plan.

It was highlighted that the second option was less likely to be successful at delivering stroke services that met the national standards and guidelines for stroke services; and the delivery of seven day stroke services.

Reference was also made to the impact for patients of the preferred option.  Particular reference was made to concerns raised during the Healthy Conversation 2019 relating to the impact on travelling times to the Lincoln Hospital site for all patients across the county.  The Committee was advised that this had been considered and detailed information had been provided within the report presented regarding this matter.

The Committee was also advised of the new Stroke Service Framework and to the fact that by March 2020, it was expected that the average length of stay in hospital would have reduced from approximately 14 days to 10 days, with an aspiration that an average length of stay of seven days would be achieved in line with best practice.

A discussion ensued, from which the following comments were raised:-

·         Some members welcomed the report and the proposals contained within it, but expressed some concern regarding travelling time for patients;

·         One member expressed concern with regard to a patient who lived in Boston being seen within the 'golden hour' period at Lincoln.  The Committee was advised that the 'golden hour' referred to a 60 minute period from door to needle for the 15% of all stroke patients who required thrombolysis (this treatment option was only for acute ischemic stroke).  It was noted that out of this 20% of stroke patients that received thrombolysis, one third of them would benefit from the treatment (5%).  The Committee was advised further that the preferred option would improve care and outcomes for the majority of stroke patients.  It was noted that with the preferred option, any patient who used the county's stroke service would benefit from a fully staffed centre of excellence that was able to deliver exceptional care for improved outcomes and better aftercare.  It was noted further that having a Centre of Excellence would also help to ensure better training opportunities which would promote Lincolnshire better in the recruitment market;

·         Another concern raised was the impact on displaced patients from Pilgrim Hospital to North West Anglia NHS Foundation Trust.  Information relating to the impact to patients regarding the preferred option was shown on page 51 at 6.1.3 and 6.1.4 of the report.  The Committee was advised that the number displaced would be minimal;

·         Concern was also expressed to the waiting time at A & E; and how this would affect stroke patients.  The Committee was advised that in Lincoln there was a direct phone line, which pre-alerted the Stroke Team of the estimated time of arrival of a patient.  The team would then take the patient direct from the ambulance which prevented any waiting time; and

·         One member enquired as to whether Lincoln would be able to cope with the additional patients.  Reassurance was given that Lincoln would be able to cope with the increased numbers.

The Chairman on behalf of the Committee thanked the representatives for their very open presentation.

RESOLVED

1.    That the Stroke Services – Case for Change and Emerging Options report presented be noted.

2.    That the Chairman be authorised to make a written response to the Lincolnshire Sustainability and Transformation Partnership on the case for change and emerging options for Stroke Services.

The Committee adjourned at 1.13pm and re-convened at 2.00pm.

Additional apologies for absence for the afternoon part of the meeting were received from Councillors M T Fido, L Hagues (North Kesteven District Council) and A White (West Lindsey District Council).

A further apology was also received from Councillor Dr M E Thompson (Executive Support Councillor for NHS Liaison and Community Engagement).