and Transformation Partnership Kent and Medway Stroke Review Joint - - PowerPoint PPT Presentation

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Transforming health and social care in Kent and Medway is a partnership of all the NHS

• rganisations in Kent and Medway, Kent County Council and Medway Council. We are working

together to develop and deliver the Sustainability and Transformation Plan for our area.

Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Kent and Medway Sustainability and Transformation Partnership

Kent and Medway Stroke Review Joint Committee of CCGs Discussion Document 31 January 2018

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Stroke is a serious life-threatening condition caused by a blood clot or bleed in a blood vessel in the brain. How well people recover is affected by speed and quality of treatment.

• Around 3,000 people a year who have a stroke live nearest to a Kent and

Medway hospital

• Around 250 patients currently treated for stroke in Kent and Medway

hospitals are from outside of Kent and Medway

Stroke and current services in Kent and Medway

Six of our seven* hospitals currently provide some urgent stroke care across Kent and Medway. But we are not consistently meeting national quality standards or delivering best practice care.

*Services not currently provided at Kent and Canterbury Hospital

Our proposal

Setting the scene (Patricia Davies)

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Hospital staff in Kent and Medway provide the best urgent stroke service they

• can. But the way urgent stroke services are set up currently, along with staff

shortages, mean local hospitals do not consistently meet national standards for clinical quality. We want anybody who has a stroke, day or night, anywhere across Kent and Medway, and our border areas, to have the best chances of survival and

• recovery. To do this we must reorganise our stroke services.

Our proposal

We want to develop 24/7 urgent stroke services

• Hyper acute stroke units
• Acute stroke units
• Transient ischaemic attack (‘mini stroke’) clinics

Investing up to £40m in hospitals and recruiting more staff

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

3

Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Significant service change requires public consultation

Kent and Medway Case for Change Development of Kent and Medway service delivery models Development of hurdle criteria Identify full evaluation criteria Identify long list

• f options

Application of hurdle criteria to produce a shortlist of

• ptions

Evaluation of shortlist of

• ptions (using

evaluation criteria) to identify a preferred

• ption(s)

Development of a Pre- Consultation- Business Case (PCBC) Submission of PCBC to NHS England National Investment Committee Public Consultation Evaluation of consultation discussions and responses Decision by Joint Committee

• f CCGs

Current position

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Timeline

2018 Jan February March April May June July August September

Consultation

31/01 Formal JCCCG

Consultation analysis

Formal JCCCG (date TBC) Mid-late Sep (date TBC) Formal JCCG Decision making meeting

Decision Making Business Case (DMBC) development Ongoing communications and engagement

01/02 Consultation launch (TBC)

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

We only have 1/3 of the stroke consultants needed to deliver a best practice service in all hospitals Specialist stroke resources are spread too thinly and most hospitals do not meet national standards and best practice ways of working. 24/7 access is not consistently available for consultants, brain scans and clot busting drugs Over 1/3 of stroke patients are not getting brain scans in recommended time Half of appropriate patients not getting clot busting drugs in recommended time Only one unit seeing enough stroke patients for staff to maintain and develop expertise (recommended minimum of 500 stroke patients per year)

Case for change (Patricia Davies)

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

• Run 24 hours a day, 7 days a week
• Always have access to a stroke consultant with seven

day/week consultant ward rounds

• Able to do brain scans and give clot-busting drugs within 2

hours of calling an ambulance, round the clock

• Staffed by teams of stroke specialist doctors, nurses and

therapists

• Inpatient care for first 72 hours is on the hyper acute unit,

follow up care is also on specialist acute stroke unit Hyper acute stroke units in action

Service model and benefits (David Hargroves)

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Seven day TIA (or “mini stroke”) clinics will be provided at the Hyper Acute Stroke Units / Acute Stroke Units Under the future TIA pathway:

• Very high risk TIA patients will be admitted to the HASU/ASU
• Probable TIA patients require urgent assessment. This will take place at the

seven day TIA clinics run at the HASU/ASU sites

• Less likely suspected TIAs require less urgent assessment, and this can be

provided locally

• In addition, the Clinical Reference Group will explore the requirement for

provision of local TIA clinics for probable TIA patients

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

TIA (“mini stroke”) pathway

Very high risk TIA requires admission

Probable TIA 35% Unlikely TIA but needs urgent assessment 20% Other neuro/specialit y 30% Clear diagnosis 15% Diagnosis and prescription

Triage 24/7

Alert Outpatient pathway Home Immediate admission 24/7 <24H 7 day >1W 5 day >1W 5 day Immediate 7 day

Outpatient pathway HASU/ASU (Local DGH) (Local District General Hospital)

Speed of response

• Approx. 10% of

confirmed strokes

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Consolidating urgent stroke services would help deliver consistently high-quality care regardless of where people live or when a stroke/TIA

• ccurs
• more patients getting brain scans and, if needed, clot busting drugs within

the recommended time

• a reduction in deaths from stroke
• fewer people living with long-term disability following a stroke
• fewer people losing their independence and being admitted to nursing/care

homes following a stroke

• shorter stays in hospital
• fewer vacancies within the stroke services and less turnover of staff
• improved experiences for patients and staff through best practice care

delivered in specialist units 24 hours a day, seven days a week. Benefits of change

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

We are consulting on

• The proposed move to a new way of delivering urgent stroke care
• The development of three sites into new stroke units
• A shortlist of deliverable three-site options

Options for consultation

Option Hospitals

A

Darent Valley | Medway Maritime | William Harvey

B

Darent Valley | Maidstone | William Harvey

C

Maidstone | Medway Maritime | William Harvey

D

Tunbridge Wells | Medway Maritime | William Harvey

E

Darent Valley | Tunbridge Wells | William Harvey

• Options are not ranked in order of preference.
• A preferred option will be agreed after consultation.
• Urgent stroke services would not be available at other

hospitals in Kent and Medway.

Options and evaluation (David Hargroves, Nick Dawe)

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

The 13 options on the medium list were evaluated against the following five

domains: Quality, Access, Workforce, Ability to Deliver and Affordability

Ability to deliver Quality

• f care

for all Access to care for all Criteria 1 2 3 4 Workforce

• Expected time to deliver
• Scale of impact
• Clinical effectiveness and

responsiveness

• Time to access services

Sub-criteria

• Sustainability
• Trust ability to deliver

Affordability and value for money 5

• Net present

value

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

The following process was undertaken to reach a shortlist of options

Clinical and other non-financial evaluation analysis Clinical Board + Stroke CRG chair Review draft analysis 24/08 Stroke CRG + Stroke Prog. Board Review output of initial eval. w/s 05/09, 06/09 Financial analysis Finance Group 25/08 Finance evaluation workshop Finance Group + Stroke Assoc. 08/09 CCG JC makes final decision whether to go to consultation 31 January 2018 Review by South East Coast Clinical Senate 16/11 Full evaluation workshop 20/09 STP Programme Board 11/09 Stroke CRG 03/10 Finance Group 06/10 STP Programme Board 09/10 1:1s with Estate Directors, Finance Directors and Dep. Chief Execs w/c 02/10 Submission to South East Coast Clinical Senate 26/10 CCG Chairs and AOs 11/10 Initial evaluation workshop 30/08

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

1) DVH, WHH, QEQM 2) MGH, MMH, QEQM 3) DVH, MMH, WHH 4) DVH, MMH, QEQM 5) DVH, MGH, WHH 6) DVH, MGH, QEQM 7) DVH, TWH, QEQM 8) MGH, MMH, WHH 9) TWH, MMH, QEQM 10) TWH, MMH, WHH 11) DVH, TWH, WHH 12) DVH, MGH MMH, 13) MGH, WHH, QEQM

1 2 3 4 5

Quality Access Workforce Finance Ability to deliver

• SEC co-adjacencies
• Co-adjacencies

for mech. thrombectomy

• Req. for MEC
• Blue light, proxy
• Private car, off

peak

• Gap in workforce

requirements

• Vacancies
• Turnover
• Expected time to

deliver

• Trust ability to

deliver

Full evaluation matrix

• Net Present Value

(NPV at 10 yrs, £m)

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

A

Darent Valley, Medway, William Harvey

B

Darent Valley, Maidstone, William Harvey

C

Maidstone, Medway, William Harvey

D

Tunbridge Wells, Medway, William Harvey

E

Darent Valley, Tunbridge Wells, William Harvey Hospital site locations Population within 30 mins by ambulance

73.4% 74.2% 76.2% 82.2% 76.9%

Population within 45 mins by ambulance

91.0% 91.3% 91.3% 92% 91.9%

Capital investment required

£30.82m £36.29m £37.86m £35.95m £30.63m

More stroke doctors needed In K&M

8 8 8 8 8

Outside K&M

2 2

Comparison of options

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Why are some sites not proposed as a future Hyper Acute Stroke Unit/Acute Stroke Unit?

Kent and Canterbury Hospital Queen Elizabeth the Queen Mother Hospital

• East Kent University Hospitals Foundation Trust felt that it would

be very difficult to deliver stroke services on two sites (William Harvey Hospital and Queen Elizabeth the Queen Mother Hospital) due to recruitment issues and the risks around staff re-location

• Therefore, all options with a HASU/ASU at both of these sites

were evaluated more poorly in the trust ability to deliver

• Kent and Canterbury Hospital does not currently meet the co-

dependency requirement for a HASU as it is lacking acute medicine and critical care

• This is due to the withdrawal of training doctors by Health Education

England in March 2017

• Options with Kent and Canterbury Hospital have not been shortlisted

for consultation.

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

• Thousands of people have engaged in stroke review since late 2014

including: stroke survivors/ their families and carers/ members of the public/ clinicians/ key stakeholders including CCGs, providers from Kent, Medway, and across the borders in Sussex, Surrey and south London

• They have provided a valuable challenge and helpful insight throughout

the review

• Views have been fed into the decision-making process
• Variety of engagement channels have been used including surveys, focus

groups, listening events, roadshows, face to face meetings

• We have used a variety of channels to communicate including e

newsletters, printed magazines, emails, media, social media, websites

• All engagement work has been logged and evidenced

Overview of stroke engagement

Stakeholder engagement (Patricia Davies)

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Since starting the stroke review we have been talking to staff, patients, the public and wider stakeholders to develop the future care model. Key advantages of the new model that people identified included: Potential advantages and benefits

Separate specialist centres 7 day service/longer hours More collaborative working Better delivery of care

Seven days a week specialist service is good.

Ashford

I understand or know that stroke services like this have better

• utcomes. It is a sad compromise

that [increased] travel may be necessary.

Deal

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Since starting the stroke review we have been talking to staff, patients, the public and wider stakeholders. Issues already raised include: Potential disadvantages and concerns

Why not have a hyper acute stroke unit at every hospital? Why not centralise everything

• n one site?

Is three the right number?

Will sites that lose stroke services suffer? Are hospitals outside Kent and Medway affected?

Impact on other hospitals

Can we recruit enough staff for the proposed changes? Will staff be willing to move to new locations?

Recruitment & retention

Can ambulances get people to a hyper acute stroke unit fast enough? Can relatives and carers visit easily?

Travel times

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Mitigations against potential disadvantages have been developed

Travel and access for carers and relatives Workforce

• Training offered for staff at non HASU/ASU sites to ensure no loss of

expertise at these sites

• Protocol in development for patients who have a stroke in a non

HASU/ASU

Transition

Risk Mitigation

Travel and access for patients

• Increased travel time will be off-set by the improved diagnostic and

treatment efficiencies in the model of care at the HASU.

• Ambition of the new model of care is to provide thrombolysis treatment

within 30 minutes of arrival – this allows for 90 minutes for call to door

• Liaise with voluntary transport services in transporting carers and

relatives

• Explore options for carers and relatives to stay overnight
• Maximise public transport accessibility through engagement with local

transport providers

• Review cost/availability of car parking spaces for carers and relatives
• Incentives to encourage staff to relocate.
• Develop a system wide approach to encourage and support the

movement of staff

• Promotion of stroke roles through the use of targeted recruitment

campaigns

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Assurance (Michael Ridgwell)

• South East Coast Clinical Senate
• Integrated Impact Assessment
• Joint Health Overview and Scrutiny Committee
• NHS England

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Integrated Impact Assessment

• An independent integrated impact assessment of the proposed options

was commissioned

• Looked at potential impact of the options in terms of health, travel and

access, sustainability and populations with protected characteristics

• The difference between the options for consultation was found to be

minimal

• Report gave recommendations for mitigations – these have been further

developed by the stroke review governance groups

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

It is proposed to launch the public consultation on 1 February 2018 to run for ten weeks. During the consultation period we will:

• Have online information, materials and questionnaire as well as hard copies
• Hold proactive listening events x 10 CCG areas
• Discuss the consultation and encourage responses at existing meetings and
• pportunities, at both county and CCG level
• Respond to meeting requests where we can
• Provide materials and support for meetings run by others (eg animation, consultation

documents, FAQs)

• Conduct outreach to seldom heard groups (building on pre-consultation

engagement)

• Conduct targeted focus groups i) IIA ii) those particularly at risk of stroke iii) staff
• Gather feedback from a representative sample population – telephone survey
• Continue 1-1 stakeholder engagement for targeted responses
• Run a digital and social media campaign
• Continue working with local media
• Take every opportunity to build in ‘FAST’ and prevention messages to our

communications.

Meeting dates will be published at www.kentandmedway.nhs.uk/stroke and on individual CCG websites, as well as cascaded through networks and publicised locally.

Consultation process

Consultation plan (Steph Hood)

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Consultation activity overview

Briefing stroke teams Disseminatio n of consultation doc Stakeholder launch event Media launch Roadshow in local towns Adverts in local media Webchat with clinician EIA target focus groups At risk of stroke focus groups Roadshow continues 3x listening events in CCG areas Adverts in local media Staff focus groups 3x listening events in CCG areas Webchat with clinician EIA target focus groups At risk of stroke focus groups 3x listening events in CCG areas Adverts in local media Telephone survey begins Staff focus groups Mid-point media push 3x listening events in CCG areas Webchat with clinician Telephone survey continues EIA target focus groups At risk of stroke focus groups 3x listening events in CCG areas Adverts in local media Telephone survey continues Staff focus groups 3x listening events in CCG areas Webchat with clinician Roadshow in local towns EIA target focus groups At risk of stroke focus groups 2x listening events in CCG areas Roadshow in local towns Staff focus group Deadline media push Final call for responses across all channels Press release/ media on close of consultation

1 2 3 4 5 6 7 8 9 10

• 2

Week number

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Consultation activity overview

Activity taking place throughout consultation period

• Supporting materials and survey on STP website and signposted from CCG and

provider sites

• Weekly topic-specific content shared via STP, CCG and provider communications

channels (e.g. website, social media, bulletins/newsletters, staff briefings etc)

• Promotion of consultation to and in 3rd party stakeholder organisations

communications channels

• Presentations to/attendance at key stakeholder meetings/groups
• Information displayed in provider organisations (including staff areas), GP

practices, libraries, community centres and other public spaces

• Providing support materials for 3rd party meetings (e.g. animation, consultation

documents, FAQs)

• Proactive outreach to seldom heard groups
• Targeted1-1 stakeholder engagement to generate responses

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Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Once our consultation has launched:

• You will be able to read more about the proposed changes

Visit www.kentandmedway.nhs.uk/stroke for the consultation document and questionnaire (these will also available in printed format), and find more information on our website including:

 pre-consultation business case  travel time modelling  options evaluation process  integrated impact assessment and more

• And when you are ready to respond
• Complete the consultation questionnaire online, by post or by telephone.

Giving your views

SLIDE 27

Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Q&A

Consultation process

Public Q&A