Better , Best, Brilliant Hyper-Acute Stroke Unit deliverability at - - PowerPoint PPT Presentation

Hyper-Acute Stroke Unit deliverability at Medway NHS Foundation Trust

Lesley Dwyer , Chief Executive Dr David Sulch, Interim Medical Director & Stroke Physician 4th September 2018 Deliverability Panel

‘Better , Best, Brilliant’

Appendix Wv

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Welcome

We are proud to be presenting our approach to creating a HASU at Medway Maritime Hospital. As a major emergency centre, we are experienced in delivering stroke services to a population with complex co-morbidities; particularly the highest cardiovascular disease in the region. Our patients are at the heart of our approach to the design of this model of care, and the engagement from our local community is evidenced in the public consultation, with the highest response coming from those in the ‘ME’ postcode, with most popular first choice being Option

• D. We have a robust plan, the capability and infrastructure to deliver a Kent & Medway model

for a hyper acute stroke unit. T

• day will cover:

 Timescale for implementation  Track record  Understanding of Capacity  Understanding of Key Risks

Darent Valley Hospital Medway Maritime Hospital William Harvey Hospital Option A

Maidstone Hospital Medway Maritime Hospital William Harvey Hospital Option C

Tunbridge Wells Hospital Medway Maritime Hospital William Harvey Hospital Option D

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Timescale for implementation

• Agreement in principle in place with local Council on

planning permission

• Refurbishment plan devised with anticipated go-live date of

June 2019

• Strong clinical engagement, led by Director of Clinical

Strategy (Dr Hamilton-Fairley) and Medical Director & Stroke Physician Dr David Sulch

Initial architect drawings with reconfiguration of existing estate to house a Kent & Medway HASU service.

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Track Record

Engagement with women on design and delivery of ‘The Birth Place’ for low risk birth Engagement with families and charity (Abigail's Footsteps) on maternity bereavement services

HEADLINES

• Patients already have direct

access to stroke services

• Thrombolysis suite in our

new emergency department

• Multi-disciplinary team of

specialist stroke staff;

• Consultant ward rounds at least
• nce a day 7 days a week in

place

• Open 24 hours a day

, 7 days a week with access at all times to brain scanning equipment and clot-busting drugs (thrombolysis) and the specialist cover to review scans and provide thrombolysis

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Staff Patients and public

External stakeholders Patients and public, including stroke patients, service user groups, Stroke Association A great deal of engagement has already taken place in the earlier stages of engagement and through formal

• consultation. Next step

will be to provide understanding and reassurance around the HASU locations and to build confidence in the new model. Staff within the HASU and host Trust, plus other health and care providers Regular, clear, consistent message required to inform, involve and feedback to this group. External stakeholders, including partner

• rganisations, MPs, councillors, Healthwatch

Stakeholders need regular and detailed information about the service change and benefits. Their feedback from their staff/members, constituents and contacts is invaluable.

Engagement – stakeholder mapping

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Track Record - Workforce

The graph on the left shows monthly starters and leavers, with the purple line showing the overall impact – a growing increase in the number of nurses holding substantive positions at the hospital

HEADLINES

• Recruited a stroke physician
• Successful nurse recruitment

campaigns in midwifery , ED and wards showing a reduction in nurse vacancy rates over 12 months

• Established nurse development

programmes with universities & business schools

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Understanding of capacity

• Medway NHS Foundation Trust cares for 520 stroke

patients per year using the existing 25 Acute Stroke beds

• Medway has following services on site:
• Interventional radiology
• V

ascular surgery

• Thrombolysis suite already in our new Emergency

Department

• Investment in 2 new CT machines
• Medway location allows patients to get here within the
• ptimal time to ensure that appropriate treatment is

assessed and undertaken

• SSNAP rating is E – with factors influencing low score

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Understanding of capacity

• Site location confirmed with clinical co-adjacencies
• Architects appointed
• Draft designs, with focus on Option D
• Experienced delivery team, with strong governance

arrangements

• Planning permission confirmation by December 2018
• Work commencing January 2019
• Go-live date June 2019
• Confident on delivery within financial envelope

indicated

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Understanding of capacity

Role Current HASU Gap Consultant 2.5 6 3.5 Specialty Dr 1 1 Junior Staff 2 6 4 Trainee 1 1 Nursing 18.6 46 27.4 Nursing: Specialist 5 3+ Physiotherapist 1.5 5.5 4 Occupational Therapist 1 5.5 4.5 Speech Therapist 0.5 2.5 2.0 Dietitian 0.3 1 0.7

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Understanding of key risks

Title R isk D escription Likelihood (gross) Consequence (gross) R a ting (gross) M itigia tion Plans Likelihood Consequence (net) (net) R a ting (net)

R ecruitment T he ability to attract and recruit qualified staff w ithin the reqw uired timeframe 4 4 16 R ecruitment plan in place, w ith good track record ov er past 12-24 months 3 3 9 Estates Potential long lead-in time on specilaist equipment (refurbishment w

• rks)

4 4 16 R isk based approach to anticipating lead-in time w ith manufacturers 3 4 12 Performance External factors influencing SN AP data score 4 3 12 C hange of therpay prov ision w ith recruitment plan commenced; amended consultant w

• rking pattern to prov

ide additional thrombolysis serv ice 3 2 6

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Implementation timeline

Feb – Jul 2018 Aug 2018 Sep 2018 Oct 2018 Nov 2018 Dec 2018 Jan 2019 Feb 2019 Mar 2019 Apr 2019 May – June 2019 Approvals Estates Clinical Service Dev Comms Workforce IG / IT

Approval of DMBC and preferred option agreed Workforce definition Estates requirements Define IG/IT requirements Consult with Stroke Association Consul- tation Evaluation framework developed Continuous learning cycle defined Metrics developed Evaluation roles defined Baseline metrics Staff informed of decision Develop comms strategy Develop comms plan New pathways start Develop DMBC Capital approval process* Phased go-live TBC#

*Approval process dependent on level of capital required for each site in the preferred option

On-going engagement and communication with workforce Public updates and information sharing on website / staff updates on intranet Patient/User/Voluntary engagement events Transfer of activity and staff from closing sites Learning cycle starts Develop JDs Post adverts Recruitment and interviews Contingency IG/IT planning IG/IT implementation Pathway development Pathway finalisation Determine improvement to service required pre go-live Implement improvements (i.e. telemedicine) Training / double running Volunteer sector mobilised Ongoing training and development Estates – negotiations/leases/planning etc. Development of estate (refurb) Detailed workforce plan

In summary

• A HASU at Medway has always been our

strategic vision

• We have a credible and robust delivery

plan and have already begun to mobilise this

• Our ambition is perfectly aligned to meet

the needs of our community