Appendix Wvi Kent & Medway Stroke Review EKHUFT Deliverability Assessment David Hargroves, Stroke Physician, EKHUFT Liz Shutler, Deputy Chief Executive, EKHUFT Phil Cave , Director of Finance EKHUFT Jim Cross, EK Patient Representative August, 2018
Content • Background and introduction • East Kent plans for wider changes • Track record of delivering sustainable patient centred innovation & change • EKHUFT Stroke implementation plan & timeline • EKHUFT Stroke implementation governance structure • Capacity requirement for delivering HASU at WHH (estates and beds) • Capacity requirement for delivering HASU at WHH (workforce) • Key interdependencies and success factors for delivering HASU at WHH • Communication and engagement • Staff training • Key risks and constraints • Questions from panel
Background & Introduction • The vision in east Kent is to create centres of excellence where specialist teams have the equipment and expert staff they need to give patients the best chance of survival and quality of life. For stroke this means: 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; and Shorter stays in hospital with better patient and staff experience as a result of excellent working practices. • In order to achieve the above vision, we have worked with patients and health and social care partners over the past few years, across Kent and Medway , to implement significant service improvement; • A shortlist of five three-site HASU options (WHH is in all options) were publicly consulted on in Spring 2018; • Therefore we are presenting a single deliverability plan for all shortlisted options.
East Kent is currently developing and engaging on plans for acute and specialist services: There are currently 2 potential options on the medium list for full evaluation As part of this process, it has been agreed that the HASU would be located at the major emergency centre (MEC) with specialist services in both options.
Track record of delivering sustainable, patient centred stroke innovation 1) 24/7 thrombolysis using horizontal telemedicine – first in UK, 2008. The Health Services Journal Award winner for Improving Healthcare with Technology, 2009 2) Rapid Access Carotid Endarterectomy (RACE) – top quartile in UK, 2008. The South East Best of Health award for transforming stroke services within East Kent (runner up), 2009 and 2010 3) 7/7 TIA service using first line MRI and CEMRA imaging – first in UK, 2008 . The Dr Foster, highest UK performing acute secondary care stroke service award, 2010 4) Introduction of community stroke nurses to coordinate post discharge rehabilitation and life after stroke service development 2009 Care Quality Commission, best performing UK stroke rehabilitation service award, 2011 5) Introduction of advanced cerebral imaging to treat SUTO, 2010. The Health Services Journal Patient safety Awards runner up 2013 6) First helicopter transfer for thrombectomy in England 2015. https://www.stgeorges.nhs.uk/newsitem/stroke-patient-flown-to-st-georges-for-urgent-treatment/
EKHUFT Stroke Implementation Plan Phase Objectives The objectives by January 2019: • Obtain baseline KPI measures and agree target; • Implementation plan drafted with mobilisation planning – workforce, IM&T, estates, capacity etc. • Develop and agree model of care - Pre-hospital (Ambulance service and TIA Clinics), HASU and Rehabilitation Phase 1 • Evidence and agree the optimal local stroke pathways for the purpose of quality assurance (now till 10 th Jan • Ensure staff retention by gaining a better understanding of staff needs through 1-2-1 pre staff consultation 2019) • Obtain Trust ’s funding for and commence training of consultants for the thrombectomy pilot • Bid for external funding to become a thrombectomy centre Phase 2 The objectives by September 2019: • Agree funding locally for the new stroke service in alignment with the STP (Post 10 th Jan to • Commence the new build and purchase of new equipment Sept 2019) • Implement new pathways based on feasibility • Develop and tender for IT and Information systems as specified • Agree staff benefits programme to ensure retention of staff • Undertake staff consultation for the new stroke service • Recruit staff required into vacancies and new posts • Perform 6 months thrombectomy pilot with 10 patients and full evaluation of expected outcomes. The objectives by December 2020: Phase 3 (Sept • Prepare for the transition in alignment with the STP, agreeing the transition plan 2019 to December • Continue the new build and purchase of equipment 2020) • Continue implementation of new pathways based on feasibility • Implement IT and Information systems as specified, incl. testing and training • Implement staff benefits programme to ensure staff retention • Continue recruitment as required • Extend pilot to more patients to support agreement for funding to become the new thrombectomy centre HASU opens to Go live date of January 2021 anticipated. The Trust hold s a detailed programme timeline with patients at MEC key milestones identified which include the 18 months new build timeline for inpatient ward at WHH site
Event EKHUFT Stroke Implementation Plan Timeline: Phase 1 Milestone Sep 2018 October 2018 November 2018 December 2018 January 2019 Obtain baseline KPIs measure and agree targets Plan Quality Assurance of pre-hosp. Agree targets Triage Raise awareness & train staff Pre-Hospital Undertake Quality Assurance Test QA Outcome Report Optimal Pathway & model of care Plan Quality Assurance of pre-hosp. triage & Door to Needle Pathway Raise awareness & train staff Undertake Quality Assurance Test QA Outcome Report HASU Optimal Pathway Set Up thrombectomy training programme with St. Georges Hospital & model of care Commence thrombectomy training SIG Thrombectomy SGH Training Business Case Programme Rehabilitation Obtain agreement ‘M odel of Car e’ from STP Develop localised model of care & pathways Optimal Pathway & model of care Develop 1-2-1 Pre- Staff Consultation Raise awareness with Workforce management Undertake 1-2-1 Pre Staff Consultation Pre Staff Consultation Plan Stroke Vision Day Outcome Report Feedback Stroke Vision Day Stroke Vision Day Outcome Staff Benefits Programme IT/Information Develop local requirement specification for information portal aligned to STP IM&T Appraisal IM&T Appraisal Information Portal Develop Capture Stroke Business Case Purchase and Plan Implementation Capture Stroke Business Case
EKHUFT Stroke implementation governance structure • EKHUFT has a good reputation of delivering sustainable change to time and forecasted budget. Example: moved acute medicine (including stroke services) out from K&CH to WHH and QEQMH June 2017 • The Trust has established project resources for stroke programme with key members of staff actively taking the following roles and responsibilities: Executive Sponsor (Deputy Chief Executive); Programme Owner (General Manager Medicine); Clinical Lead (Lead Stroke Physician); Project Manager; and Project team members which includes patient representatives, stroke consultants, ward teams, SECAmb pathway lead, local clinical resource manager (SKC & Thanet UC), inpatient therapy lead, Director of information, etc. EK patient representative: Jim Cross • Project and programme management arrangements for stroke at EKHUFT is a well established with a clear governance structure and vision to provide thrombectomy
EKHUFT Stroke Implementation Governance Structure Full time – with focus on developing and delivering stroke implementation plan including transition element
Capacity requirement for delivering HASU at WHH (estate & beds) • Historically WHH has received 450 ‘c onfirmed stroke s’ per year; • Following the medicine move from K&CH in June 2017, WHH site has seen an increase of 7,062 emergency attendances (an average of 9% increase); an average 100 ambulances per day; an increase of 130 stroke patients per year (578 currently). • In order to ensure the quality of care that will meet the required standards for approximately 1,200 stroke patients , additional capacity is required for A&E (inc. resuscitation), ITU, MRI, CT and ward capacity . For example, there are currently only 4 resuscitation bays within the department and there have been regular instances of stroke patients having to wait for a bay which is clinically not safe. In addition additional patients are expected to attend A&E because of the HASU therefore additional majors capacity is required. • The table on the next slide summarises the additional capacity required:
Capacity requirement for delivering HASU at WHH (estates & beds) The Trust has submitted a bid for emergency capital for the A&E if this is successful it will not require this element of funding but if it isn ’ t it will be required. The Trust engaged closely with MC Consult Ltd an independent estate reviewer working with all Trusts on K&M stroke review. All figures was signed off at the last K&M STP Finance Group meeting on 24 August 2018. SOURCE: K&M Trust estates returns (August 2018); Gleeds analysis (August 2017); MC Consult analysis (August 2018); Carnall Farrar analysis August 2018.
Capacity requirement for delivering HASU at WHH (estates: proposed site plan)
Inpatient ward accommodation at WHH NB: The plans will be scaled down to accommodate the right number of beds
Inpatient ITU expansion at WHH
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