Agenda item

To consider a report on proposals to change stroke services provided in Eastern Cheshire CCG area

Jacki Wilkes, Associate Director of Commissioning at Eastern Cheshire CCG, and Jane Molloy, Clinical Lead for Stroke Services and Consultant Neurologist at Salford Royal NHS Foundation Trust, presented a report on changes to the delivery of stroke services for residents in Eastern Cheshire CCG area. Jacki had previously attended Committee meetings in 2014 to consult the Committee on changes to acute stroke services whereby patients in the first 72 hours of a stroke would go to Stepping Hill, Salford Royal, or North Midlands hospitals for hyper acute and acute stroke treatment before being repatriated and having their recovery and rehabilitation at Macclesfield District General Hospital, provided by East Cheshire NHS Trust.

East Cheshire NHS Trust had since informed the CCG that it could no longer provide the in patient stroke services to the national clinical standards due to an inability to recruit specialist stroke personnel to their service. The CCG therefore was required to develop a new service model and commissioning a new provider.

The CCG had developed two options for new service delivery. The CCG’s preferred option to was that patients attending Stepping Hill or Salford Royal for hyper acute and acute services would receive their inpatient care at Stepping Hill and that those going to North Midlands would remain there for inpatient care.Both options were conditional on the delivery of a specialist stroke community rehabilitation service which included a period of intensive therapy at home for approximately 40% of stroke survivors to facilitate timely discharge home and reduce the time stroke survivors need to spend in hospital.

The Committee would support proposals that ensured good clinical outcomes for patients. However members expressed some concerns about patients being out of the Borough for longer than they had previously been, and that this would create issues for family members and carers who would have to travel further to visit them. Public transport links between some communities in the north of the borough and Stockport were not sufficient and many elderly family and carers were reliant on public transport.

The CCG recognised these concerns and was considering options for facilitating easier access to the hospitals for patient’s family/carers. Some suggestions from members included: facilities within the hospitals for family and carers to stay over night; and working with South Cheshire CCG on transport services to North Midlands Hospital.

The Committee also wanted assurance that the hospitals would have the capacity to receive these additional patients and the quality of service. Stroke services were monitored nationally and the CCG had no concerns about quality of provision at the hospitals. There wasn’t currently sufficient capacity at Stepping Hill to treat all patients based on current length of inpatient stays which is why the new community rehabilitation service was required.

Dr Heather Grimbaldeston, Director of Public Health, suggested that the promotion of hypertension and prevention of strokes as well as education about Transient Ischaemic Attack (TIA – mini strokes) was needed to help reduce stroke cases in the Borough.

RESOLVED – That the Committee supports Eastern Cheshire CCG’s proposal to deliver inpatient stroke care at Stepping Hill Hospital and North Midlands Hospital on the condition that a specialist stroke community rehabilitation service is commissioned for Eastern Cheshire and that supported transport arrangements for family members and carers of patients are considered.