Previous reference: Minute 66 (2017/2018)

The report of NHS Bradford City CCG and NHS Bradford Districts CCG (Document “AG”) outlines the work and progress to date since the last report on the provision of a single hyper-acute stroke unit (HASU) which allows rapid patient access to specialist care and treatment and then transfer to a dedicated stroke unit for rehabilitation once patients are stabilised. The report also detail plans to continue to develop a sustainable, high quality stroke service in the future.

Recommended –

That the Committee:

(1)       Receive, note and acknowledge significant progress made on the Stroke service across Bradford and Airedale.

(2)       Support the work underway to establish a single stroke service.

(Kath Helliwell - 01274 237735)

Previous reference: Minute 66 (2017/2018)

The report of NHS Bradford City CCG and NHS Bradford Districts CCG (Document “AG”) outlined the work and progress to date since the last report on the provision of a single hyper-acute stroke unit (HASU) which allows rapid patient access to specialist care and treatment and then transfer to a dedicated stroke unit for rehabilitation once patients are stabilised. The report also detailed plans to continue to develop a sustainable, high quality stroke service in the future.

The Chief Medical Officer at Bradford Teaching Hospitals NHS Foundation Trust provided a summary of the report which outlined the progress over the last 12 months.  He provided a brief history of the background to the service which saw the Airedale HASU move to Bradford Royal Infirmary in 2015.  He stated that the service had developed a strong frontline workforce which considered the whole patient pathway for stroke services rather than the HASU working in isolation.  Following treatment on the HASU, which was usually between 24 and 72 hours, Airedale, Wharfedale and Craven patients were transferred back to Airedale General Hospital for the rest of their care.

He referred to the Sentinel Stroke National Audit Programme (SSNAP) results as stated in paragraph 3.2 of the report which showed that Airedale had stayed at a rating of ‘D’ and Bradford had improved from an ‘E’ to a ‘B’ rating.  He stated he was confident Bradford would be able to at least maintain its ‘B’ rating, although it was aiming for an ‘A’ and that measurable improvements had been made to the service in Airedale, therefore a ‘C’ rating was anticipated as an outcome of the next reporting period.

Members were reminded of the particular workforce challenges that had been present in Airedale General Hospital in relation to stroke services prior to the re-location of its HASU in 2015, which, in hindsight, was considered the right decision.  Members were informed that the centralisation of HASUs was now becoming commonplace across the country and lessons were being learned from Bradford’s stroke services.  It was stressed that Airedale General Hospital maintained capacity to repatriate patients from Bradford Royal Infirmary as soon as they were ready to leave the HASU and ways in which the entire workforce, across Bradford and Airedale’s stroke services, aimed to provide consistency of care were outlined.

The Head of Collaboration for Stroke Services across Bradford and Airedale spoke of the work being undertaken around patient engagement to gain a better understanding of the patient pathway.  She stated that a single stroke patient survey was due to be rolled out in March 2019 and outlined the work that was being undertaken with Healthwatch over the next 12 months which included the recruitment of a stroke ambassador to aid this work.

The Chair thanked officers for their report and commended the amount of progress that had been made within stroke services since last reported to the Committee in February 2018.

A Member commented that the SSNAP results had remained poor for Airedale compared to those for Bradford and questioned what the timescale was to improve the rating for Airedale.  In response, the Chief Medical Officer explained that most quality improvements took six to twelve months to fully implement and sustaining them took much longer.  He explained that there was a two month time lag between audits being published and that he was confident that if the current rate of improvement continued the whole system would be rated ‘good’. 

In response to Members’ questions, it was reported that:

·         A number of small changes had helped to improve the SSNAP rating for Bradford e.g. re-organising the order in which patients were seen for physiotherapy so that new patients were seen first and increasing therapy time from 40 minutes to 45 minutes to meet one of the targets.

·         There was no difference to patient outcomes whether they were admitted to the HASU on weekdays or weekends as there was 24/7 cover.

·         Data in relation to SSNAP targets was now also collected internally on a weekly basis and fortnightly meetings were held with clinical staff to discuss them.  If a SSNAP target had not been met, ways in which to meet it next time were considered.

Members welcomed the progress made to date.

Resolved –

(1)       That the improvements made in stroke services over the last 12 months be commended and welcomed.

(2)       That future progress be monitored through the CCGs’ annual performance report to the Committee.

(3)       That the Committee notes the commissioned work that Healthwatch will be undertaking on patient voice and on-going service improvements and that Healthwatch be invited to a future meeting to report back on this work.

ACTION: Scrutiny Lead Officer/ NHS Airedale, Wharfedale and Craven CCG, NHS Bradford City CCG and NHS Bradford Districts CCG