NHS Bradford City CCG and NHS Bradford Districts CCG will submit Document “AA” which provides an overview of the current position regarding the Bradford Stroke Service, its relationship with the Airedale service and action plans to move a coordinated Bradford and Airedale Stroke Service forward.

Recommended –

(1)       That the Clinical Commissioning Groups’ commitment and actions taken to improve stroke services for the Bradford and Airedale patch be noted.

(2)       That the actions being implemented to improve the stroke services in Bradford and Airedale be noted.

(3)       That a further report be submitted to the Committee in 12 months on progress against the action plan.

(Kath Helliwell – 01274 237735)

NHS Bradford City CCG and NHS Bradford Districts CCG submitted Document “AA” which provided an overview of the current position regarding the Bradford Stroke Service, its relationship with the Airedale service and action plans to move a coordinated Bradford and Airedale Stroke Service forward.

The Head of Commissioning for the CCGs provided an overview of the report.  She explained that there was one Hyper Acute Stroke Unit (HASU) within the district, based at Bradford Royal Infirmary (BRI); the HASU provided immediate care for stroke patients and met the national recommended guidelines; patients spent 42-72 hours in the HASU before being transferred to their local stroke unit for on-going care; the HASU that had previously been provided (prior to March 2014) at Airedale General Hospital had experienced problems delivering the service due to staffing issues and it had not me the national guidelines.

Paragraph 2.3 of the report contained a breakdown of activity relating to patients from the Airedale, Wharfedale and Craven area who were admitted to BRI in 2016.  In relation to stroke patients from the Bradford area, it was reported that 843 patients were admitted to stroke beds in the acute stroke unit at Bradford Teaching Hospitals NHS Foundation Trust, from 908 referrals.  Of the 65 patients not admitted to stroke beds, 34 were discharged quickly form the admitting wards, 18 had died on the admission wards, 8 were repatriated (7 to Airedale and 1 to Calderdale), 2 were discharged to care homes and 3 were transferred directly to intermediate care for on-going rehabilitation.  The mean age of the 843 patients was 72.8 years and the range was 27-99 years.

A representative of the CCGs referred to the Sentinel Stroke National Audit Programme (SSNAP) data informed by the National Clinical Guidelines for Stroke.  The combined key indicator level for overall performance for Bradford Teaching Hospitals NHS Foundation Trust was rated ‘D’.  He explained that this rating covered at least 10 indicators, of which there were sub indicators within them.  While the overall rating was not high, he stated that there was good practice within the areas assessed and that care planning and rehabilitation in the later part of the pathway were areas for improvement.

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

·         The SSNAP data rating had moved from a ‘C’ rating to a ‘D’ rating but had been at ‘D’ for some time.  Discussions were taking place with colleagues in Calderdale in relation to improving the way the data was reported and learn lessons from them as their rating was higher.

·         The level of data to ascertain the exact areas requiring improvements were not available at the meeting but would be circulated to Members after the meeting.

·         There had been good working relationships and discussions between the services in Bradford and Airedale in relation to Airedale patients receiving stroke services in Bradford and being repatriated back to Airedale Hospital.

·         In relation to the prevention of strokes, work was on-going to identify and treat patients with untreated atrial fibrillation (AF) which meant they had an irregular heartbeat, as this was one of the causes of stroke.  This work was expected to prevent 190 strokes.

·         In 2017 Healthwatch Bradford and District produced a report on patients’ experience and feedback from that report was being taken on board.  Views from patients would also be invited when the wider pathway was reviewed.

·         Feedback from patients was regularly received via the Stroke Association.

·         The figures provided in the SSNAP data within the report showed an increase in the patients discharged (176) in comparison to the number of patients admitted (175) due to data covering a snap shot period.

·         If a patient from Airedale was not fit to be transferred back from BRI, they would be transferred to an acute care unit within BRI from the HASU.

·         Transfers back to Airedale were by ambulance.

·         The emergency services used the FAST test to help detect and enhance responsiveness to stroke victim needs and high priority was given to those patients. 

·         The ambulance staff were treating as well as transferring, therefore a transfer by car was not appropriate for suspected stroke patients.

Members were informed that concerns from Airedale patients, about whether the transfer time by ambulance to the BRI HASU would be detrimental to their health, had been fed back from patients through the Healthwatch report.  However, patients who had gone through this pathway had stated that it had not been an issue and that the quality of the service was more important than the additional travelling distance.  It was also highlighted that there would be a measurable impact of additional repatriation journeys carried out by the Yorkshire Ambulance Service.  A Member suggested that a study be undertaken to measure the impact.  In response, it was reported that the CCG could not track patients themselves but the idea was welcomed as the information would be valuable; this would be suggested to Healthwatch.

It was agreed that further information on the SSNAP data would be circulated to Members.

Resolved –

(1)       That the Clinical Commissioning Groups’ commitment and actions taken to improve stroke services for the Bradford and Airedale patch be noted.

(2)       That the actions being implemented to improve the stroke services in Bradford and Airedale be noted.

(3)       That a further report be submitted to the Committee in 12 months on progress against the action plan.

ACTION: NHS Bradford City and NHS Bradford Districts CCG