More patients across South Tyneside and Sunderland are getting access to high quality stroke care and life saving treatment thanks to major changes made as part of Phase One of the Path to Excellence programme – and these changes are supported in a written judgement which is now available to read.
A judicial review hearing took place in December 2018 which challenged the decision of NHS South Tyneside and Sunderland Clinical Commissioning Groups following a public consultation into the future of hospital-based stroke, maternity, gynaecology and urgent paediatric care.
Due to the level of service vulnerability stroke changes took place from December 2016 with changes to maternity, gynaecology and emergency paediatric care in South Tyneside starting from 5 August 2019.
The judgement and order in the case can be read at the bottom of this article.
Speaking on behalf of South Tyneside Clinical Commissioning Group and Sunderland Clinical Commissioning Group (CCGs), Matt Brown, director at NHS South Tyneside CCG, said: “We are pleased that the written judgement is now available for people to read. It shows, very clearly, that the judge supported our decision for phase one of the Path to Excellence programme and found our robust public consultation in 2017, undertaken together with NHS Sunderland CCG, to be a fair and lawful process.
“While we understand people’s natural concerns about changes to healthcare services, these changes have always been about doing what is right for our patients and protecting hospital services which are extremely vulnerable.”
Since December 2018 when the court hearing took place, new independent data shows that the quality of stroke services has risen significantly over the past two years with more patients now receiving timely care, delivered by specialists, in a dedicated acute stroke unit.
This means that more people in South Tyneside and Sunderland are surviving a stroke and less people are suffering lifelong disability because of the improvements made in stroke services.
Matt added: “Stroke, maternity, gynaecology and emergency paediatric care are much valued services and both CCGs took their decision making very seriously, based on clear clinical evidence and in the best interests of people in South Tyneside and Sunderland. We can’t delay making these changes any longer and I want to be very clear that if we don’t make changes, we are putting both patients and our staff at risk.”
“Making sure we can continue to deliver safe, high quality care has always been our driving force for change and I have no doubt that our new models of maternity and emergency paediatric care coming into operation from 5 August will safeguard these services in the long-term.”
The Independent Reconfiguration Panel, an independent body which provides advice to the Secretary of State for Health and Social Care, also determined that these changes were in the interests of local health services.
Matt said: “The Path to Excellence programme is all about making sure we have the very best possible care and clinical outcomes so we can create future services which are amongst the very best in the NHS. As the stroke changes are proving, this is how we make things better for patients.
“Staff at both hospitals in South Tyneside and Sunderland have been working hard to prepare for the vital changes to maternity, gynaecology and emergency paediatric care from 5 August which are being made in the very best interests of patient care.
“We will continue to engage openly with colleagues, patients and partners as we implement these changes, providing independent evidence of improvements to care, as we continue to develop plans to deliver clinical excellence through phase two of the programme.”
Background to stroke improvements
Data from the Sentinel Stroke National Audit Programme (SSNAP) shows the quality of stroke services has risen significantly over the past two years with more patients now receiving timely care, delivered by specialists, in a dedicated acute stroke unit.
SSNAP is used to measure the quality of stroke services across the NHS. It uses a number of key measures which are known to prevent serious, long-term disabilities and give patients the very best chance of surviving a stroke and returning to as normal a life as possible following a stroke.
Since changes were made in December 2016 to centralise all acute inpatient stroke care at Sunderland Royal Hospital, there have been major improvements in clinical outcomes for patients, in particular for South Tyneside residents:
- 70% of patients are now receiving a CT within 1 hour compared to just 22% of South Tyneside patients prior to the change
- 85% of eligible patients are now receiving thrombolysis (clot busting drugs) compared to just 9% of South Tyneside patients prior to the change
- 74% of patients are now directly admitted to a dedicated acute stroke unit compared to just 6% of South Tyneside patients prior to the change
- The average time taken for South Tyneside patients to receive a CT scan has reduced from 2 hours to 35 minutes
- The average time taken for South Tyneside patients to be assessed by a specialist has reduced from 13 hours to 5 hours and 47 minutes.
By concentrating teams of stroke consultants and therapy specialists into one dedicated acute stroke unit, there have also been many positive benefits for Sunderland patients who are now also receiving more timely care:
- 70% of patients are now receiving a CT within 1 hour compared to just 41% of Sunderland patients prior to the change
- 85% of eligible patients are now receiving thrombolysis (clot busting drugs) compared to just 63% of Sunderland patients prior to the change
- The average time taken for Sunderland patients to receive a CT scan has reduced from just over 1 hour to 35 minutes
- The average time taken for Sunderland patients to be assessed by a specialist has reduced from 8 hours to 5 hours and 47 minutes.
Overall, the new specialist acute stroke inpatient service across South Tyneside and Sunderland is now rated at level B and very close to level A – the very highest level available in the NHS. Prior to the changes, stroke services in South Tyneside were rated at level E and in Sunderland level D.
Consultant Stroke Physician Dr Jon Scott has helped deliver the new service across South Tyneside and Sunderland.He said: “By consolidating stroke services, we have been able to improve dramatically against national standards and best practice recommendations and this has undoubtedly saved and improved lives. When we talk about ‘clinical excellence’ this is exactly what we mean.
“Patients from both South Tyneside and Sunderland now have access to seven-day specialist stroke services and, as a result, are being seen far quicker by medical and nursing staff which means they can start their rehabilitation sooner. The whole team have done a fantastic job of improving the service we offer and we will continue to build on this to ensure we provide our local populations with stroke care of the highest quality.”
Dr Matthew Walmsley, local GP and Chair of South Tyneside Clinical Commissioning Group (CCG) said: “These results are really fantastic to see and very clearly demonstrate the vast improvements in clinical care for our patients in South Tyneside. This could not have happened without making the difficult changes to our acute stroke services to bring our two teams together and strengthen the pool of stroke experts we now have readily available to care for our patients 24/7.”
Dr Ian Pattison, local GP and chair of NHS Sunderland CCG said: “These improvements in stroke services speak for themselves. By bringing our services together, patients in both localities are now getting quicker access to life saving treatment and that is testament to the hard work and vision of our stroke teams to improve care for patients.
Background to Path to Excellence
The Path to Excellence programme is a partnership of local NHS organisations working together to plan for the future and identify new and innovative ways of delivering high quality, joined-up, sustainable hospital services that will further improve the quality of care and patient outcomes for local people. The partners include:
- NHS South Tyneside Clinical Commissioning Group
- NHS Sunderland Clinical Commissioning Group
- South Tyneside and Sunderland NHS Foundation Trust (prior to 1st April 2019 the trusts were separate organisations known as South Tyneside NHS Foundation Trust and City Hospitals Sunderland NHS Foundation Trust)
The CCGs’ decisions
Stroke, obstetrics (maternity) and gynaecology and paediatrics (children’s) urgent care services are amongst those South Tyneside and Sunderland hospital-based services that are facing the most severe workforce sustainability challenges, driven predominantly by a shortage of medical staff resulting in service continuity, quality and financial pressures.
The proposed changes on how these services will be arranged in the future, means they can improve and, ensure better care for patients as well as provide the new opportunity to develop a modern holistic birthing centre for the first time in South Tyneside and Sunderland. The CCG decisions mean that clinical leaders at South Tyneside NHS Foundation Trust and City Hospitals Sunderland NHS Foundation Trust can start to work with local staff teams to make changes over the next several months.
The two clinical commissioning groups decided:
Stroke consultation option 1 will be formally implemented which is all acute strokes are directed to Sunderland Royal Hospital (SRH), with the consolidation of all inpatient stroke care at Sunderland. This model has been running temporarily since December 2016 due to service vulnerability and is showing improvements in patients accessing key diagnostics and treatment earlier. For example the rate of the use of clot busting drugs (thrombolysis) has doubled for South Tyneside residents, and with the percentage of eligible patients thrombolysed within an hour has gone from 0 to 60 per cent, meaning fewer people will die or have serious disability and more people have the chance to fully recover from their stroke.
This is based upon a very clear and compelling clinical evidence base, universally supported by clinicians. The change will aim to be fully complete by April 2019.
Maternity (obstetrics) and women’s healthcare (inpatient gynaecology) services option 1 will be implemented which is the development of a free-standing midwifery-led unit (FMLU), known as a birthing centre, at South Tyneside District Hospital and medically-led obstetric unit at Sunderland Royal Hospital. Gynaecology care requiring an overnight hospital stay will be carried out at Sunderland Royal Hospital, and care for minor gynaecology conditions, including day case surgery and outpatients clinics, will continue at South Tyneside District Hospital.
This provides an exciting new opportunity for both South Tyneside and Sunderland women as they said they wanted the choice of a home away from home birthing experience, a birthing centre for pre and post-natal care, with more holistic therapies.
This new centre will be developed with staff, women and other interested partners, and the ambition would be to create a vibrant new birthing centre at South Tyneside District Hospital which offers more choice for women across both South Tyneside and Sunderland.
Children and young peoples (urgent and emergency paediatrics) services option 2 the development of a nurse-led paediatric minor injury and illness facility at South Tyneside District Hospital – open 8am to 10pm – and 24/7 paediatric emergency department at Sunderland Royal as the most sustainable long-term model.
However, the clinical commissioning groups recognise that it will take a period of time for the development work for this be deliverable therefore approve option 1 for implementation in the short-term which is the development of a daytime paediatric emergency department at South Tyneside District Hospital and 24/7 paediatric emergency department at Sunderland Royal.
How to stay involved
For more information and to stay up-to-date with the Path to Excellence programme visit: www.pathtoexcellence.org.uk and sign up to MY NHS to receive regular updates.
Written judgement and order