Stroke care services
How services are currently delivered in South Tyneside and Sunderland
Until recently, we offered a full range of stroke services in both South Tyneside District Hospital and Sunderland Royal Hospital – this covered everything from emergency treatment and specialist stroke nurse practitioners to rehabilitation support and out-of-hours community care. However South Tyneside services have temporarily been relocated to Sunderland due to staff shortages.
The potential service changes relate specifically to hospital service provision. Community-based rehabilitation services will continue to be provided in both South Tyneside and Sunderland.
Why do stroke services need to change?
Although stroke services across South Tyneside and Sunderland generally provide a safe standard of care, provision can differ across the region, with some areas falling short of national guidelines. To ensure a consistent service we need to address a number of challenges:
- low staffing levels and inefficient working arrangements are making it difficult to make much-needed clinical quality improvements
- to improve compliance with national stroke clinical guidelines so that patients are assessed and treated as quickly as possible
- work towards national expectations to deliver seven-day stroke hospital services, with specialist acute stroke centres treating a minimum of 600 patients each year
In a national audit of stroke services carried out by the Royal College of Physicians, stroke services across the country are rated on a scale of A-E. The most recent audit rated our stroke services as level ‘D’. This means that improvements are required in a number of areas – many of which are related to staffing.
Quality of care and number of patients
When doctors see a wide range of cases in sufficient volumes, they maintain their clinical skills and, as a result, improve the outcomes for patients. This is known as ‘critical mass’. The Royal College of Physicians recommend a critical mass of 600 patients per year for stroke cases. Over the past few years neither of our areas has reached the critical mass. Last year South Tyneside treated 283 cases and Sunderland was just short of the target at 569.
Temporary changes to stroke services
In South Tyneside we have been trying to recruit more senior medical staff into the acute stroke service since 2014 but a local and national shortage of stroke specialists means we have not succeeded in filling the vacancies. Given how vulnerable this left the service, all acute stroke care was temporarily centralised at Sunderland Royal Hospital in 2016. This difficult decision was made to improve care until we could develop proposed solutions and carry out this public consultation.
Developing the stroke services options
As part of the temporary changes to hospital stroke services in 2016 we talked to representatives of different clinical groups and patients and carers with experiences of local stroke services. As a result, we felt that locating all elements of stroke care onto a single hospital site was the best way to address local workforce and quality challenges.
The temporary changes have been effective. It has resulted in shorter hospital stays and improved access to a dedicated stroke bed for patients. Stroke clinicians tell us that they can provide better patient care under this model but when looking at the longer term we are also considering two alternative options. These options would offer South Tyneside stroke patients the opportunity to be cared for at their local hospital following an initial period of care at Sunderland Royal Hospital whilst their condition is at its most serious.
When considering options, we took into consideration the following:
- clinical quality improvements
- staffing levels
- health outcomes of patients
- travel time to the stroke unit
Maternity (obstetrics) and women’s healthcare (gynaecology) services
How services are currently delivered in South Tyneside and Sunderland
Our local community can access both maternity and women’s healthcare services at both hospital sites and around 4,500 babies are born every year (1,300 at South Tyneside and 3,200 at Sunderland).
There are many areas of crossover in maternity, women’s services, children and young people’s healthcare services and special care baby services so doctors and nurses often work across the different clinical areas. Due to this shared medical team and the interdependence of both maternity and Special Care Baby Unit (SCBU), SCBU services are being considered as part of the proposed maternity and gynaecology service changes.
The consultation covers the hospital-based inpatient aspects of the services. Community based services will remain unchanged in South Tyneside and Sunderland.
The maternity (obstetrics) services currently on offer in South Tyneside and Sunderland include:
Antenatal care:
- midwifery appointments
- ultrasound scans
- appointments with a consultant if there are any risk factors
Delivery:
- maternity (obstetric) unit
- midwifery-led care
- home birth
- elective surgery or emergency caesarean
Postnatal care:
- any inpatient stay following birth including neonatal or Special Care Baby Unit (SCBU)
- visits at home from a midwife or health visitor
Why do maternity (obstetrics) and women’s healthcare (gynaecology) services need to change?
The review of maternity and women’s healthcare (gynaecology) services in South Tyneside and Sunderland is being driven by pressures across the service in both areas.
The challenges we face include:
- a shortage of senior doctors to meet required staffing levels
- an over-reliance on temporary staff to fill the gaps – this lack of consistency can prevent long-term quality improvement
- meeting national standards for quality of care
- special care baby unit staffing pressures that can limit the number of babies that can be cared for locally
- inability to increase the availability of senior medical cover and senior medical decision-makers as they are spread across two sites
- making further clinical quality improvements in line with national standards
These factors combined mean we cannot always offer people the birth experience they have chosen in their birth plan. It also increases the potential of exposing mothers to clinical risks. Whilst we work hard to manage the safety of the service day-to-day if we make changes now, we can ensure a better, safer service for every single patient in the longer term.
National recommendations suggest that hospital maternity providers and local commissioners work together across populations of at least 500,000 to ensure services are safe and fit for the future. Combining resources across South Tyneside and Sunderland will help us achieve this.
Children and young people’s healthcare (urgent and emergency paediatrics) services
How services are currently delivered in South Tyneside and Sunderland
A wide range of children and young people’s healthcare (urgent and emergency paediatrics) services are offered across both areas, with more specialist care centred at Sunderland Royal Hospital. This consultation relates specifically to hospital service provision. Community based services will continue to be provided in both South Tyneside and Sunderland.
Why do children and young people’s healthcare (urgent and emergency paediatrics) services need to change?
The clinical teams in children and young people’s urgent and emergency care services provide excellent quality care in many areas, but it is becoming increasingly difficult to work within existing resources.
Our services face a number of challenges:
- we are meeting many NHS quality standards, but we need to ensure we have the correct staffing levels to cover all services all of the time
- a national shortage of qualified consultants and other senior medical staff means we are struggling to recruit the number of doctors we
need to provide a sustainable and safe service, particularly in South Tyneside - both areas are spending a lot of money on short term locum doctors to fill staffing gaps at very short notice
- to meet national standards, we need to work towards delivering seven-day hospital service access and specialist services in emergency hospitals
If we want to give local children and young people, the best quality care and secure the future of services across both areas, we need to make some changes.
Developing the children and young people’s healthcare (urgent and emergency paediatrics) services options
When considering potential changes to services all solutions had to meet a number of criteria. The options we developed further had to:
- deliver safe, high-quality care
- support service sustainability and resilience
- be affordable
- be achievable within the next couple of years
A number of different clinical options were put forward and there was a difference of opinion amongst the teams.
Children’s inpatient services at Sunderland Royal Hospital and the Adult Emergency Department service at South Tyneside would remain unchanged in both options.
Children’s outpatient clinics would also continue to be provided as locally as possible, with the continued provision of children’s day surgery such as dental surgery at both hospital sites. The proposals offer the opportunity to provide more specialised children and young people’s outpatient clinics in South Tyneside. We are confident that both options could create a safe and sustainable solution for all routine, urgent and emergency care across South Tyneside and Sunderland whilst keeping services local, where possible.