Stroke care services
The two clinical commissioning groups decided:
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.
CCGs decision making process on stroke care services
Option 1 will be implemented which is all acute strokes are directed to Sunderland Royal Hospital (SRH), with the consolidation of all inpatient stroke care at Sunderland.
This was based upon the clear clinical preference for option 1 by the local clinical team, unequivocal support from Northern Cardiovascular Disease Network and the National Clinical Director for Stroke. In terms of reducing health inequalities, option 1 was most likely to deliver greatest improvement in quality and safety for both populations, building on the substantial increase in the key stroke quality indicators known as SSNAP scores for South Tyneside patients since December 2016.
In terms of the public engagement and consultation feedback, it was noted that option 1 had broad support and particular consideration was given to the feedback about:
- Delay in treatment – it was noted that the key consideration is timely transport to the right hospital that is able to deliver excellent hyper-acute stroke care, rather than getting to any hospital
- Capacity at Sunderland Royal Hospital (SRH) – while people in the consultation have raised concerns about this it has not been an issue since the temporary changes, nor is it expected to be, with at least 90% of patients spending at least 90% of their stay on a stroke unit for residents of both South Tyneside and Sunderland, since the temporary change in December 2016 carried out on safety grounds.
- Increase in travel for South Tyneside residents – all the stroke options had South Tyneside patients to be directed to Sunderland in the first instance, but that patients would stay longer at Sunderland under option 1. The clinical benefits were felt to outweigh the increased time for the approximately 500 visitors for those patients per year. (Stroke patients would be likely taken to hospital by ambulance). Also, recognised was the significant amount of work being undertaken on travel and transport would help to mitigate the travel impact
- Patient repatriation – the clinical team shared the concerns expressed by the public that repatriation, under options 2 and 3, would itself hamper recovery.