Agenda item

Janet Spurling, Scrutiny Officer, reported on the above Programme. 

 

There were a number of workstreams in the programme with options for substantial changes to Hyper Acute Stroke Care and non-specialised Children’s Surgery and Anaesthesia being consulted on in the Autumn.

 

The report and appendices provided an overview of the work already undertaken and the development of operations appraisals for both Services which included:-

 

Stroke Care

-          Hyper Acute (first 72 hours) – would be in one of the proposed centres (Doncaster, Sheffield or Chesterfield)

-          Acute – would be in patient’s local hospital once well enough to transfer

-          Rehabilitation – local sites

 

Hyper Acute Stroke Care

-          Recognised minimum number of patients per annum – 600

-          Rotherham Hospital – 482

-          Barnsley – 554

-          Chesterfield 586

-          Doncaster – 677

-          Sheffield – 1,009

 

Children’s Surgery – 6 sub-specialities

-          Ear, Nose and Throat (ENT)

-          Trauma and Orthopaedics (T&O)

-          General Surgery

-          Opthalmology

-          Urology

-          Oral

 

Children’s Surgery – Patient Numbers for Rotherham Hospital 2014/15

	No Stay	Elective in-patient	Non-elective
ENT	214	96	71
T&O	109	26	238
General Surgery	56	5	294
Opthalmogy	71	6	5
Urology	70	0	10
Oral	446	5	94

 

Model for the 6 sub-specialities

Surgery Tiers

-          Tier 1 Day case

-          Tier 2 Elective in-patient/non-elective in-patient – where most of the changes were proposed

-          Tier 3 Tertiary

 

Discussion ensued with the following issues raised/highlighted:-

 

Hyper Acute Stroke Units

·           The first hour was the most important part of a stroke.  A paramedic had to try and assess whether it was a bleed or a blockage and that was very important in how to begin to treat a patient.  It would be more onerous for Rotherham patients if they had to travel further afield

 

·           45 minutes travel time did not give much time once arrived at hospital for assessment and treatment – this did not include the waiting time for the ambulance to arrive

 

·           Concern that the ambulance crews would have the skills to be able to make that diagnosis to carry out the appropriate treatment (bleed v blockage) and have the equipment in place

 

·           National shortage of skilled staff and the importance of maintaining those skills through the volume of patients seen each year in line with recognised minimum numbers. Both Rotherham and Barnsley Hospital had vacancies for senior staff with the requisite skills

 

·           The need for statistics or data for assessing the outcomes for people admitted to Rotherham and Barnsley versus admittance to Sheffield and Doncaster in terms of survival rate etc? 

 

·           Did Sheffield and Doncaster have the capacity to take additional patients in terms of bed availability?

 

·           Importance of assessment process for clots and the time.  Not everyone was suitable for the assessment but staff had to have had training to carry it out

 

·           The hour was based on how long it took an ambulance to arrive – the proposal should be looked at in conjunction with ambulance response times

 

·           Travel time to Sheffield Hallamshire Hospital taking into consideration peak hour traffic

 

·           Would it be better/less risky for patients to stay longer at the centres with HASU for their acute care rather than transferring 

 

·           Possibility of bed blocking pressure if people had to stay longer

 

·           The Rotherham Place Plan’s aim was to see patients within 20 minutes in the Emergency Centre – would it not be better/safer for patients to be seen at Rotherham?

 

·           Would any Rotherham patients be taken to Chesterfield?

 

·           Adequacy of public transport infrastructure for patients’ families from Rotherham to Sheffield and Doncaster

 

·           Ensuring staff with appropriate skills for quality care at all 3 phases – hyper, acute and rehab

 

·           Consideration to the scheduling of post and pre-op appointments and prioritisation for families who had to travel further to take account of work, travel time etc.

 

Children’s Surgery and Anaesthesia

·           Travel for families and carers to visit inpatients and the effect this may have on other family members and those in paid employment

 

·           Would treatment be based on proximity to where people lived or the sub-speciality?

 

·           Would the changes have an impact on waiting times for electives?

 

·           How the consultation question was worded with regard to “preparedness to travel” – parents would naturally say they were prepared to travel anywhere to ensure the best care/treatment for their child

 

·           Adequacy of public transport for patients and visitors

 

·           Would there be a staff drain from Rotherham Hospital?

 

·           Would the removal of services from Rotherham Hospital put the sustainability of the Hospital at risk?

 

·           Difference in the wording contained with the overview appendix and the consultation document with regard to “willingness to travel for right care” as opposed to specialist care”

 

·           Need for the outcomes of patient satisfaction surveys to enable them to make an informed decision

 

·           Would the 3 hospitals specialise in different sub-specialities or would they all provide all 6?

 

·           Where would front line services for Rotherham actually start?

 

Resolved:-  (1)  That the work undertaken to date by the Joint Health Overview and Scrutiny Committee be noted.

 

(2)  That with regard to Hyper Acute Stroke Units more information be provided on:-

 

-          The same model successfully implemented in other areas (best practice)/other areas of health care e.g. coronary with regional specialist units

 

-          Comparative data on performance of the 5 HASUs with regards to positive outcomes for stroke patients c/f SSNAP and other performance data

 

-          The current rating of the Rotherham Foundation Trust and the HASU and up-to-date statistics on performance

 

-          How had the first 72 hours  been determined as the key period – was this a critical period for the likelihood of a further stroke or for monitoring?

 

-          What was the incidence of patients having a relapse/further stroke shortly after the initial 72 hour period