Agenda item

Louise Barnett, Chief Executive and Dominic Blaydon, Associate Director of Transformation, TRFT to present (paper attached)

Louise Barnett, Chief Executive of the TRFT, and Dominic Blaydon, Associate Director of Transformation, gave the following powerpoint presentation:-

 

Overview of the Trust’s vision for the next five years

-          We will continue as a stand-alone district general hospital

-          We will build a reputation for innovation and quality care

-          We will achieve a CQC rating of “good” or better

-          We will deliver financial sustainability

-          We will have a strong emergency and urgent care function

-          We will develop sub-regional specialist care centres

-          We will provide a strong community health service offer

-          We will integrate with health and social care partners

 

Community Transformation Programme

-          Integrated Health and Social Care Teams

-          The development of a Reablement Village

-          A multi-disciplinary Integrated Rapid Response Service

-          A joint approach to care home support

-          An enhanced Care Co-ordination Centre

 

Acute Care Collaborations

-          Hyper-Acute Stroke Services

-          Breathing Space

 

Children’s Transformation

-          Integrated Locality Teams

-          Review of Children’s Assessment Unit

-          Rapid access to a Community Paediatrician

-          Reconfiguration of Inpatient Bed Base

-          A joint approach to Workforce Development

 

Discussion ensued on the presentation with the following issues raised/clarified:-

 

·           Currently if a Rotherham resident had a suspected stroke they would be taken by ambulance direct to the Stroke Unit at the District General Hospital and assessed for thrombolysis (an immediate treatment to enable to reduce the possibility of having a secondary stroke). If, due to the capacity of the Stroke Unit, a patient would be taken to A&E and receive the medical intervention or wait in A&E for a bed in the Stroke Unit.  They would then spend the first seventy-two hours on a local Stroke Unit and then moved to stroke rehabilitation either at the Stroke Unit, intermediate care or rehabilitation.

 

·           Under the new model, dependent upon where the patient lived, they would either go to the Hallamshire or Doncaster Hospitals for the first seventy-two hours.  After that time they would be repatriated to Rotherham Hospital. 

 

·           Currently Rotherham residents would be taken to Rotherham Hospital to receive care unless their needs were particularly specialist/had very severe needs when they would then go to Sheffield.

 

·           There was concern with regard to the response times, changes to the journey and what affect that would have on a patient if there was a delay in getting the right treatment.  The CCG would be making the decision about what happened to Stroke Services in Rotherham and one of the key principles to making the decision was whether the quality of care to Rotherham patients was going to be better.  The Governing Body would be looking very closely at if outcomes for patients would be better or worse.  Travel factors would be taken into account.

 

·           The commissioners collectively across South Yorkshire looked into whether the new care pathway would improve the quality of care.  They also looked at the evidence base available which showed that where you potentially centralised the care you could provide high quality care irrespective of whether the place that a patient went to currently was providing it at the moment so there was the expectation that that would increase.  It was on that basis upon which they were putting forward the proposal. 

 

·           Rotherham Trust’s performance had been poorer than the Trust would have liked but had improved recently and providing much better care than previously in terms of the Sentinel Stroke National Audit Programme (SSNAP) Indicators (national metrics upon which the Trust was measured) and seeking to improve further.  The case for change was there in terms of the clinical outcomes and the Trust needed to ensure through consultation that there was real input and feedback.  All of the issues could be thrashed out in terms of patient experience and the lack of clarity over patients that mimicked a Stroke so that the commissioners in Rotherham and other commissioning bodies were absolutely clear on the basis on which they were making the decision and that it related to outcomes.

 

·           There was a set of indicators that was used nationally around stroke and were gathered by SSNAP which included how quickly a patient got into a Stroke Unit, received thrombolysis and how much time they spent on a Stroke Unit when in hospital.  When aggregated Rotherham performed very well even when compared to Doncaster and Sheffield.  As part of the consultation process feedback had been provided that Rotherham was already a relatively high performing Stroke Unit and asked the question as to what the criteria was being used to decide who the specialist unit was.  In principle the Trust did not have a problem with centralising the resource in terms of sustainability and quality of the Service but the information submitted to the Trust and CCGs as part of the consultation process had not evidenced that.  The Trust needed them to look in more detail about the impact of transporting those patients and then work through the detail of the precise plans so as to be confident that the quality of the outcomes would manifest if it happened in South Yorkshire. 

 

·           Information available regarding outcomes following a stroke such as chances of survival and maximising recovery e.g. speech, movement as well as the metrics on the stroke care pathway.

 

·           In terms of clinical evidence around the number of individuals that the Hospital supported in terms of stroke, it was important because there was a threshold and it was helpful for clinicians to see lots of people in terms of their practice and outcomes for patients.  However, since this process had begun Rotherham was slightly above the threshold that had been identified. 

 

·           Sustainability of the Trust as a standalone hospital if services were removed – Whilst the Trust would support stroke patients post-72 hours or all  the way through depending upon the outcome, it needed to ensure that overall it had a breadth, depth and range of services that held together as a high performing organisation in Rotherham for patients.  It was looking internally and across the place on community and making sure that integration was strong and effective but also what was needed in terms of acute.  The Trust had recognised that it did not have the workforce resilience to deliver what it needed regularly, was quite vulnerable in certain teams with small numbers of clinicians and there were national shortages and so needed to work in partnership with other organisations.  The aim would be to get the sustainability required with the service configuration based on population need.   There was a case for specialist centres such as for spinal care, but there were still many conditions and complex needs that needed to be provided at home in the community looking at in-reach.

 

·           The transformation of Acute and Community Care model would look at patient safety, ensuring that people were better off in terms of how the Trust did things and the need to reduce harm in terms of falls and pressure ulcers.  Another area was patient and family experience and patient expectations; it was recognised that whilst medical advancements had been made, people wanted things more quickly.  It was a big piece of work that the Trust needed to carry out and ensure they were able to be part of shaping what future provision would look like and do it together rather than imposing on the public.  It was acknowledged that, as an organisation, it needed to get better and listen to people’s opinions.  The Trust had the clinical expertise but did not experience it the same as a patient and their family. 

 

·           No alternative model was being considered other than localised specialist acute model; the Trust needed to decide whether it was going forward on that particular model as part of the consultation.  Should the CCG decide it did not want to proceed with the model the Trust would need to look at how it would deliver it locally.  Locally there was a fully integrated Stroke pathway and there would have to be a very strong argument to fragment it and take out Hyper Acute and move to another centralised centre.  There would need to be absolute assurance that the additional travel time and inconvenience for relatives and patients would achieve better outcomes and better quality service.   

 

·           The importance of easy read information and ensuring effective communication with patients and their families so everyone knew which hospital a person was being taken to following a stroke.

 

·           It was really important that people were able to access local services that were easy to get to.  There may be certain situations where it was better for the patient and family to move services further from Rotherham but the decision would not be taken lightly and every attempt made to ensure the right balance taking into account the importance of delivering services locally and the impact on patients and relatives.

 

·           The Foundation Trust and CCG were stating that if proposals, in their view, resulted in a Stroke Care pathway that was not viable then they would not agree to it. 

 

·           Staffing and bed capacity in Sheffield and Doncaster and sharing information between services to manage additional capacity?

 

·           Once the pathway was in place Yorkshire Ambulance Service would be fully involved and clear about where a patient was taken. The Trust had raised the point in their consultation response with regard to Doncaster and Sheffield Hospitals having the capacity and capability to be able to delivering the extended service.  

 

·           Where was the best medical team going to be? 

 

·           With regard to the proposed Children’s Transformation, one area that had been rated "Inadequate" by the CQC was Safeguarding but there was no remedial action mentioned in the proposal – information to follow. 

 

·           A multi-agency project group was overseeing the Co-ordination Centre single point of access.  There were three workstreams – how to incorporate the Mental Health element, how to encourage the Social Care element and also links with the Integrated Rapid Response Service.  It was thought that the new extended version of the Care Co-ordination Centre would be agreed within the next year with an implementation plan of six months.

 

·           Under the proposal everyone who might have had a stroke would initially go to Sheffield or Doncaster not Rotherham.  There was still some ambiguity about a person who presented with stroke-like symptoms.  More sophistication was needed through the consultation to deal with those instances. 

 

·           Once a stroke patient had stabilised they would be repatriated to Rotherham.   There had been discussion as to whether the whole of acute stroke would transfer but the consultation document just dealt with the first seventy-two hours.  Rotherham Hospital would have a stroke unit to deal with everything after the first seventy-two hours.

 

·           Concerns regarding the immediate family getting to and from Sheffield/Doncaster had been raised at the JHOSC. 

 

·           The proposed model would be advantageous to those patients that were more complex and avoid them having to be transferred to the Hallamshire Hospital for treatment. 

 

·           Governance and influence over future services if transferred from Rotherham would be through the CCG.

 

·           It was unclear what would happen in the case of those patients who unfortunately then had secondary strokes.

 

·           Feedback had been provided on the issue of travel times.  Work had been carried out on Yorkshire Ambulance Service having the capacity to meet the travel target, however, the Service’s response times were not performing well currently on their eight minute response time.  The guidelines stated that a patient needed to receive thrombolytic treatment within an hour; the assessment from the consultation process stated it could be achieved by having two centralised units at Sheffield and Doncaster. 

 

·           Was the chance of having a second stroke more likely to happen within the first seventy-two hours?  How did Rotherham treat patients differently in that period?  An answer would be supplied.

 

·           Transformation of Children’s Services and the Locality Teams and ensuring adequate staffing given some of the recruitment and retention issues – Currently there was a lot of duplication and inefficiency in the way professionals worked with an individual coming into contact with a number of agencies, having to retell their story each time and some of the information not being joined up.  If a team was brought together to support the child and family there may be less professionals but should create an ability to provide a better and more responsive support compared to the current fragmented service.  There would be still be national shortages in certain fields but there would be more attractive roles and give the opportunity to develop apprenticeship roles, Bands 2, 3 and 4, to those who had a wealth of skills and experience which would then free up others. 

 

It was noted that Louise Barnett would seek the Trust Board’s consent to supplying the Commission with a copy of its consultation response.

 

Resolved:-  (1)  That the report be noted.

 

(2)  That a future report on the evaluation of The Village pilot be presented to the Commission.