January 2012 - Sandwell & West Birmingham Hospitals

SWBTB (1/12) 286 (a)
EXECUTIVE SUMMARY
Introduction
We provide acute and inpatient rehabilitation stroke and Transient Ischemic Attack (TIA)
services at both City Hospital and Sandwell General Hospital. There are significant clinical
drivers at a national, regional and local level to consolidate the acute element of these
services in order to provide a critical mass of specialist experience and skills that can deliver
improved health outcomes as measured by reduced mortality rates and increased numbers of
patients returning to independent living following a stroke. In response to these drivers for
change we have established, in partnership with our local commissioners, a project to identify
and develop the options that will provide a configuration of services that delivers these
improved outcomes for our local population.
The purpose of this report is to outline for the Trust Board:
the clinical case for reconfiguration of our acute stroke, Transient Ischemic Attack
(TIA) and inpatient Neurology services,
the short listed options,
the case for formal public consultation on the proposed reconfiguration of these
services, including the draft consultation document,
the initial activity, capacity and financial analysis of the short listed options.
Clinical Case for Change
In October 2010 a peer review visit by the West Midlands Quality Review Service (WMQRS)
to look at our Stroke Services raised concerns about the long term sustainability of
maintaining high quality acute Stroke Services on both City and Sandwell Hospital sites that
are able to robustly meet the standards identified for Stroke Services. It stated:
“The sustainability of the current configuration of services should be considered. Achieving
the expected Quality Standards on two hospital sites will be difficult given current staffing
levels. The health economy may wish to consider the improvement in quality, and expected
outcomes, which could be achieved by providing acute stroke care on one hospital site.
Improving the availability and speed of response of imaging services will be an important part
of this consideration.”
We had also undertaken some work internally that identified similar concerns. In view of this
the Trust Management Board agreed in January 2011 to initiate a project to develop options
that would ensure a configuration of acute stroke and TIA services that meet quality
standards in a sustained way and allow the service to continually improve. A Clinical Case for
Change was developed and approved by our Clinical Services Reconfiguration Programme
Board in June 2011.
This acknowledged that since the WMQRS findings, our Stoke Action Team has been
working to introduce streamlined processes with a focus on developing and improving our
Stroke and TIA service with the aim of ensuring the quality and safety of the service in
response to national guidance and to local concerns. These efforts have produced some
good results with clear improvements in meeting national, regional and local key performance
indicators (KPIs) for the stroke and TIA service (target times). However, we struggle to
consistently meet the required quality and performance standards for all patients at all times.
To do this requires our acute stroke and TIA services to be consolidated on one site allowing
the concentration of specialist staff and giving a critical mass of patients that allow these staff
to further develop specialist skills. Evidence is emerging from service reconfigurations in
other parts of the country (end especially London) that consolidation of acute stroke and TIA
care in fewer but more specialist units delivers improved clinical outcomes, including reduced
mortality rates and improved levels of independent living following an acute stroke.
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