January 2012 - Sandwell & West Birmingham Hospitals

SWBTB (1/12) 286 (a)
The Department of Health guidelines require that proposals for significant reconfigurations
are subject to initial clinical assurance by the National Clinical Advisory Team (NCAT). In line
with this requirement a visit by NCAT took place in January 2012 and whilst we have yet to
receive their written report, their verbal feedback endorsed the clinical case for change and
the need to consolidate acute stroke and TIA services on one site. They strongly supported
the direction of travel and if anything were surprised these changes had not already been
made. NCAT felt both of the short listed service models were appropriate.
Options
The Project Board and Steering Group through several staff engagement events developed a
long list of options along with a set of evaluation criteria and a short listing process. Using the
agreed evaluation criteria and weighting the long list of 6 options were scored by 3
stakeholder groups: –
1. Local patients and carers who are stroke and TIA experts by experience
2. Stroke Reconfiguration Project Steering Group
3. Clinical staff from all relevant professions working in stroke and TIA services at SWBH
at a ‘Listening into Action’ event.
GPs have subsequently been engaged by the project team on a one to one basis with
representation across the relevant Sandwell and West Birmingham Clinical Commissioning
Group (SWBCCG) to discuss the proposed short list and the process. All the individual GPs
consulted were satisfied with the process that had been undertaken and stated preferences
for the short listed options. The Project Board then identified the two options with the highest
scores as the short list. These are:
Option 3: A single site model with all inpatient (acute and rehabilitation) stroke, Neurology
and TIA facilities and services located at one Hospital.
Option 6: A two site model with one hyper-acute stroke unit, acut Neurology inpatients and
high risk TIA services located at one Hospital. Rehabilitation services would be provided at
both City and Sandwell Hospitals.
At this stage no clear clinical reasons had been identified to suggest which of the City and
Sandwell Hospital sites the acute services should be located on. Subsequently a high level
scoping analysis has been undertaken around the areas of activity, capacity, facilities, staffing
and finance. Whilst the Trust is currently engaged in discussions with commissioners on the
overall funding settlement for services in 12/13, the findings from this work confirm that the
impact associated with the short listed options are within the boundaries of what would
normally be affordable to the health economy taking account of capacity and feasibility and
that the variations between placing the acute services on either City or Sandwell Hospital are
not significant enough to discount either site at this stage. As a result it is proposed that each
or the short listed options has two variant options with one locating acute services at the City
site and the other at the Sandwell site giving four short listed options for consultation. It is
important to recognise however, that further, more detailed work will need to be undertaken in
each of these areas, for each of the short listed options with the findings being fed into the
decision making process that will be undertaken at the end of consultation, to determine a
preferred option. It should also be noted that at this stage all options appear likely to require
some capital investment.
It was agreed that the options of Do Nothing and retain the current configuration but introduce
new ways of working for medical teams in order to provide acceptable levels of cover at all
times would not be scored as they did not meet the clinical drivers for change in terms of
consolidating acute stroke and TIA services in order to provide the critical mass of expertise
and skills that could meet the standards in a consistent was and deliver improved clinical
outcomes. They will however need to be included in the next stage of detailed financial
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