January 2012 - Sandwell & West Birmingham Hospitals

SWBTB (1/12) 286 (a)
Cluster Directors of Commissioning Development and with the Strategic Health Authority
(SHA) confirmed that although these processes are linked, our reconfiguration process
should continue on the basis that:
a significant momentum has already been achieved,
the reconfiguration of our stroke services could form a helpful ‘first piece in the jigsaw’
which the Birmingham configuration could then build upon and
there is an imperative to improve the quality of this stroke service for local patients to
deliver better outcomes.
The Black Country Cluster Clinical Senate received a report in December 2011 from the
Black Country Cardiovascular Network on stroke services across the Black Country. A key
recommendation of that report was “the need for a formal review of the provision of hyperacute
stroke services across the Black Country Cluster…. And whether a review in the Black
Country should form part of a wider West Midlands review, as patient flows impact on
providers outside the Black Country Cluster.” The relationship of our proposed reconfiguration
will relate to any future Black Country review in a similar way as to the Birmingham Cluster
review.
2.3 Local Context
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. Whilst acute
stroke and TIA services are currently provided at Sandwell and City Hospital sites, the type of
service provision and activity varies between the sites. For example:
In-patient bed facilities and configurations differ
Consultant cover differs on both sites
Nursing configurations and competencies differ
Delivery of Care pathways is not mirrored
Imaging times and facilities and staffing differs
Therapy input is managed differently
Approach to rehabilitation and early supportive discharge differs.
Table 1 below summarises the total number of patients we admitted during 2010/11 with a
main diagnosis of stroke or a main diagnosis of TIA and the number of patients seen as
outpatients with a TIA.
Table 1 – Number of patients seen by SWBH for stroke and TIA in 2010/11
Trust City Hospital Sandwell Hospital
Stroke – patients 625 338 287
admitted
TIA – patients admitted 201 121 80
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