January 2012 - Sandwell & West Birmingham Hospitals

SWBTB (1/12) 286 (a)
Other strategic risks relate to Birmingham PCT Cluster starting to undertake a reconfiguration
review of stroke services across UHBfT, HEFT and SWBHT half way through the SWBH
reconfiguration process being underway. If the Birmingham review seeks a conflicting
solution for SWBH to the internal SWBH reconfiguration project this could limit
implementation. However, close working is anticipated with the Birmingham review and early
indications are that translating the model to Birmingham and the Black Country would lead to
3 hyper-acute units, one of which could be at SWBH. Both Birmingham and Black Country
commissioning directors have agreed for the project to proceed despite these other review
processes taking place.
9.2 GP Engagement
As reforms to the NHS develop GPs are involved in large scale upheaval and changes in
roles. As such their focus is rightly on these emerging roles and organisations. It has proved
challenging to sufficiently engage GPs in this stroke reconfiguration project at present,
beyond presenting the project to them in their CCG meetings. GP engagement has improved
significantly over the last 2 months of the project and with the newly formed Sandwell and
West Birmingham CCG this is anticipated to become more straight forward.
9.3 Personnel/Staffing Risks
The reforms have a potentially destabilising effect on the project team (particularly from the
PCT side). There are significant risks for the formal consultation process if the PPI lead is no
longer in post, given her experience and reduced PPI personnel locally. However, as a
priority of the local health economy, it is anticipated to be supported through the reforms by
senior managers.
9.4 Finance/Activity Risks
With the location of the hyper-acute stroke unit on one site, this will geographically
disadvantage a section of SWBH’s catchment population leading to increased ambulance
journey times. This could have a detrimental effect on the number of stroke and TIA patients
attending SWBH with corresponding impact on PbR income, with potential operational and
capacity issues at other local acute NHS provider trusts. However the mitigating planning
being undertaken with WMAS should offset this risk significantly.
9.5 Unexpected Risks
As stroke and TIA services are so complex and the web of inter-dependencies so intricate it
is possible for the project to deliver a new model of service provision which leads to
unintended consequences elsewhere in the system. Strong clinical engagement throughout
the project should ensure that all reasonable eventualities have been addressed within the
project. The strategic commissioning role within the project team also ensures that this
reconfiguration project is embedded in the whole pathway work for stroke and TIA.
10. EVIDENCE OF NATIONAL RECONFIGURATION TESTS
10.1 The Four National Tests of Reconfiguration
In December 2010, Ian Cumming (Chief Executive, WMSHA) wrote to PCT Cluster Chief
Executives outlining the four national tests of reconfiguration that must be demonstrated in
any significant service change (such as stroke reconfiguration). The four tests are -
there has been real engagement of patients and public,
GPs particularly in their commissioning role, have been actively involved in
shaping the options, they support the overall approach and increasingly “own
the process”.
there has been full use of the evidence base for service change by clinical
leaders across the continuum of care and
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