The report attached at Appendix A provides an update on NHS Herefordshire and Worcestershire ICS on stroke services across Herefordshire and Worcestershire.  This includes a paper on Improving Stroke (including TIA) Services across Herefordshire and Worcestershire, September 2022. The committee is asked to consider and comment on the information provided and seek assurance that the wider public engagement undertaken on this will be focused on delivering the required improvement further inform possible solutions.

The Managing Director and Chair of the Stroke Programme Board for the Herefordshire and Worcestershire Integrated Care System (ICS) gave a presentation on ‘Stroke Services: Pre-consultation Engagement Autumn 2022’, as published in a supplement to the agenda (link to the presentation).  This included slides showing:

·             Welcome and introduction, identifying that around three people each day had a stroke in Herefordshire, Worcestershire and Powys, the number was set to rise as the population aged, and the ICS was looking at the way in which stroke and TIA (transient ischaemic attack or ‘mini-stroke’) services were organised and run;

·             The National Stroke Pathway and current acute hospital treatment, rehabilitation and after care settings;

·             The case for change which included the difficulty to recruit stroke specialist consultants, resulting in reliance on support from outside the ICS area to ensure 7-day access, and keeping services as locally accessible as possible but balanced with providing the best care for patients;

·             The identification of four potential solutions [1. No change to current service / 2. One hyper-acute stroke unit (HASU) and two acute stroke units (ASU) / 3. HASU and ASU out of counties / 4. HASU and ASU on one site], with ‘potential solution 4’ being the preferred solution by the clinicians and following the options appraisal but this would not be taken forward until there had been full engagement with the public and with stakeholders;

·             Diagrams of the potential solution (with movement to HASU / ASU at Worcestershire Royal Hospital) for Herefordshire and Powys patients where Herefordshire County Hospital was the nearest imaging centre, and for Worcestershire and Herefordshire patients where Worcestershire Royal Hospital was the nearest imaging centre; and

·             People were being invited to have their say during September – November 2022, it was acknowledged that previous engagement had highlighted that some families in Herefordshire had expressed concerns about being able to visit Worcestershire Royal Hospital, especially if they did not have access to their own transport.

The principal points of the discussion included:

1.           In response to a question from the Chairperson, the Stroke Consultant said that the infrastructure and workforce issues meant that it was unlikely that two HASU sites could be operated in the near future and the ‘hub and spoke’ model was considered the best way to move forward.

2.           A committee member commented on the difficulties for the ambulance service to meet demand currently.  In response, the Managing Director outlined the dedicated pathways for suspected stroke, intended to reach assessment imaging within the ‘golden hour’, and said that the ICS would work with the ambulance service on the agreed model to support the movement of patients.  The committee member considered that this would be a concern for the public and suggested that this should be referenced in the consultation.

Another committee member questioned whether there was confidence that the ambulance service had the capacity for the extra journeys.  The Managing Director said that more capacity would be commissioned and this might only involve a small number of  ...  view the full minutes text for item 17