The Committee considered an overview of the burden of disease and mortality from stroke, the range of services in Herefordshire for the prevention of stroke and the treatment and care of people who have had a stroke. 

The Committee had requested a report in greater depth on Stroke Services following its consideration in December 2007 of the Director of Public Health’s Annual Report 2007.

Dr Akeem Ali, Director of Public Health, referred to his report on stroke services included with the agenda papers and gave a presentation highlighting key issues.

Whilst deaths from heart disease and stroke were lower than the national average stroke remained the leading cause of death in Herefordshire.  Factors included old age and lifestyle issues.  It was clear that more could be done within the County to reduce deaths.

He highlighted the need in particular for preventative action through measures such as lifestyle advice.  It was estimated that 80% of strokes could be prevented.  The PCT was one of the few PCTs spending a reasonable amount on such measures and he suggested this provided scope for practitioners to do more.

He also remarked on the need for improved clinical support, noting that many stroke patients required long term care outside the hospital environment.  This required an integrated approach from a range of organisations.

There was a tension in that the pressure to meet targets created an incentive to invest in acute services rather than preventative measures.  The development of a prevention plan was needed to address this and ensure that services worked together.

In the ensuing discussion the following principal points were made:

·         Treatment of stroke within three hours of the onset of stroke symptoms was required to improve outcomes.  It was asked whether this was achievable in the County.  In reply it was said that work was being done to seek to improve the position but the three hour standard was not being achieved at the moment.  It was noted that the Ambulance Trust was also working on the problem, for example considering the use of an air ambulance in the more rural areas.

·         Asked about the scope for improvement Dr Ali reiterated that although there was currently a better outcome than the West Midlands average more needed to be done.  Long term plans needed to be put in place.  He had asked GPs to look into risk areas and he intended to develop a quality risk framework.  Joint working was taking place with social care on a single assessment process.

·         Questions were asked about limits on capacity, including resources.  Dr Ali replied that rurality was an issue but the development of practice based commissioning could contribute to meeting that challenge.  There was also a clinical governance issue to be addressed.  A critical mass of patients was needed to ensure that specialisms could be maintained to the required standard.  The Stroke Network was considering this issue to seek to avoid inequality of care.

·         It was acknowledged that there was scope to increase involvement with the Voluntary Sector. 

·         The Head of Adult Social Care added that the more progress made to develop multi-disciplinary teams the greater the chance would be of providing the complete support people required.  She added that the emphasis was on reducing time spent in hospital, replacing that with greater community support.  The development of personalised budgets was an important element of this process and an area the Service had identified as one of its priorities.

·         It was asked whether GPs would be expected to be proactive in seeking to encourage those registered with them to take preventative measures.  Dr Ali said that this was a complex issue and there was a also a question of investment but he did consider that there were avenues that GPs could proactively explore in relation to prevention that would make a difference.

RESOLVED:  That progress in development of Stroke services be kept under review.