Agenda item

The Chair to advise the Committee of any items on which members of the public have requested to speak and advise those members of the public present of the details of the Council’s public participation scheme.

For those members of the public who have submitted any questions or statements, please note, a three minute time limit applies to each speaker and you will be asked to speak before Councillors debate the issue.

We are now live webcasting most of our committee meetings and you are welcome to view and listen to the discussion. The link to each webcast will be available on the meeting webpage, please see details under ‘click here to join online meeting’.

There were two public questions received. The questions and the responses are provided below.

 

Eva Bryczkowski:

 

THE PROPOSED CLOSURE OF YEOVIL HOSPITAL ACUTE STROKE UNIT

·       The fact that NHS Somerset is still looking at ending emergency stroke treatment, given in the first 72 hours, does not bode well for future stroke victims. 

·       The quicker the person is seen, the greater chance of survival, with far less damage and disability if they survive the stroke. 

·       If the stroke unit at Yeovil still remains open, there will be far less expense long term for the NHS as patients will not be so severely affected and less likely to need long term care. 

·       Thus closing down the emergency treatment is a false economy, and there will be far less ability to save lives. 

·       It was reported in BBC news that NHS Somerset's plan is a step in the right direction. 

·       But they are still planning, at this stage, to dilute the service at Yeovil hospital acute stroke unit. 

·       The knock - on effects of this possible dilution will be poorer health outcomes and slower recovery times, leading to greater costs for  adult social care, especially if it is subsidised by the council, incurring more expense for council tax payers in Somerset. 

·       I do wonder whether NHS Somerset/Somerset Council have considered these implications.

QUESTION ONE 

i)               What, specifically, are NHS Somerset going to do about preventing poorer health outcomes, slower recovery times, and the potential risk of rising morbidity for future Somerset stroke patients?

ii)             How are councillors/officers on the Health and Wellbeing Scrutiny Committee going to square the circle financially, regarding the extra cost of subsidised adult social care, and paying expensive consultancy fees, which will lead to a further drain on the adult social care budget, seeing as the council is threatened with a 114 notice and possible bankruptcy?

·       We know that the clear legal duty of the council is to balance the books. 

·       Ratcheting up costs by employing an expensive consultancy firm, which has not proved its worth yet, is the last thing the council needs. 

·       This job should be done by the leading councillors and officers responsible for adult social care. 

·       (Goodness, I'd be happy and I'm sure other people would be willing to do the necessary research and number crunching to avoid our money helping this consultancy firm make even more profits, at the expense of us council tax payers). 

THE CONSULTATION PROCESS 

·       At the end of the Health and Wellbeing Scrutiny Committee held on 31st of May 2023, I spoke up and asked everybody in the room whether they had participated, or came across the consultation process, which was closed on 24th of April 2023.

·       Only 3, maximum 4, people raised their hands. 

·       In response, people from the ICB and Foundation Trust enthusiastically told me that they had put on talking cafes and numerous other ways of consulting people about this. 

QUESTION TWO 

I would like to know what were the parameters of the consultation process:

Which people in all of Somerset, parts of Wiltshire and Dorset, plus the surrounding areas affected by the proposed closure, were consulted and how, precisely was this carried out?

 

A MAJOR CONCESSION?

·       NHS Somerset seem to be posing their decision to dilute emergency stroke care at YDH as a major concession. 

·       It is anything but. 

·       There seems to some confusion and obfuscation over the issue at this stage in time, particularly when it comes to actually making a decision - or not - to dilute emergency stroke care at Yeovil hospital. 

QUESTION THREE 

What have you got to say to future stroke victims in Somerset and other affected areas,  (ie potentially any of us), about:

The current extremely long wait for ambulances, length of drivetime, slower recovery rates, leading to further necessary aftercare, and possible risk of higher morbidity rates, that will surely ensue from dilution of stroke services, at Yeovil hospital, and when will this decision be finally made?

 

Response from Julie Jones, NHS Somerset Foundation Trust:

Question One i) Getting to hospital quickly is important when you have a stroke, but being seen by specialist staff quickly when you arrive and access to the best treatment available provides better outcomes for individuals. One hyper acute stroke unit at Musgrove Park Hospital would be better able to support this care by providing rapid access to the right expertise and specialist equipment 24/7.

 

It is widely accepted that to provide sufficient patient volumes to make a hyperacute stroke service clinically sustainable, to maintain expertise and to ensure good clinical outcomes, 600 stroke patient admissions per year are required.

 

This is achieved in Musgrove Park Hospital, and Dorchester County Hospital however Yeovil District Hospital does not achieve the required yearly numbers to be able to deliver a clinically sustainable hyperacute stroke service.

 

Yeovil has also struggled over many years to recruit to the stroke consultant posts even though many strategies have been used to attract specialist stroke consultants. 

 

Having the right specialist staff and getting access quickly to the best treatment available provides better outcomes for individuals and in turn reduces the potential risk of rising morbidity.

 

Response from Mel Lock, Director of Adult Social Care

 

Question One ii)

Adult Social Care engaged Newton Europe in the summer of 2023 as a delivery partner to deliver our transformation programme (‘My Life, My Future) which is aligned to our Adult Social Care Strategy and is targeted at making sustainable operational changes, valued in the range of £14.2m-£17.2m per annum as well as improving the lives of our residents.  This follows an evidence-based review of the service undertake across the winter of 2022/23 which identified priority areas for change and improvement.  

  

A detailed overview of the background to, and latest progress of, this work was recently presented to the Adults & Health Scrutiny Committee on 7 December 2023 – papers are in the public-domain and available here:  

  

·       https://democracy.somerset.gov.uk/documents/s18707/Scrutiny%20Committee%20My%20Life%20My%20Future%20Report%20Dec%202023.pdf  

·       https://democracy.somerset.gov.uk/documents/s18702/112023%20Scrutiny%20MLMF.pdf  

  

The support from Newton Europe is provided on a contingent fee basis; these are fixed and contingent on financial benefits being delivered and signed off by Somerset Council.  As such, Newton guarantee that the recurrent, annualised benefits delivered in the programme will at least exceed 1.3 times the combined fee from the original diagnosis and programme.  As such the guaranteed benefit is £10.0m.  

  

A monthly Contract Monitoring forum is established as part of wider governance and oversight arrangements for delivery of the programme, where progress against operational and financial targets is reported and benefits associated with the programme are signed off. 

 

 

Response from Julie Jones, NHS Somerset Foundation Trust:

 

Question Two: The public consultation focused on reaching people within Somerset and also those in neighbouring areas who may also be affected by the proposals. We worked with Opinion Research Services (ORS) who are producing a themed report of the consultation insights. The full report will be shared with the decision making business case. A summary of the responses and key themes can be found in the ‘you said, we are doing’ report.

 

Our consultation activity overview report highlights how we reached people during the consultation.  To ensure we reached a representative proportion of the Somerset and neighbouring wards, ORS conducted a representation telephone survey.

 

Question Three:

 

The answer to the question around risk of higher morbidity and slower recovery rates has been answer in question 1.

 

When you have a stroke, you’re more likely to survive and live with less disability if you go straight to a place that offers the most specialist treatment. This already happens for people who have a heart attack or major trauma. National guidance and research says that people need to get to specialist hospital care within 4.5 hours after a stroke to have the best chance of surviving and avoiding severe disability. That’s why we want to centralise hyper acute stroke services at one hospital. Getting to hospital quickly is really important when you have a stroke, but it’s also really important to be seen by specialist staff quickly when you arrive and to have access to the best treatment available. One hyper acute stroke unit would be better able to support this care by providing rapid access to the right expertise and specialist equipment. This means that even if some journeys to hospital were slightly longer, there would still be an overall benefit to patients.

 

The preferred option keeps an Acute Stroke Unit at Yeovil Hospital so that patients can continue their specialist rehabilitation closer to home.

The decision-making meeting will take place at our Board meeting. The final decision-making meeting will be held in public to allow those interested to hear the discussion and how the decision is made. We expect this to take place at our January Board meeting.

 

Ray Tostevin, chair of the Quicksilver Community Group:

 

Thank you for this chance to speak further on behalf of Quicksilver Community Group. Our online petition to save Emergency Stroke treatment services at Yeovil Hospital, now has more than 7,000 signatures.

 

We welcome NHS Somerset agreeing that Yeovil’s Acute Stroke Unit, should stay open. We are deeply concerned the Integrated Care Board remains on course, to close down Yeovil’s Hyper Acute Stroke Unit.

 

We accept national guidance is all about developing large well-staffed HASUs, with 24/7 consultant and other specialist staff access. And a target capacity for 600 patients a year. This model has real appeal for positive patient care: patients get a speedy response from a well-staffed, skilled and equipped Hyper Acute Stroke Unit. The ICB has told this committee today that stroke is the single largest causes of complex disability, and has a significant impact on health and social care, unpaid carers, and lost productivity.

 

Current trends predict within 3 years, more than a third of Somerset’s population will be aged 65 or over. Stroke treatment is likely to be a growth industry. The NHS Somerset consultation documents present an upbeat vision: “Stroke patients in Somerset will receive timely acute interventions and receive access to world-class services, regardless of where they live.”

 

It’s also noted most people with a suspected stroke are admitted by ambulance to either Musgrove Park Hospital in Taunton or Yeovil District Hospital. It is acknowledged journey times are a challenge, because of the rural nature of our county. Whilst one option from the original consultation remains, it still involves shutting the Hyper Acute Stroke service at YDH.

 

In our view, it is incomprehensible to have a vision of stroke patients receiving timely acute interventions, regardless of where they live, yet propose closing one of Somerset’s two existing Hyper Acute Stroke Units. Knowing the result will be hundreds of patients being forced to travel further and for longer, before their emergency treatment can even begin.

 

If Yeovil HASU were to close, with all emergency stroke treatment relocated to Musgrove Park, the expected capacity at MPH would be around 815 patients. Add to this, the 255 patients from North and West Dorset who currently rely on Yeovil HASU, who would go to Musgrove instead. A total of 1,070 patients. Just a little short of the 1200 patient target for TWO fully-functioning HASUs in Somerset. With rising demand for emergency stroke treatment, as our population gets older, the need for Hyper Acute Stroke provision will undoubtedly increase.

 

Surely, NHS Somerset should be doubling down on developing the capacity of BOTH existing HASUs at Yeovil and Taunton. We understand a new stroke consultant has just been appointed at Yeovil. While the excellent consultant who has led Yeovil’s stroke team, puts off his retirement a little longer.

 

We urge this committee to use the influence at your disposal to urge the NHS Somerset Board to review and reject the proposal to close Yeovil’s Hyper Acute Stroke Unit.

 

Response

 

The points made have been heard as part of the wider consultation.