Agenda item

To consider the report.

The committee received a report on the stroke service proposal and consultation process, with an overview of the themes of feedback and the next steps.

Cllr Oakes (Chair) proposed that the committee resolve this is not the best proposal for the people of Somerset. Cllr Mike Ashton seconded this, and the proposal was unanimously approved.

It was proposed that the committee should write to the Executive to inform of their decision, and Cllr Bruce proposed that this be delegated to Cllr Oakes and Democratic Services. Cllr John Bailey seconded, and this was unanimously approved.

The committee received a report from Julie Jones, Sara Bonfanti, David McClay and Dr Robert Whiting on the stroke service proposal and consultation process, with an overview of the themes of feedback and the next steps.

During the discussion, the following points were raised and responded to:

• What does the 600 patient viability figure for the stroke service mean? The threshold is the ability to do intensive hyperacute treatments as quickly as possible. Large volume centres who do treatments more frequently are able to do them quickly, which is important for strokes. The service also needs to be sufficiently large to have the financial stability to keep the service operating with enough consultants and to provide a high level of service 24 hours, 7 days a week.
• How many patients are currently seen in Yeovil? 400 patients a year.
• The service is demand-led, and Somerset has an aging population, so demand is likely to grow. What does that mean for the future of the service? We have looked at population growth in ten years and what beds and staff will be required in ten years.
• Is it going to be a postcode lottery for stroke services in Somerset? The postcode lottery will be more significant if one of the services did not meet the standards of a Hyper Acute Stroke Unit.
• With speed being important for stroke treatment, there are concerns about the travel time. The travel time between the stroke and getting help would increase by 25 minutes. The longer travel time would be mitigated by faster treatment times once the patient has arrived at the hospital.
• Isn’t it better for services to be balanced between two locations in case one gets overwhelmed? Is there a plan for that? There is already a plan to expand the stroke unit in Musgrove Park Hospital. It has already expanded to be two wards.
• Concerned there are inaccuracies in the report around travel times, as 25 minutes from Yeovil is only feasible when there is no traffic, i.e. at 3am. Particularly with current delays in ambulance times.
• The consultation feedback has been largely negative, with people wanting the Yeovil HACU to stay open.
• Concerns about if there are poorer outcomes as a result of this closure, that will fall on Adult Social Care to provide ongoing care after they are discharged from hospital.
• Does the 600 viability figure take into account rural nature of the population? Yes, and in NHS England Section 9.2, a balance must be considered between travel times and sustainability. Increased travel times for someone to get to a unit that has the qualified staff.
• Has the report taken into account the impact on Adult Social Care?
• The consultation has narrowed it down to one option, have any other options come forward as part of that process and have they been considered? Mobile stroke units were considered, but a trial in South East England has shown they are not cost effective and national guidelines state there is not enough evidence for their use at the moment.
• Is there a possibility to improve ambulance waiting times to address some of the access issues? It’s not only the ambulance arriving, it’s what happens once they get to the hospital. Ambulance waiting times are also influenced by flow across the whole system, and stroke is a Category 2 for an ambulance response. They may be reprioritised in future. SWAST has recently improved its waiting times and there ongoing work around that.
• Somerset Council considers Rurality a protected characteristic, so it needs to be factored in. It will be part of the Equality Impact Assessment that will form part of the Decision Making Business Case.
• Is the decision already made? No, the Decision Making Business Case will be put forward to the ICB in January, with financial, geo-spatial modelling and EIA. It needs to be proven deliverable or we will have to revisit the broader options.
• Travel time for family to visit is also a concern, as it is shown that family visits result in beneficial outcomes.
• Workforce fragility for Yeovil Hospital could be a result of previous decisions around unit closure, rather than the lower number of patients not making the unit viable.

Cllr Oakes (Chair) proposed that the committee resolve this is not the best proposal for the people of Somerset. Cllr Mike Ashton seconded this, and the proposal was unanimously approved.

It was proposed that the committee should write to the Executive to inform of their decision, and Cllr Bruce proposed that this be delegated to Cllr Oakes and Democratic Services. Cllr John Bailey seconded, and this was unanimously approved.