Thursday, August 15, 2013

Future of Stroke Services for Mid Wales and Shropshire

For many years I have taken a close interest in Shropshire NHS services because they are so important to Montgomeryshire. I want services we depend on to be as accessible as reasonably possible. And I was warned 30+ yrs ago that Shropshire could not support two DGHs. The warning came from Dr Paul Brown, who was the top 'guts' specialist and a squash playing colleague. He was fiercly opposed to the building of The Princess Royal Hospital. He predicted it would eventually mean the closure of The Royal Shrewsbury - though I do not believe this will happen. We discussed it a lot, and I've always known the day would come when reality would have to be addressed. A few yrs ago the plan was to build one new hospital to replace the the current two at Shrewsbury and Telford on a new site between the towns. Would cost best part of a £billion. Not feasible. So we are looking at a genuine merger into one hospital on two sites. The horrors of the Mid Staffs scandal has forced the issue. This post is about one aspect which typifies the questions that must be faced - stroke services.

Last June, the Trust was faced with a consultancy staffing gap at Shrewsbury, and felt there was no option but to transfer all hyper-acute and acute stroke services to Telford for a two month period.  Stoke rehab was still at Royal Shrewsbury. A review of how it had gone was carried out on Aug 1st. This is what the Trust tell us emerged.

"The meeting received clear feedback that a single site hyper-acute and acute stroke service is delivering positive benefits for stoke patients."

In the first six weeks of operation, 129 patients were seen, half of whom would normally have been treated at Shrewsbury. 12% of patients were thrombolysed compared with 10% in the previous 7 mths. Transfer time led to no missed opportunities to thrombolyse. 95% of patients were admitted to the ward within 4 hours rather than 75%. 94% of patients received CT scanning as opposed to 87%. 99% of patients received at least 90% of care in an acute stroke unit as opposed to 84%. Now I've been around long enough to know that you can prove anything with statistics. But these outcomes must give us a difficult bone to chew on.

What we are being told is that the temporary move to 'maintain' services in the face of staffing problems has actually led to an 'improved' service with better outcomes - reduced mortality, reduced morbidity, reduced disability and shortened recovery times. We are also being told that clinicians have raised concerns that these improved standards (which have described to me as "astonishing") could not be maintained if the service returns to a two-site model as programmed in September. Now this puts the hospital bosses (and me) in a bit of a quandary.  How can I ask for an early return to a model which we are told will lead a reduced service in an area of care in which I have a special interest.

Decisions. The Trust has decided to extend the single site service until Oct 14th to reinforce review findings. The Trust also proposes that an assessment should then be made about the way forward over the next year. The Trust will look at impact on pre-hospital, in-hospital and post-hospital care, considering access, clinical outcomes, patient experience, feasibility and wider operational impact. I feel I need another discussion with hospital bosses for satisfaction that we are not being fed stats that lead inexorably to their favoured conclusion. This will be done.

But the big issue for me is the longer term. I fully accept that a review of how best to deliver services across the range of care must take place. I'm keen that Montgomeryshire plays a part in this review. I have written to the Chair of the Powys CHC to ensure this happens. And its absolutely crucial that the 'interim' arrangements for stroke care do not rule out that the single site of future stroke care provision  (if thats what is decided) could be in Shrewsbury. I warned you this was not a straight forward issue.


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