Agenda item

Chris Burton (Medical Director NBT and Chair for the BNSSG Stroke Programme Board) in introducing the presentation on the Stroke programme, emphasised the partnership approach taken to the development of the programme which brought together a diverse range of people around a shared vision for future stroke care in the region. These included: key clinicians; the charitable sector; social care staff and service managers; and people with lived experience.

The presentation was structured around the following four aims:

·       to share progress on the BNSSG Stroke Programme;

Members received an outline of the challenges associated with strokes; the programme vision for stroke care; national evidence; the case for change; the co-design/partnership approach to programme development; and the emergent engagement themes. This part of the presentation also included representation from two participants in the “lived experience group”, whose personal experience had contributed to guiding the development of the programme.  

·       to seek JHOSC feedback on the plan for public consultation;

·       to seek JHOSC feedback on the draft evaluation criteria for decision-making; and

·       to agree how JHOSC would like to engage with the proposals for change once approved for consultation by the BNSSG CCG Governing Body

Before inviting Members comments and queries on the presentation, the Chairman thanked the team for the comprehensive and detailed presentation and particularly welcomed the open and frank contributions from the lived experience group representatives.

The Stroke Programme team responded to Members’ comments and queries as follows:-

a)      Had the team factored-in post-covid issues such as blood clots and other cardiology issues? - These problems presented early and had already been picked up in the programme.

b)      Parish & Town Councils needed to be involved in the consultation, together with local resident groups and the farming community – This would be taken into account;

c)       Would any weighting be attached to the evaluation criteria? – It was likely that a combination of quantitative and qualitative factors would be used in the evaluation. A group had been established, as part of the governance structure, with oversight of the evaluation process.

d)      The clear focus on prevention was welcomed: was this something that BNSSG was leading on or working with Public Health and if so, what would this look like? -  They were still working with partners on this.  It would build on work already going on in Primary Care around, for example, lifestyle, hearty rhythm disturbances, public health lifestyle measures etc).

e)      It made sense for hyperacute services to be focussed where there was expertise but were there any concerns around services being moving away from local hospitals and anticipated difficulties convincing local communities of the need for these changes? - There was a shortage of workforce with the required skills. Clinical evidence and NICE Guidance were that workforce should be consolidated to maximise available skills.  Proposals to move care were necessary if the programme ambitions were to be achieved and they were carefully considering how best to introduce this into the conversation going forward. Where distances were greater such as in North Somerset, the focus was around quicker transport and “equalling out” travel time where possible.

f)        Given the critical importance of treating stokes in the first hour, were there lessons that could be learnt from the Scottish Highlands were “clot busting” injections could be administered by paramedics?  -  unlike the situation with heart attacks, in the case of Haemorrhagic stokes, a brain scan would be required first to avoid making matters worse. There were significant challenges around equipping ambulances with CT scanners.

g)      Had consideration been given to the needs of people with leaning difficulties – They were in touch with leads in the community, the acute providers. and learning disability teams to establish links with key stakeholders. It was recognised that focus was needed around planning discharge and this was being taken into account in the planning of out-of-hospital services.

h)      Inequality maps showed significant pockets of depravation in Bristol and North Somerset.  Members wanted assurance around the development of mitigation proposals and the extent of the work around prevention – the guiding principle underpinning the programme was maximising access for the whole population.  Location, travel times and deprivation effects were all key considerations and built into the decision-making criteria.  Prevention also a workstream of its own so would have proper focus across all factors.  Members would have an opportunity to scrutinise these plans when recommendations were brought forward.

In concluding discussions it was:-

Resolved:

(1)        that the update report and progress made by the BNSSG stroke programme in planning for consultation be noted;

(2)        that the plan for public consultation, taking into account the flexibilities that may be required in delivering the consultation in the context of the pandemic and any other government restrictions at that time, be supported;

(3)        that the draft evaluation criteria developed for the decision-making process be supported;

(4)        that the proposed process, involving discussion with the JHOSC, for fixing a date by which the JHOSC must provide comments on any proposals arising from the consultation, be noted; and

(5)        that, in confirming how the JHOSC would like to be consulted with on our proposals once the decision to consult has been made, it be agreed that a workshop be arranged by the CCG during the consultation phase (between June and September 2021).