Outcome of review into acute stroke services in Huntingdonshire public consultation

NHS Cambridgeshire’s Board has today (25 January) endorsed a recommendation for reconfiguring stroke services in Huntingdonshire.

There have been considerable changes to hyperacute stroke care and the approach to managing stroke and improving patient outcomes in recent years. The National Stroke Strategy for England has set out the need for changes in the way services for people with a stroke are delivered. Consequently, NHS Cambridgeshire reviewed its acute stroke services in Huntingdonshire and identified three options for change, which were then publicly consulted on between 12 September and 5 December 2011.

At its meeting today the Board of NHS Cambridgeshire discussed each of the three options and the response to the public consultation. The Board welcomed the engagement of the community and agreed that Option 1 offered the best solution for patients and for improving clinical outcomes. A number of concerns were addressed in the following ways:

•           Transport - friends and family visiting patients

NHS Cambridgeshire agreed with feedback from the consultation that it is important for patients to be close to family and friends, and also recognised the potential transport difficulties. However this has to be balanced against the best outcomes for patients. This is one of the reasons for NHS Cambridgeshire’s decision to implement Option 1, which means the patient will be further away from family and friends for the shortest amount of time - usually only the first 72 hours after a stroke. Under this option, patients will be moved to Hinchingbrooke Hospital as soon as clinically appropriate, when the hyperacute phase of stroke has ended. The patient will then be close to family and friends for all their acute care and rehabilitation.

•           Transport - traffic on the A14 and A1 roads

NHS Cambridgeshire has taken into account the challenges posed by the A14. Ambulance crews deal with the A14 for emergencies on a daily basis. The time window for thrombolysis is now much extended to 4.5 hours and the Ambulance Service is used to dealing with emergency medical conditions which are much more time critical for treatment. The ambulance crew will make a decision at the time of the incident as to which hospital to take the patient to (Addenbrooke’s or Peterborough), therefore road conditions will be taken into account and the patient will be taken to the most appropriate hospital. We are in a fortunate position in Cambridgeshire, with two specialist hyperacute stroke units at either end of the county.

•           Ambulance response times

There are no specific problems in the region at present regarding ambulance response times, and performance has actually been improving in recent months. The Ambulance Trust has a category A (life threatening emergencies, which includes stroke) target response time of 8 minutes, which they have met, and we will continue working with the Ambulance Service on this.

•           The long term future of Hinchingbrooke hospital

NHS Cambridgeshire is keen to secure the long term future of Hinchingbrooke hospital. The option being implemented (Option 1), means that only hyperacute stroke care would be provided away from Hinchingbrooke Hospital. This represents around 1-2% of all emergency admissions to the hospital and therefore a very small number of patients.  Furthermore, this option means that patients would come to Hinchingbrooke Hospital for their acute care and rehabilitation. This arrangement ensures that a full range of high quality acute hospital services - including accident and emergency and maternity services - will continue to be provided for local people at Hinchingbrooke, as agreed at the end of the 2007 public consultation.

•           Future population growth and increased demand

NHS Cambridgeshire is aware of new developments happening in the area, such as Northstowe and St Ives West. The increase in population is likely to have a small impact on stroke. Furthermore, incidence of stroke has also decreased in recent years as the public health campaigns have succeeded in changing people’s lifestyles - less smoking, healthier eating, more exercise.

NHS Cambridgeshire will now implement the plans which will see all suspected stroke patients in the Huntingdonshire catchment area taken to Addenbrooke's hospital in Cambridge or Peterborough and Stamford Hospitals in Peterborough for their hyperacute care (normally up to three days after a stroke). When clinically appropriate patients will then be taken to Hinchingbrooke hospital for their acute care and rehabilitation (normally three to seven days after a stroke).

Dr Christine Macleod, Medical Director at NHS Cambridgeshire said,

“NHS Cambridgeshire’s Board agreed that Option 1 from the consultation offered the best deal for patients. The Board recognised that stroke patients need access to the best clinical care possible, and this usually means being seen by a specialist stroke care team. But we also recognised the fact that patients are often keen to be close to home, their friends and their families. Through a thorough consultation the PCT received detailed feedback from a wide range of stakeholders on the proposals, which helped shape our thinking and decision making process.  There were a number of issues the Board addressed, including travel times, transport issues and the future of Hinchingbrooke as a local district general hospital. We believe this solution offers the best of both worlds by giving patients access to the very best specialist care when they need it, and being able to transfer to their local hospital at Hinchingbrooke for the rest of their care and rehabilitation.”

Dr Gina Radford, Consultant in Public Health Medicine at NHS Cambridgeshire said,

“Stroke care has changed considerably in recent years. We know that the first 72 hours after a stroke (the hyperacute phase) are critical in terms of a patient’s recovery. Modern stroke care requires fast access to specialist clinical teams and diagnostic equipment 24 hours a day. This is currently not possible at Hinchingbrooke hospital. To ensure that patients have access to the very best care this means being seen by specialist staff with the skills required to treat the early hyperacute phase of stroke, which is currently provided at Addenbrooke’s Peterborough and Stamford hospitals.

“However, we did not want Hinchingbrooke to lose the valuable stroke service it already provides and we know that patients and their families often want to have their care at a local hospital, without the hassle of having to travel long distances to see their loved ones. That is why, we believe, this offers the best solution because patients will get access to the first class care provided by specialist stroke care teams, while being able to have their acute care and rehabilitation at their local hospital closer to friends and relatives. In addition it allows Hinchingbrooke to focus on developing its vision to be a centre of excellence for rehabilitation care.

"Ultimately this is about securing the best possible outcomes for patients based on recognised good practice, whilst utilising the skills and resources of the different providers in the best way.”

ENDS

Notes for editors

1. The Board paper Review of acute stroke services in Huntingdonshire public consultation can be accessed here http://www.cambridgeshire.nhs.uk/About-us/board-papers.htm
2. NHS Cambridgeshire consulted on the proposals for changing how hyperacute and acute stroke services are delivered between 12 September and 5 December 2011.