Coventry & Warwickshire COVENTRY AND WAICKSHIRE CARDIOVASCULAR NETWORK NETWORK BOARD and MIDLANDS AND EAST STROKE REVIEW MINUTES Present Friday, 13 th July 2012 Westgate House, Warwick Coventry and Warwickshire Board Martin Lee (ML) Chair Medical Director, Arden Cluster, Network Chair Dr Martin Been (MB) Consultant Cardiologist, UHCW and Network Clinical Lead for Cardiology Mel Duffy (MD) Deputy Director of Development, SWFT Darren Spencer (DS) Service Redesign Officer, Warwickshire County Council Matt Ward (MW) Head of Cardiac & Stroke Management, West Midlands Ambulance Service Rob Wilson () Director, Coventry & Warwickshire Sonia Godfrey (SG) Associate Head of Nursing & Health Studies, Coventry University Jacqueline Barnes (JB) Associate Director of Nursing, Arden Cluster James Egbuji (JE) Stroke Consultant, GEH Kay Farmer (KF) Divisional General Manager, GEH Ben Knight (BK) Associate Director, Coventry & Warwickshire Stroke Review Martin Lee (ML) Chair Medical Director, Arden Cluster Rob Wilson () Director, Coventry & Warwickshire Laura Dendy (LD) Deloitte Tim Lawrence (TL) Deloitte Gavin Farrell (GF) Consultant Clinical Neuropsychologist, Clinical Lead, Coventry Community Neuro-Rehabilitation Team Matt Ward (MW) Head of Cardiac & Stroke Management, West Midlands Ambulance Service Norman Phillips (NP) Patient representative Jacqueline Barnes (JB) Associate Director of Nursing, Arden Cluster Richard Hancox (RH) Programme Director Sustainable Specialties and Transformation, Arden Cluster Darek Ceglarek (DC) Professor, University of Warwick Sudi Lahiri (SL) Senior Research Fellow, University of Warwick Barbara Fowler (BF) Stroke Clinical Nurse Specialist UHCW Ben Knight (BK) Associate Director, Coventry & Warwickshire Mel Duffy (MD) Deputy Director of Development, SWFT Kay Farmer (KF Divisional General Manager, GEH James Egbuji (JE) Stroke Consultant, GEH Padma Bhakta (PB) Service Development Manager, Coventry and Warwickshire Raj Thanvi (RT) Stroke Consultant, Warwick Hospital Sonia Godfrey (SG) Associate Head of Nursing & Health Studies, Coventry University Nick Foster (NF) Director of Delivery (UHCW) Sue Thelwell (ST) Stroke Services Co-ordinator, UHCW Juelene White (JW) Service Development Manager, Coventry and Warwickshire Darren Spencer (DS) Service Redesign Officer, Warwickshire County Council
Apologies: Peter Barker, Jan Fereday-Smith, Tony Kenton,, Najmi Qureshi,, Mark Farthing, Naseer Ahmed-Iqbal, Graham Perry, Etain McDermott, Kath Kelly, Sarah Mountford, Maggie Hall, Tracey Robbins Item Subject Action 1 Welcome and Introductions ML welcomed everyone to the meeting. Apologies noted above. ML informed the group that today s meeting would be split with Cardiac matters being dealt with from 1.30 2pm and then the impending Stroke Review from 2 4.30pm. 2 Minutes from Last Meeting The minutes were agreed as accurate, actions noted or carried forward. 3 Matters Arising / Action Log 4 Cardiac Business items 1. New Consultant Cardiologist at GEH MB said that it wasn t clear at the last Board meeting (May 2012) that the Network Board had given its support for this position or that it had to be approved by the Network Board but he was now asking for formal agreement for this post. The Board gave its approval for this appointment retrospectively. KF said that the post had already been advertised and yielded 6 candidates. 2. Improved STEMI Alerts process MB gave a presentation which illustrated the considerable improvement during May in the reduction in the time that it was now taking to deliver PPCI. MB said this was mainly due to the Ambulance Service using an automated pre alert process and the education session that the Network has been delivering on raising awareness of ACS symptoms to ambulance personnel. MW explained the process now being used. ML congratulated MB and MW on the improvement and said it would be worth sending a summary of the presentation to the Midlands and East Strategic Health Authority, in particular: the Medical Director, Chris Welsh, CE Sir Neil McKay and Professor Harris. said it might be worth waiting to see if the improvement had been sustained through June and July before sending any reports. MB will prepare a short summary of the improvement. Presentation to be circulated 5 Specialised Commissioning Update Enc 3 to note 1. Scoping for QIPP ideas during 2012/13 for 2013/14 contracts asked the group to note the paper and for any comments, projects or QIPP savings they may have. SG said that her students had several projects that they had developed that could be submitted. said to send them through to him and he would forward them to Specialised Commissioning. said if there were any further QIPP projects relating to Cardiovascular he would be happy to collate them and send through to Specialised Commissioning. MB SG/ 04 May 2012 Page 2 of 5 Coventry & Warwickshire Board Minutes
6 Recent Network events evaluation reports drew the group s attention to the education and evaluation reports pointing out that the ACS evaluation supports the MB/MW improvement in PPCI performance. 7 National Review of Networks said that there was no further news even though the results were due shortly. ML stressed the importance of Networks. Sustainability of Acute Services is being considered, a proposal is going to the Arden System Board for a forum to be formed. 8 Any Other Business None Next meeting 12 th September 9 10. 2.00PM at this point the formal Board Meeting closed and the open session on the Stroke Review began. 1. Timeline, response templates & modelling Deloitte presentation 2. Feedback from Specification Launch Event on 11 th July 3. Identify what the possible options might be for future provision 4. Understand the process we are all facing 5. Next steps and who does what 6. Proposals sign off? ML introduced the session and welcomed the attendees. Introductions were made and apologies noted. ML asked to update the group on purpose, progress and timelines. explained the process and timelines, which he said were very tight. said that the Stroke Steering Group discussion in July had agreed 3 options and these had been sent to Deloitte for modelling and would inform the discussion at today s meeting. also explained that it was not the Networks responsibility to complete the forms on behalf of the providers as the Network did not have the detailed information required for this. said that the Network s role in the process was to facilitate and collate the submission. ML commented on strong theme on improving outcomes for patients backed by external expert advisory group led by Damian Jenkinson asked TL from Deloitte to talk through timelines, modelling process and take questions. - Timeline tight (early September) Network response to cover whole pathway, one single proposal preferred. - Template developed in line with timeline - The Expert Advisory Group has agreed a set of approval criteria: Good practice, improve clinical outcomes and patient experience. - Deloitte are supporting two parts of work: provide detailed mathematical model that will conclude mid-august and a modelling exercise. ML asked about expectation for system responses in terms of Governance. said that with regards to the timelines proposed, responses would be needed within five working days prior to dates. asked if the detailed model will be for use locally for all networks. TL will confirm who will have access to model once it is complete. said that as networks and providers, we need to be able to give a model 04 May 2012 Page 3 of 5 Coventry & Warwickshire Board Minutes
of the service we are proposing. ML pointed out it would be useful for everybody to communicate on time line and clarify by email communication what is needed from whom. From commissioners point of view make sure there is awareness of the whole process. TL continued: Post code directory, 2001 census data were used. Three options presented from the Stroke Steering group: 1) Things stay the same i.e. thrombolysable patients going into UHCW and other acute strokes going to current destinations. 2) All acute strokes to go to UHCW. 3) All three hospitals deliver hyper acute service. Discussion on different models/scenarios followed and outcomes on patients. said we need to prioritise options in order to move forward within the time scale. ML stressed the cut off between hyper acute and acute is not easily defined. Are we clear about the specification? There are variations within options 1 and 2 that need to be more clearly defined and modelled. Does anybody feel it is necessary to pursue the option of all sites to deliver hyper acute interventions? Would everybody feel comfortable to omit option 3 and deal with options 1 and 2 and variations within that? Point raised about Clinical need versus workforce able to provide the clinical need. We do not want a degradation of patient safety at the other end of the pathway. RH said we could have an integrated model with a slightly different provision at SWIFT than at GEH. Point raised about the best interest of the patient and families who want rehabilitation to occur in the community as close to them as possible. ML concluded that scenario 2a /b. There needs to be a lot of numbers and modelling required to substantiate and support the best option within that. observed that the argument at the moment is about GEH & South Warwick as to what exactly they would provide. NP raised the point of access to the patient with families having to travel long distances suggested a centralised service to give the optimum immediate benefit to patients with a fairly rapid repatriation. Initially we work on the basis of scenario two that provides acute care post 72 hours at GEH and SWFT including longer term care and deliver services in line with the spec. ML expressed concerns about how to get input around Primary prevention, Secondary prevention and End of Life Care. Do we have a formal route for that? We need PH input, how is this being managed throughout the project? replied that high level communications have gone out. It says in the spec that this is not focusing on Primary Prevention, though it is acknowledged as being part of the pathway. ML stated that it is vital that Public Health (PH) is aware of this and should be communicated to Health and Well being boards. Speak to PCT, CCG and PH leads that attend the meeting. Secondary prevention is in scope (Primary Care) There is a template. The current TIA pathway runs through all three Acute Trusts. Will it meet the spec as it is? The data needs to be validated. ML sums up: We have agreed we are looking at scenario 2 with a need to clarify what happens to GEH and SWFT in respect of Acute Care. Include UHCW in discussions. Volunteers for Table Top exercise suggested by MD: ST, MD, KF next Thursday 10.00 to 13.00 Completed template in a week s time. will copy Gill Entwistle on all communications re: Finance. ALL MD/ST /KF/R W 04 May 2012 Page 4 of 5 Coventry & Warwickshire Board Minutes
ML thanks all attendees 11. Next meeting Friday 14 th September 2012, 2.00 4.00pm, Committee Room, Westgate House 04 May 2012 Page 5 of 5 Coventry & Warwickshire Board Minutes