Stroke Services Reconfiguration Project Working in Collaboration with Birmingham, Solihull and Black Country CCGs and Providers 30 th January 2014

Background

Stroke is a major cause of mortality and morbidity: 40,000 deaths in England; 12,000 in NHS Midlands & East region alone (2009) 2008 National Stroke Strategy – little progress January 2012, NHS Midlands & East Review – concern re stroke performance Variation in clinical outcomes across the region Significant underperformance against national and international best practice Regional best practice service specification developed Background

Stroke Mortality

Lifestyle Risk Factors Stroke deaths attributable to smoking: –12% males –6% females Rising obesity Increase in alcohol consumption Co-morbid Risk Factors Hypertension Raised cholesterol Diabetes Mellitus Atrial Fibrillation Atherosclerosis

Benefits of Reviewing Services Improved patient care: – Reduced deaths – Improved chance of recovery – Reduced risk of long term disability – Ability to live more independently High quality, safe services 24/7 Access to specialist staff, services and facilities

Do we need to reconfigure services?

9 major acute hospitals across Birmingham, Sandwell, Black Country and Solihull Hyper acute stroke services (HASU) will not be provided at: City Hospital Good Hope Solihull Hospital Acute Hospitals

Maximum 6 HASUs (based on 600 confirmed strokes) Access analysis has shown range of possible configurations: Less than 3 HASUs compromise access More than 6 HASU sites does not significantly improve access Net benefit needs to be demonstrated if changing number of sites (quality, access, workforce etc.) The review will identify if there is a need to change What are the Options?

Local Access The following services will still need to be provided locally: Acute Stroke Unit (hospital care after first 72 hours) Outpatient Transient Ischaemic Attack (TIA) Inpatient and community rehabilitation Long term care services End of life care Model covers current demand and potential changes due to possible reconfigurations in neighbouring areas

How Will We Decide?

Clinically sustainable stroke services Services will cover stroke care from prevention through to long term and end of life care Patients should have access to the best quality care possible 24/7 Our Vision

Stroke Pathway

Clinical quality of service Workforce needs, including training, teaching and resource Access Ease of deliverability Improved strategic fit Cost/efficiency Criteria

Aim to deliver service change within the current financial envelope: –Payment By Results –Best Practice Tariff (BPT) –Local tariffs Up to £4.5m BPT estimated cost pressure (based on 2012/13 data – to be validated) Identify new tariffs Identify options for optimal configuration in financial terms Financial Principles

Optimum Configuration: Optimum configuration will be determined as follows: Option 6 HASUS Option(s) 5 HASUs Option(s) 4 HASUs Options(s) 3 HASUs Meets 30 minute access time Meets Health Needs Cost and Affordability Option configurations summary

Decision Making Process

Proposal for substantial service change Pre-reconfiguration discussion with CCGs, AT and OSC & Stakeholders Development of Programme Brief Health Gateway and ICAG report delivered assurance Develop Full pre-consultation business case, consultation documentation Business case and consultation agreed with CCGs and AT Proceed to consultation 12 week minimum consultation process Analysis consultation responses Preferred options drawn up and submitted to CCG CCG Governing Bodies make final decision OSC to meet to discuss CCG Governing Bodies final decision OSC content Proceed to implementation Scheme not pursued Review findings and agree actions Amendments in discussion with AT OSC not content OSC referral to Sofs SOfS referral to IRP SofS rejects referral Sofs upholds referral

Modelling Access (Travel Time) Data Provider Trust Financial information Available Workforce Information on potential optimum HASU configuration options available using only access (30 mins) & workforce Provider Trust Financial information re critical mass becomes available Information on potential optimum HASU configuration options available using only access (30 mins) & workforce Provider Trust Financial information re critical mass becomes available Programme Board makes recommendation on future HASU configuration Discussion/Decision with CCGs/AT and OSC on potential options Further Analysis required Develop pre-consultation business case Independent Clinical Advisory Group Feedback and recommendations Health Needs Assessment Cost Benefit Analysis Programme Board makes recommendation on future HASU configuration Discussion/Decision with CCGs/AT and OSC on potential options >6 HASUs Develop pre-consultation business case case >6 HASUs Develop pre-consultation business case case 6 HASUS Improvement through existing contractual arrangements 6 HASUS Improvement through existing contractual arrangements Further Analysis required Jan- Feb 2014 Feb 2014 March 2014 March – May 2014 July 2014 July/August 2014 July/August 2014

Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14 Oct 14 Nov 14 Dec 14 Jan 15 Feb 15 Mar 15 Scoping √ Activity Modelling √√√ Financial Modelling √√√ Public Health data √√√√ Provider Submissions √√ IEAG √ CBA √√ Recommendation PB √ Decision 7 CCGs √√ Public Consultation √√√ Milestones

Recommendation for 6 HASU sites – improvement through existing contracts Recommendation for less than 6 HASU sites – formal public consultation followed by competitive procurement process Procurement Strategy

Communication & Engagement Lead on programme board Communication & Engagement Sub Group in place Communication & Engagement high level plan in place e.g. Governing Bodies, Overview and Scrutiny Committees Populating a comprehensive Communication and Engagement Stakeholder Plan Patient Advisory Group to offer assurance to the process Stroke Engagement Event aimed at patients and their carers – 30 January 2014 Communication & Engagement

Future Communication Monthly updates to all stakeholders Confidential detailed reports for the key decision points will be sent to CCGs, Area Team and Overview and Scrutiny Committees Minutes of the Programme Board and respective sub-groups

Recommendations: The Governing Body is asked to: Note and endorse the programme scope & approach including governance arrangements Agree sign up to the: – Memorandum of Understanding – Conflict of Interest – Confidentiality agreement Ensure CCG has sufficient representation Ensure CCG has in place a process to accept and agree a decision on Programme Board recommendations

Questions? Nighat Hussain Stroke Programme Director