Agenda item

This report seeks to inform the Medway Health and Adult Social Care Overview and Scrutiny Committee about an emergency service transfer of the Medway and Swale TIA (Transient-Ischaemic Attack) service that was effective from 26th June 2023. The report will explain what led to the emergency service transfer, the timeline involved, the options considered, how the service is currently operating and the potential number of patients affected by this change.

Discussion:

Members considered a report about an emergency service transfer of the Medway and Swale TIA (transient-ischaemic attack) service that was effective from 26 June 2023. The report explained what led to the emergency service transfer, the timeline involved, the options considered, how the service s currently operating, and the potential number of patients affected by this change. 

In response to a comment that it had been disappointing the Committee had not been told about this change and had found out about it through other channels, the ICB representatives acknowledged this should not have happened, apologised and undertook to make sure this did not happen in future.

The following issues were discussed:

Transport times – it was noted that when the acute stroke service had been moved from Medway, the Committee had previously been told that the TIA service was a mitigation for this. Statistics from the Southeast Coast Ambulance Service showed that it took 90 minutes to transport patients to a place of care. The consultation on stroke review service had said over an hour was too long. Members were advised that TIA was different to a stroke and most TIA patients were referred by their GP and did not arrive by ambulance. There was no wish for patients to travel more than they needed to and the ICB wanted to treat patients as close to home as possible and felt people would not be disadvantaged in terms of outcome by travel times. The providers of the TIA service (Maidstone and Tunbridge Wells NHS Foundation Trust and Dartford and Gravesham NHS Foundation Trust) had been issued with information about providers and organisations (including the voluntary sector), commissioned and non-commissioned that could support patients and carers to access their services. The Medway and Swale Health and Care Partnership had been helpful in collating this information to share with providers and referrers to aid in conversations with patients.

In relation to Members’ comments about the emergency stroke pathway and SECAmb travel times to stroke units, Members were advised that the Integrated Stroke Delivery Network was responsible for monitoring the effectiveness of the pathways, including travel times. People were able to access patient transport services if eligible. If not eligible, there were a range of other services provided by the voluntary sector and also commissioned services to ensure patients are not disadvantaged with regard to travelling to Maidstone or Dartford for TIA management.

Returning the service to Medway – Members asked if the ICB planned to recruit staff and bring the service back to Medway. The ICB representatives responded that the issue was not about funding but the availability of a skilled workforce. Virtual treatment had become more common since Covid. It was always desirable to deliver services as close to home as possible but important to ensure the service is also safe and viable.

The plan was for the service to be brought back to Medway, provided the stroke clinicians supported the model and the timelines around TIA services set out in national guidance could be safely delivered. Currently the stroke clinicians did not feel the service could be delivered safely in Medway hence the current model had been implemented and included virtual elements such as video and telephone appointments with stroke experts so that as much of the care as possible could be delivered locally. Patients were able to be seen in person in clinics as well should virtual appointments not be suitable to meet the needs of the patients.

Prevention – Members were advised there was a national campaign on prevention and the ICB was looking at how primary care could better recognise TIA symptoms.

Remote care – noting not everyone was able to access remote care, whether help could be provided in Healthy Living Centres was queried. Members were advised that assessment and potential diagnosis was done by GPs and patients were then referred to the TIA service who would then determine what diagnostics are required and onward refer for those. Members were advised that some patients would still be seen face to face.

Safe local diagnostic pathway – a concern was expressed that this element of the pathway may not be implemented until at least quarter 4 of 2023/24 due to an IT system implementation that was not scheduled until the end of quarter 3, therefore what assurance could be given around whether this remained on track and who was responsible for this system implementation. The Director of Public Health commented that the Council was part of the Integrated Stroke Delivery Network so could give some assurance on monitoring progress against that. Members were also advised that responsibility for Ordercomms (the electronic IT system which allowed diagnostic tests to be ordered instantly) was the responsibility of Medway NHS Foundation Trust and not the ICB and so support from partners was welcome to support its timely implementation. Once implemented, this would allow diagnostics to be delivered locally.

Decision:

The Committee agreed to:

a)     note the report.

b)     express its disappointment at not being informed of this emergency transfer at the time.

c)     request that the ICB, in the case of any future emergency service transfers, notifies the Committee as soon as possible that consultation will not take place and the reason for this.

d)     request a report to the October meeting setting out whether the TIA service will be coming come back to Medway and when this will happen and, if not, what are the reasons.