Hyper-Acute Stroke Unit deliverability at Medway NHS Foundation Trust Lesley Dwyer, Chief Executive Dr David Sulch, Interim Medical Director & Stroke Physician

4th September 2018

Deliverability Panel

‘Better, Best, Brilliant’

Appendix Wv

CONFIDENTIAL – DRAFT FOR INTERNAL USE ONLY

Welcome

We are proud to be presenting our approach to creating a HASU at Medway Maritime Hospital.

As a major emergency centre, we are experienced in delivering stroke services to a population with complex co-morbidities; particularly the highest cardiovascular disease in the region. Our patients are at the heart of our approach to the design of this model of care, and the engagement from our local community is evidenced in the public consultation, with the highest response coming from those in the ‘ME’ postcode, with most popular first choice being Option D. We have a robust plan, the capability and infrastructure to deliver a Kent & Medway model for a hyper acute stroke unit.

Today will cover:

Timescale for implementation

Track record

Understanding of Capacity

Understanding of Key Risks

Darent Valley

Hospital Medway

Maritime

Hospital

William

Harvey

Hospital

Option A

Maidstone

Hospital

Medway

Maritime

Hospital

William

Harvey

Hospital

Option C

Tunbridge

Wells

Hospital

Medway

Maritime

Hospital

William

Harvey

Hospital

Option D

CONFIDENTIAL – DRAFT FOR INTERNAL USE ONLY

Timescale for implementation

• Agreement in principle in place with local Council on

planning permission

• Refurbishment plan devised with anticipated go-live date of

June 2019

• Strong clinical engagement, led by Director of Clinical

Strategy (Dr Hamilton-Fairley) and Medical Director &

Stroke Physician Dr David Sulch

Initial architect drawings with

reconfiguration of existing estate to

house a Kent & Medway HASU

service.

CONFIDENTIAL – DRAFT FOR INTERNAL USE ONLY

Track Record

Engagement with women on design and delivery of

‘The Birth Place’ for low risk birth

Engagement with families and charity (Abigail's

Footsteps) on maternity bereavement services

HEADLINES

• Patients already have direct

access to stroke services

• Thrombolysis suite in our

new emergency department

• Multi-disciplinary team of

specialist stroke staff;

• Consultant ward rounds at least

once a day 7 days a week in

place

• Open 24 hours a day, 7 days a

week with access at all times to

brain scanning equipment and

clot-busting drugs

(thrombolysis) and the specialist

cover to review scans and

provide thrombolysis

CONFIDENTIAL – DRAFT FOR INTERNAL USE ONLY

Staff Patients

and public

External

stakeholders

Patients and public,

including stroke patients,

service user groups,

Stroke Association

A great deal of

engagement has already

taken place in the earlier

stages of engagement

and through formal

consultation. Next step

will be to provide

understanding and

reassurance around the

HASU locations and to

build confidence in the

new model.

Staff within the HASU and

host Trust, plus other health

and care providers Regular, clear, consistent message required to inform,

involve and feedback to this

group.

External stakeholders, including partner

organisations, MPs, councillors, Healthwatch

Stakeholders need regular and detailed information

about the service change and benefits. Their

feedback from their staff/members, constituents and

contacts is invaluable.

Engagement – stakeholder mapping

CONFIDENTIAL – DRAFT FOR INTERNAL USE ONLY

Track Record - Workforce

The graph on the left shows

monthly starters and leavers, with the purple line showing

the overall impact – a growing

increase in the number of nurses holding substantive

positions at the hospital

HEADLINES

• Recruited a stroke physician

• Successful nurse recruitment

campaigns in midwifery, ED and

wards showing a reduction in

nurse vacancy rates over 12

months

• Established nurse development

programmes with universities &

business schools

CONFIDENTIAL – DRAFT FOR INTERNAL USE ONLY

Understanding of capacity

• Medway NHS Foundation Trust cares for 520 stroke

patients per year using the existing 25 Acute Stroke beds

• Medway has following services on site:

• Interventional radiology

• Vascular surgery

• Thrombolysis suite already in our new Emergency

Department

• Investment in 2 new CT machines

• Medway location allows patients to get here within the

optimal time to ensure that appropriate treatment is

assessed and undertaken

• SSNAP rating is E – with factors influencing low score

CONFIDENTIAL – DRAFT FOR INTERNAL USE ONLY

Understanding of capacity

• Site location confirmed with clinical co-adjacencies

• Architects appointed

• Draft designs, with focus on Option D • Experienced delivery team, with strong governance

arrangements

• Planning permission confirmation by December 2018

• Work commencing January 2019

• Go-live date June 2019

• Confident on delivery within financial envelope indicated

CONFIDENTIAL – DRAFT FOR INTERNAL USE ONLY

Understanding of capacity Role Current HASU Gap

Consultant 2.5 6 3.5

Specialty Dr 1 1 0

Junior Staff 2 6 4

Trainee 0 1 1

Nursing 18.6 46 27.4

Nursing: Specialist 5 3+ 0

Physiotherapist 1.5 5.5 4

Occupational Therapist 1 5.5 4.5

Speech Therapist 0.5 2.5 2.0

Dietitian 0.3 1 0.7

CONFIDENTIAL – DRAFT FOR INTERNAL USE ONLY

Understanding of key risks

Title Risk Description Likelihood

(gross)

Consequence

(gross)

Rating

(gross) Mitigiation Plans

Likelihood Consequence

(net) (net)

Rating

(net)

Recruitment The ability to attract and recruit qualified staff within

the reqwuired timeframe 4 4 16

Recruitment plan in place, with good

track record over past 12-24 months 3 3 9

Estates Potential long lead-in time on specilaist equipment

(refurbishment works) 4 4 16

Risk based approach to anticipating

lead-in time with manufacturers 3 4 12

Performance External factors influencing SNAP data score 4 3 12

Change of therpay provision with

recruitment plan commenced; amended

consultant working pattern to provide

additional thrombolysis service

3 2 6

CONFIDENTIAL – DRAFT FOR INTERNAL USE ONLY

Implementation timeline

Feb – Jul 2018 Aug 2018 Sep 2018 Oct 2018 Nov 2018 Dec 2018 Jan 2019 Feb 2019 Mar 2019 Apr 2019 May – June 2019

Ap

pro

vals

Es

tate

s C

linic

al S

ervi

ce D

ev

Co

mm

s W

ork

forc

e IG

/ I

T

Approval of DMBC and

preferred option agreed

Workforce

definition

Estates requirements

Define IG/IT requirements

Consult with Stroke Association

Consul-

tation

Evaluation framework

developed

Continuous learning cycle

defined

Metrics

developed

Evaluation roles

defined

Baseline metrics

Staff

informed of

decision

Develop comms

strategy

Develop comms plan

New pathways

start

Develop DMBC

Capital approval process*

Phased go-live

TBC#

*Approval process dependent on level of capital required for each site in the preferred option

On-going engagement and communication with workforce

Public updates and information sharing on website / staff updates on intranet

Patient/User/Voluntary engagement events

Transfer of activity and staff from closing sites

Learning cycle

starts

Develop JDs Post

adverts Recruitment and interviews Contingency

IG/IT planning IG/IT implementation

Pathway development Pathway finalisation

Determine improvement to service required pre go-live Implement improvements (i.e. telemedicine)

Training / double running

Volunteer sector mobilised

Ongoing training and

development

Estates – negotiations/leases/planning etc. Development of estate (refurb)

Detailed workforce plan

In summary

• A HASU at Medway has always been our

strategic vision

• We have a credible and robust delivery

plan and have already begun to mobilise

this

• Our ambition is perfectly aligned to meet

the needs of our community