Agenda item

11.30 am

The purpose of this item is to report on progress by Oxfordshire Primary Care Trust (PCT) and the Oxford Radcliffe Hospitals NHS Trust (ORH) in developing and improving stroke care and prevention in Oxfordshire. A paper by Suzanne Jones, Senior Commissioning Manager, PCT; Dr James Kennedy, lead consultant for Stroke at the ORH and joint regional clinical lead for Stroke; and the PCT’s Development Manager for Stroke is attached at JHO8.

Members of the Committee welcomed Sylvie Thorn, Mary Barrett and Suzanne Jones, Oxfordshire PCT;  and Dr James Kennedy, Consultant in Stroke Medicine, Oxfordshire Radcliffe Hospitals NHS Trust to the meeting. They gave a presentation to the Committee and afterwards responded to questions. There follows a selection of those that were asked and the responses received:

Q         To have a stroke is a very frightening experience, what kind of information is available to patients and their families and friends afterwards?

R         (Sylvie Thorn) We have tried to address this by setting up a one year pilot scheme whereby a Stroke Co-ordinator is based at the ORH Stroke Unit. That person will work with the patients, on a face to face basis, who have been admitted. The Co-ordinator will give them the advice and information they require and signpost them to other services, if needed. S/he will also contact patients at home and signpost them back into services if this is so required.

Q         Will services such as physiotherapy and speech therapy be available for patients in their home?

R         (Suzanne Jones) The PCT has put in some investment into this service. They have concentrated on the acute side first, then it will be the turn of the rehabilitation side.

Q         Will everybody be called in for some kind of screening for stroke?

R         (James Kennedy)  We are not investing in it – there are no risk factors for stroke. Dr McWilliam and his deputy reported that currently there is in situ one clinic in Oxford City and two in Banbury who are offering the service for one year for targeted patients. We invited GP practices in the area to identify screened patients from the 43 – 47 age group, who might be offered intervention or treatment. The programme plan is to eventually expand across Oxfordshire.

Q         At what stage does the County Council’s Adult Services take over? How does funding work out with the PCT?

R         (Suzanne Jones) In respect of the first question, the decision is made on a clinical basis. When somebody has a long term care need, any decision is made by the people looking after that person. In respect of the funding, at the moment it is carried out via a handover from Health to Social Care. The Stroke Association have a return to work programme on the voluntary side.

Sylvia Thorn commented that funding goes through the normal process integrating the additional services that have been developed since the Strategy started. We use the grant to try to develop services. At the end of the pilot scheme.

James Kennedy further commented that the Strategy is the paradigm of necessity for Health and Social Care to work together. Formerly the intensive acute model could not be matched with social Care. Now we are trying to run with Social Care in at the beginning of the process in order to manage people’s expectations and in order to smooth out the pathway and make it seamless. Our job is to get the maximum recovery possible.

The Committee AGREED to note the progress report and also to note that Health and Social Care may be required to take action to maintain coordination once pump priming monies are put in place, as it was possible that funding might not be included within the next service review.

Dr McWilliam commented that it was good to now have prevention in at the start of a patient’s pathway. He asked James Kennedy if the funding for the prevention programme in the right place.  Dr Kennedy responded in the past, funding had focussed only on acute care, but this was now changing. The SHA and the Clinical Stroke Network were taking the preventative aspect very seriously and they would be performance managing the PCT and the section managers, He added that the United Kingdom had a very bad record for unhealthy life styles.

Q         Unfortunately there does not appear, so far, to be ‘joined up’ thinking in terms of life style and awareness training. Many people do not see their GPs very often and therefore are under the ‘radar’. Is there sufficient publicity for it?

R         (Dr Kennedy) Yes. People have a clear idea of what a heart attack entails, but it is a different picture for stroke. The Stroke Association will only achieve persistent media coverage of issues such as the signs appertaining to mini strokes, in television ‘soaps’.  The Stroke Association are given a total of 130 minutes of public awareness media time. It has chosen to select opportunities to highlight the prevention agenda, such as targeting the television programme ‘Top Gear ‘ for screening its message, which attracts a targeted audience of middle aged males.

Dr McWilliam pointed out that Public Health were also carrying out outreach. For example, information had been given out and Health Checks performed at  two football matches in a bid  to get people, particularly middle aged men,  into screening earlier.

Q         Do you do work with the younger generation?

R         (Dr McWilliam) Yes prevention is part of the promotion of a healthy lifestyle, ie. Healthy eating, weight control and exercise.

Q         How are you addressing the challenge to get the Oxfordshire public more involved?

R         (Dr McWilliam) We are starting a Stroke Community Forum, the first meeting of which is on 17 February. It will include a number of stroke survivors and their carers and will highlight and discuss a number of communication problems. A web site is also being set up where members of the public can pose questions to be answered if they are not able to come along to the Forum.

(Dr Kennedy) This is indeed a major challenge and the targets will have huge outcomes and be of enduring benefit. Stroke has had its moment in the sun with these new initiatives. This Committee could assist in this by keeping up the pressure on Health and Social Care to maintain the co-ordination between them once the pump priming money is put in place. The danger might be that it may not feature in the next service review.

The Committee thanked Sylvie Thorn, Mary Barrett, Suzanne Jones and James Kennedy for responding to questions and for taking part in the discussion. It was AGREED to note the progress report and also to note that Health and Social Care may be required to take action to maintain co-ordination once the pump priming monies are put in place, as it was possible that funding might not be included within the next service review.