Appendix Wv ‘ Better , Best, Brilliant ’ 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
CONFIDENTIAL – DRAFT FOR INTERNAL USE ONL Y 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. T oday will cover: Timescale for implementation Track record Understanding of Capacity Understanding of Key Risks
Option A Darent Valley Medway Hospital Maritime Hospital William Harvey Hospital
Option C Medway Maritime Hospital William Maidstone Harvey Hospital Hospital
Option D Medway Maritime Hospital William Tunbridge Harvey Wells Hospital Hospital
CONFIDENTIAL – DRAFT FOR INTERNAL USE ONL Y 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 ONL Y Track Record Engagement with women on design and delivery of ‘ The Birth Place ’ for low risk birth HEADLINES • Patients already have direct Engagement with families and charity (Abigail's access to stroke services Footsteps) on maternity bereavement 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 ONL Y Engagement – stakeholder mapping Patients and public, Staff within the HASU and including stroke patients, host Trust, plus other health service user groups, and care providers Regular, clear, consistent Stroke Association message required to inform, A great deal of engagement has already involve and feedback to this Patients group. Staff taken place in the earlier and public stages of engagement and through formal consultation. Next step will be to provide understanding and External reassurance around the stakeholders HASU locations and to build confidence in the new model . 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 .
CONFIDENTIAL – DRAFT FOR INTERNAL USE ONL Y 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 ONL Y 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 • V ascular 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 ONL Y 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 ONL Y 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 ONL Y Understanding of key risks Likelihood Consequence R a ting Likelihood Consequence R a ting Title R isk D escription M itigia tion Plans (gross) (gross) (gross) (net) (net) (net) T he ability to attract and recruit qualified staff w ithin R ecruitment plan in place, w ith good R ecruitment 4 4 16 3 3 9 the reqw uired timeframe track record ov er past 12-24 months Potential long lead-in time on specilaist equipment R isk based approach to anticipating Estates 4 4 16 3 4 12 (refurbishment w orks) lead-in time w ith manufacturers C hange of therpay prov ision w ith recruitment plan commenced; amended Performance External factors influencing SN AP data score 4 3 12 3 2 6 consultant w orking pattern to prov ide additional thrombolysis serv ice
CONFIDENTIAL – DRAFT FOR INTERNAL USE ONL Y Implementation timeline Feb – Jul 2018 May – June 2019 Aug 2018 Sep 2018 Oct 2018 Nov 2018 Dec 2018 Jan 2019 Feb 2019 Mar 2019 Apr 2019 Approval of DMBC and Phased go-live Approvals Consul- preferred option agreed TBC # tation Develop DMBC Capital approval process * Estates requirements Transfer of activity and staff from closing sites Estates Estates – negotiations/leases/planning etc. Development of estate (refurb) Evaluation framework Metrics Clinical Service Dev Pathway development Pathway finalisation developed developed New pathways Baseline metrics start Determine improvement to service required pre go-live Implement improvements (i.e. telemedicine) Learning cycle Continuous learning cycle Evaluation roles starts defined defined Develop comms strategy Comms Develop comms plan Patient/User/Voluntary engagement events Staff informed of Public updates and information sharing on website / staff updates on intranet decision Workforce Post Recruitment and interviews Contingency Volunteer sector mobilised Develop JDs Workforce definition adverts Ongoing training and Detailed workforce plan Consult with Stroke Association Training / double running development On-going engagement and communication with workforce IG / IT Define IG/IT requirements IG/IT planning IG/IT implementation * Approval process dependent on level of capital required for each site in the preferred option
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
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