Healthy Ambitions Bulletin May 2009

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2 Welcome to the Healthy Ambitions bulletin. It provides a regular update on key pieces of regional work that are being taken forward to support the implementation of recommendations made by local clinicians and others in Healthy Ambitions. Delivering Healthy Ambitions explains how the recommendations in Healthy Ambitions are being taken forward either locally or regionally. The majority of work is being taken forward locally, led by Primary Care Trusts. This update focuses on regional work. If you have queries or feedback please use the contact details on the final page. 02

3 Stroke Update The clinicians working on the acute care pathway in Healthy Ambitions highlighted the need to improve stroke care to save lives and reduce disability from stroke. To support the drive to improve stroke care across Y&H the SHA is working with the three cardiac and stroke networks in the region to develop a stroke assurance framework. This work is building on the work of the Y&H Acute Episode Clinical Pathway Group (set up as part of the NHS Next Stage Review), the national stroke strategy and the standards already set by both the North Trent and West Yorkshire networks in their models of stroke care. The aims of the stroke assurance framework are to: Be clear about the service standards which will lead to the best outcomes for patients (based on the best available clinical evidence) and which should therefore apply to all providers of stroke services across the region Provide guidance for PCTs on the pathways and standards that they should be commissioning from their providers Learn from the approaches already being taken at local and sub-regional levels and the impact of these approaches Assure plans for improved stroke services and provide a basis for an approach to accreditation based on the different levels of service provided by different units This work is being undertaken by a sub group of the Healthy Ambitions Acute Pathway Delivery Board. The sub group is chaired by David Dawson and includes clinicians and managers from the cardiac and stroke networks. Notes of meetings and full details of membership are available on request to sarah.kocinski@yorksandhumber.nhs.uk Draft stroke assurance framework Taking a pathway approach the sub group, has identified seven key elements of a stroke service, each of which has a set of standards within it. The seven elements of the draft framework are: 1. Effective prevention 2. TIA and minor stroke management 3. Acute stroke care 4. Acute Stroke plus thrombolysis 5. Specialist intervention by neurosurgery 6. Stroke rehabilitation a. Acute b. Early supported discharge c. Continuing rehabilitation 7. Coordination role if services shared between centres or as part of a network In addition to these seven service elements the sub group has examined the different descriptions of stroke units being used by the networks (e.g. acute stroke unit, primary stroke centre, comprehensive centre, hyper acute stroke unit etc). Given the multiplicity of terms in use the draft of the assurance framework proposes describing units on a simple 1 to 5 scale. This will provide a clear description of the various different types of units across the region whilst allowing different terminology to be used as deemed appropriate locally. 03

4 Stroke Update Continued. The proposals for describing these five levels of service and the ways in which these relate to local terminology is shown in the table below: SHA Level North Trent (South Yorks) West Yorks North and East Yorks * Elements of comprehensive service include: Level 1 Comprehensive centre Tertiary neurosciences service Specialist intervention by neurosurgery Hyper acute diagnosis for patients presenting in first 6 hours Acute management of stroke if established >6 hours TIA and minor stroke management Level 2 Primary stroke centre Hyper-acute stroke Unit Hyper acute diagnosis for patients presenting in first 6 hours Acute management of stroke if established >6 hours TIA and minor stroke management Level 3 District stroke centre Acute stroke unit TIA and minor stroke management Acute management of stroke if established >6 hours Level 4 Stroke recovery unit Level 5 Continuing rehabilitation post discharge Continuing rehabilitation post discharge Continuing rehabilitation post discharge Effective (secondary) prevention *Includes North, East and Northern Lincolnshire Areas 04

5 Stroke Update Continued. It should be noted that it could be that different hospitals might be designated as providing different levels of service at different times, e.g. in and out of hours. Also the service levels are not mutually exclusive so a level 2 centre may well also provide level 3 and 4 services. Next steps The sub group has worked though all of the service elements and levels to produce an initial draft of the assurance framework. Sarah Halstead (from the North Trent network) and Gillian Richardson from the West Yorkshire network) along with colleagues from all networks are now working through all of the standards in detail. They will recommend combined agreed standards back to the group at its next meeting in May. Possible approach to the implementation The group agreed to propose the following approach to the implementation of these standards: Networks to carry out a baseline assessment against the standards Gap analysis to be produced, leading to a plan to address them, along with the relative levels of priority and timescales as described above 2009/10 networks to carry out internal peer review exercise to assess levels of service along with this gap analysis/plan A decision about the final version of the assurance framework and the approach to implementation will be made by the Strategic Commissioning Board (made up of the SHA and all PCT CEs with clinical and LA input) following discussion at the Acute Pathway Delivery Board. It will be important to ensure all decisions are taken with full understanding of the organisational impact. Work is underway to design how this might be done most effectively. Full details will be provided in future editions of this bulletin. For further information, or to discuss the work of the sub group please contact helen.dowdy@yorksandhumber.nhs.uk or tim.barton@yorksandhumber.nhs.uk 2010/11 inter-network peer review leading to accreditation for individual units against the service levels described in the appendix Linked programme of service improvement to run alongside these reviews. Helen Dowdy (Associate Director of Strategy at the SHA) will discuss possible approaches to this with Laura Hibbs (Innovation and Improvement Lead at the SHA) and Lis Rogers (SHA clinical lead) Networks to take consistent approaches to data collection working with HIY&H 05

6 Vascular Review The clinicians working on the planned care pathway as part of the Next Stage Review recommended a review of the organisation and delivery of vascular services. Their view was that this was a priority and necessary to ensure the best standards for patients and to ensure services were delivered by specialist teams working as a part of a network with clear governance arrangements. As a result of the recommendations made by these clinicians the SHA has agreed with the Y&H Specialised Commissioning Group (SCG) that it should undertake the vascular services review. It was agreed that this piece of work should be one of a small number of Healthy Ambitions recommendations to be taken forward at regional level. It will be overseen by the Planned Care Delivery Board as described in Delivering Healthy Ambitions. The SCG launched the review in October 2008, with the following terms of reference:- to agree the most appropriate patient pathway for patients requiring vascular services to assess the level of need for these services across Yorkshire and the Humber to develop service specifications and standards for the provision of these services, in order to identify options for providing resilient vascular services across the region, which deliver world class outcomes for patients, cater for local need and inform the delivery of planned and future vascular screening programmes The manager leading the review for the SCG is Pia Clinton-Tarestad, Chris Welsh, SHA Medical Director is SRO for the review at the SHA. Progress so far and next steps include; Producing a draft service specification for vascular services in line with comments from Chris Welsh and following a sense-check with vascular clinicians who have expressed particular interest (David Berridge, Leeds, Jai Patel, Leeds, Peter McCollum, Hull, Nick Shaper, Bradford). This was widely circulated to stakeholders on 16 March Feedback to be reported to the SHA and SCG A clinical event to discuss areas of debate and reach clinical consensus Final Service Specification and Designation Standards to go to all providers for completion of self-assessment Summary report to SCG and SHA scheduled for Sep 09 At this point, the review will pause, to allow the SCG and SHA to reflect on the report and consider the potential need for strategic change and the implications. Communication Each PCT and NHS Trust within Yorkshire and the Humber has provided a list of stakeholders whom they would wish to be kept informed of the review process. Pia Clinton-Tarestad from the SCG has written to brief them and to encourage wide engagement with the review. 06

7 Clinical Leadership Work to broaden and deepen clinical leadership to deliver Healthy Ambitions is underway. As we stated in Delivering Healthy Ambitions: Implementation will need strong clinical leadership and clinical involvement at every level in every NHS organisation in the region Local Leadership A clinical leadership network has now been established with 120 clinicians developing key implementation projects within their local organisations. The CLN holds its first meeting on 28 April and individuals will agree to deliver change projects in their locality. Pen portraits of all CLN members will be circulated so this resource can be utilised and best practice shared amongst local organisations. Pathway Leadership NHS Yorkshire and the Humber are in the process of recruiting a team of senior clinical figures to work with the existing clinical pathway chairs to offer clinical leadership and involvement across pathways. Senior clinical leaders will be seconded for up to one session per week over a year. Members of the Healthy Ambitions Pathway Delivery Boards, these leaders will offer clinical leadership to the implementation of Healthy Ambitions recommendations and enabling work including the regional service reviews. The vacancies are currently listed on NHS Jobs ref: SHA. Interviews and appointments will be made during May. 07

8 Governance Arrangements are being put in place to establish the governance structures described in Delivering Healthy Ambitions. Each of the original eight pathways plus primary care and cancer are being overseen by a pathway delivery board (PDB) chaired by a PCT Chief Executive, supported by senior clinical leaders and an SHA senior manager. These groups are currently agreeing their full membership and have responsibility to assure themselves of delivery on key issues and priority areas. They will identify developments relevant to their pathway, including any further work that may be required and advise the Strategic Commissioning Board on risks to delivery. We are currently finalising local authority input to each of the PDBs. The Strategic Commissioning Board will have oversight of the entire Healthy Ambitions programme including; region-wide implementation, regional service reviews and enabling work. This group, chaired by the SHA CE and attended by PCT CEs will meet quarterly beginning in June. The key roles for each clinical pathway are as follows: Pathway Staying Healthy Maternity and Newborn Long Term Conditions Children s Services Planned Care Acute Care Mental Health End of Life Primary Care Lead CE Simon Morritt Andy Buck Ivan Elul Chris Outram Jan Sobieraj Jane Lewington Ailsa Claire Alan Wittrick Rob Webster Senior Clinical Leaders Wendy Richardson Vacancy Dotty Watkins Eileen Burns Vicky Pleydell Ian Lewis Ian Jackson Mark Baker David Dawson Nick Morris June Toovey David Levy SHA Lead Manager Kay French Jean Hawkins Colin McIlwain Jean Hawkins Ian Holmes Amanda Bloor Heather Raistrick Cath Wardle Helen Parkin Cancer David Levy Brian Hughes 08

9 Further information can be found at and Or contact