Agenda and minutes

No declarations of interest were made by Members.

Key Issues:

The Chair explained that the purpose of the meeting was to hear contributions from partner services and a stroke survivor to help the Adults Select Committee understand more about Stroke Services in Monmouthshire.

The Select Committee received a presentation from the Executive Director of Therapies and Health Science, Aneurin Bevan Health Board.  Following the presentation, Members asked questions and made observations.

The Committee watched a short film clip demonstrating the importance of quickly recognising the symptoms of a stroke and to act FAST (Face, Arms, Speech, Time to call 999) because the quicker treatment is obtained, the better the outcome. 

The Committee heard that services work well together and it was explained that the stroke pathway has been redesigned to make the service better for residents in the Gwent region.  Service performance is monitored both internally and by Welsh Government. 

Historically, services for stroke patients were provided at 11 different hospitals and allocating specialist members of staff to those sites, to provide the same level of service, was problematic hence the redesign using the best clinical evidence available.

It was explained that most suspected stroke patients, who live in the Gwent area, will automatically be transported to the Royal Gwent Hospital (RGH) where they will be met at front door by specialist stroke team (9am – 5pm, 7 days a week).  The patient will quickly have a CT scan, and if it is determined they have suffered a stroke, they will be admitted to the Hyper Acute Stroke Unit (HASU) typically involving 3-4 days stay. Some people will recover quite quickly with some, little or no support and, if medically fit can be discharged home and receive rehabilitation there.

Patients from north of the region will be transferred to Nevill Hall Hospital stroke ward, patients from the west (Caerphilly area) will go to Ysbytty Ystrad Fawr and those in the south east will be transferred to St. Woolos Hospital.  The aim is to return the patient home, where recovery is quicker, as soon as possible with the support they need.

The Committee were provided with information about the establishment of a Community Neuro-rehabilitation team which is a multi-disciplinary service for those people medically well but in need of rehabilitation.

It was explained that since January 2016 there has been 7- day per week stroke consultant, nurses, physiotherapist and occupational therapist available.

Monmouthshire residents will no longer be taken to Nevill Hall Hospital and a concern has been raised that it takes longer to travel to RGH both for the patient and for relatives in terms of travel and parking.  It was explained that to minimise the impact, the ambulance team will telephone the hospital ahead to notify that a possible stroke patient will be arriving whereupon they will typically be met at the door by the specialist stroke team.  An assessment will be conducted and if it’s not a stroke, patients suffering a Trans Ischemic Attack (TIA) can benefit from having the necessary tests and the necessary advice  ...  view the full minutes text for item 2.

Key Issues:

Richard Lee, Executive Director of Operations, and Louise Platt, Assistant Director of Operations provided a presentation on the Wales Ambulance Services NHS Trust.

It was explained that the most popular reason to call an ambulance in the UK is related to older persons falling and requiring assistance.  Capacity is the biggest challenge. The strategic aims were explained and also the three services lines of Emergency Medical Services and Urgent Care Services (Yellow Ambulance), non-urgent Patient transfer (White Minibuses) and NHS Direct Wales.

It was explained that there is an Ambulance Five Step Model which breaks down the service starting with helping patients choose what service is most appropriate for their needs and also the availability of available alternative services.  It was confirmed that, regrettably, trivial calls still come through 999 calls. The second step involves the importance of call takers finding out as much as possible about a patient’s condition.  It was also explained that paramedics and nurses are also utilised to take calls to filter out those patients that don’t need an ambulance, and to prioritise as appropriate. 

The third step involves deciding the most appropriate health board service to visit a patient.  The fourth is to ensure that the most appropriate treatment is provided and finally the fifth option, the decision to take the patient to hospital.

The Clinical Response Model was explained and details of how priorities are drawn were provided. An example of the response to a Red category call was provided explaining that the first response at the scene will be either a paramedic in a car, the fire service, a community first responder or a Police Community Support Officer; second to arrive will be an ambulance.  The Ambulance Service Trust is working hard to ensure that defibrillators are available in every community and sought the support of the Council to secure defibrillators in hard to reach areas; the need for no specific training to operate the equipment was emphasised.  It was explained that, unlike the previously available, lengthy course and expensive machinery, a 20 minute course can now be provided for a machine costing less than £1000.

It was explained that Amber category calls (65% of call volume) are responded to by an ambulance on blue lights.  It was explained that the ideal response has been defined for every call and the example was provided of a person suffering a suspected stroke who will be sent an emergency ambulance with a two person crew of emergency medical technicians who can conduct a FAST test, and can convey the patient to the appropriate hospital.  A patient suspected of having a heart attack will be sent an ambulance with a paramedic to administer an ECG.

Green calls may not necessarily require an ambulance or for whom their GP has requested an ambulance to transport them to hospital, and will not have a blue light response.  These patients may be spoken to over the telephone and asked to make their own way to hospital for  ...  view the full minutes text for item 3.