The NHS England 2016/17 Business Plan stipulates specialist services for stroke, heart attack, major trauma, vascular surgery and children’s critical care will be organised into networks to ensure the highest standards of access and treatment. The purpose of such specialist centres is to maximise good outcomes through the provision of high quality services that are resilient and sustainable over the longer term, and that meet the minimum thresholds of institutional activity for these conditions laid out in professional guidance and in national policy and commissioning specifications.
As part of Sustainability and Transformation Plans (STPs), transformational footprints are required to set out their plans to achieve 7 day services by 2020. However, there is a national commitment that all urgent network specialist services (vascular surgery, stroke, major trauma, STEMI heart attack, and children’s critical care) will implement the 4 priority clinical standards by autumn 2017 which include:
- Timely consultant review: All emergency admissions have a thorough clinical assessment by a suitable consultant as soon as possible, but at the latest within 14 hours of arrival at hospital.
- Improved access to diagnostics: Hospital inpatients have scheduled 7 day access to diagnostic services. Consultant-directed diagnostic tests and reporting available 7 days a week: within 1 hour for critical patients; within 12 hours for urgent patients; and, within 24 hours for non-urgent patients.
- Consultant directed interventions: Hospital inpatients must have timely 24 hour access, 7 days a week, to consultant-directed interventions.
- Ongoing review in high dependency areas: All high dependency patients (including acute medical unit, surgical assessment units and intensive care unit) seen and reviewed by a consultant twice daily, unless it is determined by a senior decision-maker that this would not affect the patient’s care pathway; and consultant- directed ward rounds.
The SW CN has mapped the provision of hyperacute stroke, primary percutaneous coronary interventions and complex cardiology services for the region. The remit of the project was to provide the clinical context and to understand the regional and local implications of national policy and standards on emergency and elective cardiac and stroke services, including compliance with specialised commissioning national service specifications. As well as the net clinical benefits from time- and volume-sensitive interventions for both ST-elevation myocardial infarction and acute stroke, the analysis took into consideration co-dependency with other critical services such as vascular surgery and interventional neuroradiology.
The report offers detailed, evidence-based analysis supported by operational modelling expertise provided by the SW Peninsula CLAHRC. The options appraisal has shown that in order to develop a regional network of cardiovascular centres that is resilient to anticipated changes in demand, technology and workforce, services should be provided in either 6 or 7 Heart Attack Centres and between 8 and 10 Hyperacute Stroke Units. Taken as a whole region, the incremental gains from configurations at the upper end of that range are marginal. However, the dis-benefits from reconfiguration are not equally spread across the region, with particular issues of emergency access for people in North Devon, Wiltshire, and in some configurations, Torbay.
Clearly the implications of the available options need further consideration to ensure they reflect the needs of cardiovascular patients across the region as well as closing the three gaps across the health and care system that were highlighted in the Five Year Forward View. However, it is hoped the findings will inform thinking when developing the ambitions for the redesigning of urgent and emergency care services and the delivery of 7 day services.
The preliminary findings of the project were presented to key stakeholders in the region in November 2015.
British Cardiovascular Society (BCS) Working Group Report: Out-of-Hours Cardiovascular Care: Management of Cardiac Emergencies and Hospital In-patients
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