Welsh Stroke Alliance

Minutes

Meeting held Wednesday 14th March 2012

Venue: Stroke Association Offices Cardiff CF15 7AB

Chairman:Dr Anne Freeman

Secretary:Bevany Swanson

Present: / DrAnne Freeman / AF / WASP/Clinical Lead for Wales
Ken Smith / KS / Welsh Ambulance Service NHS Trust
Ana Palazon / AP / The Stroke Association, Director Wales
Michelle Graham / MG / 1000 Lives Plus
Dr Richard Dewar / RD / Regional rep for WASP (SE Wales)
Dr Louis Fligelstone / LF / Welsh Vascular Surgeons - Networks
Susan Wilson / SW / WAPS
Ruth Newenhuis / RN / RCSLT
Andrew Jones / AJ / DSU
Susan White / SW / WASP (Representing Dr Mushtaq Wani)
Carole Saunders / CS / WSNA
Ken Smith / KS / WAST
Julie Wilcox / JW / Clinical Psychology
Dr K Ganeshram / KG / Regional rep for WASP (N Wales)
Guest / Dr Geoff Tinkler / GT / PCQIS
Bevany Swanson / The Stroke Association, Minutes only
ACTION
1 / Meeting Governance
a. / Welcome and Introductions
Dr Freeman welcomed all to the meeting and introductions were made around the table for the benefit of Dr Geoff Tinkler who was invited to provide an update on current Atrial Fibrillation work within Public Health Wales
b. / Meeting Requirements
Housekeeping details provided.
c. / Apologies
The following apologies were received from:
Dr Alison Cooper
Mr Nigel Monaghan
Dr Alan Willson
Dr Mushtaq Wani
Daniel Harris
Dr Hamsaraj Shetty / Dr Phil Jones
Prof Ken Woodhouse
Dr Caroline Adams
Debbie Lavelle
Dr Tom Hughes
Theresa King
d. / Minutes of Meeting Held 16 November 2011
Content agreed and typos identified. Corrected minutessigned by Dr Anne Freeman.
e. / Matters Arising
Item 5 / Nigel Monaghan report
Welsh Government are now planning to link national audits to quality improvement work. NM is being invited to provide Public Health Wales input to this process, potentially this will include support for development and use of outcome measures within these audits.
Item 6 / Nigel Monaghan report
Following discussion it is suggested that any review of the process for data collection should be preceded by the rapid review of evidence for Transient Ischaemic Attack to inform that review. In addition the findings of such a review should be used to assist any “Post-Halcox” recommendations regarding vascular risk and primary care, including implications for Quality and Outcomes Framework.
2 / Future of WSA/NSAG (AF)
Deputy CMO Chris Jones has been reviewing all NSAGs with a view to changing these into multidisciplinary groups and the intention is that one of these would be stroke specific.
Discussion followed on whether WSA would co-exist alongside the new NSAG or cease to exist andwhat is the scope of the new NSAG. AJ explained that the WSA acts in an advisory capacity whereas NSAG’s have a direct medical link, therefore for WSA and a stroke NSAG to co-exist would provide greater scope for involvement within the stroke arena.
AJ advised that WSA would continue in its current format for the time being and consideration would be given to the possibility of WSA and NSAG running side by side in the future.
3 / Stroke Risk Reduction Plan (AF)
Health and Wellbeing Report
AF handed out an update report from Nigel Monaghan (see attached) regarding current works underway within Public Health Wales which is of interest to the WSA.AJ advised there will be a Public Health Wales event in Llandrindod Wells in April to discuss outcomes of the Health and Wellbeing report.
Action: AJ to forward details of April event to BS for distribution to members. / AJ
Ministers Response
The Minister has requested a five year plan, which has now been drafted and sent to WAG for both internal and then wider consultation.
It was noted that there is a slight delay with the stroke response going out to wider consultation.
Action: AJ to seek clarification from WAG on when the Stroke response will be released for wider consultation. / AJ
4 / 5 Year Stroke Plan
See above.
5 / Intelligent Targets; Update on Performance (AJ)
Generally across Wales bundles are reaching a compliance of 90% and above on a regular basis, however problems continue with access to stroke units within 24hrs.
Different levels of changeare now required around hyper acute management and opinion was sought on where the main problems currently lie in this area. The unanimous response was that the main difficulties arewith the timely flow from A&E through to a stroke unit.
RD commented that a flexible approach to this problem is used at Cwm Taf and worksdependent on staffing levels at the time. This has shown a positive resultand reducedthe mean average time from A&E to a stroke unit from 16hrs to 6hrs.
AF advised that consideration is currently being given to the benefits of having fewer hyper acute units as opposed to the current stroke units.
Action: AF to commence work on hyper acute facilities and update WSA as appropriate. / AF
6 / RCP Organisational Audit; Update on LHB (AJ)
Although this has proven to be a useful exercise and remains on-going
problemscontinue to become apparent with continuing use. Query was raised regarding delivery of figures on a monthly basis. AJ advised that this is patchy at present, RD commented that his team have found the figures useful formaking positive changes based on data outcomes and thateveryone should be using the data as a tool to develop services.
The clinical audit is due on the 2nd May 2012 and in preparationeach LHB has been considering their previous scores and completing action plans to fill the gaps. Improvement across Wales is anticipated and at release of the Royal College report in July a significant close in the current gap should become evident.
Action: AJ to present scores to WSA following dissemination of the final audit report in July. / AJ
7 / Changes to RCP Clinical Audit; Implications for NHS Wales (AJ)
The RCP clinical audit is changing to a web based tool which will be accessible to patients. AJ has developed a paper for presentation to WSA which assesses the changes and the options and best fit for Wales. Walesis considering whether to continue with intelligent targets and not to instigate the new model. Concern was raised that Wales might be seen to be opting out because of thepoor report received in a previous audit. It is ultimately the decision of the National Clinical Audit Unit in WG chaired by Chris Jones LF suggested an interim report noting the changes which would ensure that Wales is not seen to be opting out of the new audit method.
The current high priority should be TIA. AP queriedthe current position regarding a 24/7 service. AFadvised that a protocol has been developed and forwarded to Medical Directors for comment/input. Recommendations from WSA should then be presented to WAG
Action: AJ to pull together evidence base for the acute bundles and bring to the next meeting. / AJ
8 / Update: Life After Stroke (MG)
The programme is going well and meeting all timescales. A consultation event was held in Swansea on the 2ndMarch 2012 and proved to be very successful with 100 patients and carers attending. Attendees were asked for their input regarding services received from the point of discharge, what has been helpful, what hasn’t and what could be done to make improvements. The biggest complaint from the feedback has been that people have felt patronised and humiliated by health care professionals as well as a lack of information from GPs. MG is currently compiling a report of further recommendations for improvement.
A national event is planned for the end of May for service providers and following the identification of logistical difficulties another event is being planned for North Wales, this is in consultation and a date is expected soon.
MG hopes that the full feedback report will be issued within the next month and copies will be presented to the WSA.
Action: MG to forward feedback report to WSA
RN enquired how many of those attending the event on 2nd March had communication difficulties. These figures were not available however AP confirmed that the majority of the attendees came from The Stroke Association (TSA) services or stroke clubs that the TSA works with and did include people with language difficulties. The majority of the facilitators were staff from TSA. One of these is a qualified Speech and Language Therapist who ensured that the necessary communication aids were available.
AF asked if the Stroke Association has any plans to duplicate in Wales the new Life After Stroke centre that it has recently opened in Bromsgrove. APexplained that development of Bromsgrove would be closely monitored before the same would be considered for Walesbut the WSA would be kept posted regarding any future plans. / MG
9 / AF Management in Primary Care (Dr Geoff Tinkler)
Dr Geoff Tinkler representing Primary Care Quality Information Services attended the meeting to provide an update on the Atrial Fibrillation works being completed at the present time by Public Health Wales. A paper was handed out showing the driver bundles for AF services and an overview was given of the AF report setting out a ‘how to guide’ and a ‘technical explanation’of the process.
GT explained the process of anti-coagulation services across Bridgend, Neath Port Talbot and Swanseaand the problems currently being experienced in instigating this new recommended protocol.
The programme is currently not being used and will be reliant on the good will of GPs to get it off the ground neither are services currently being monitored by PCQIS. GT explained current anti-coagulation procedures across Bridgend, Neath Port Talbot and Swansea and the difficulties in getting LHBs on board. A response from the Minister suggests that QOF might be adapted to include AF. GT asked if the WSA could be involved in developing the provision of a timely anti-coagulation service across all areas.
AJ raised concern that at present the programme is based on good will only and by giving GPsthe option to opt outmeans the paper will carry no weight for full instigation. Attendance at the Cross Party Group on Stroke was suggested to forward this programme.
Request: GT asked for the guide to be recommended and steered by the WSA.
Action: GT to provide updates at future meetings. / GT
10 / Access to surgical intervention/advice – What does the WSA want/need to ensure rapid access? Integration of Stroke and Vascular networks – time to set standards (LF)
LF, a Vascular Surgeon for ABMU, stated that work undertaken between Stroke service/Radiology/Vascular Surgery has produced a practical pathway resulting in quality improvement for the reduction of stroke rates following TIA.The current service is audit compliant and is performing well. LF and colleagues are now looking towards the development of a gold standard service in which the ideal timescale would see a 48hr window from referral to surgical intervention.
LF explained the need to integrate stroke and vascular networks, set the gold standard and ultimately ensure rapid access to services.
The WSA was asked to consider the grey area as to whether a patient with 50%+ stenosis with high risk carotid plaque and presenting symptoms appropriate for that carotid territory should be considered for surgery.
24/7 vascular provision was also discussed and LF advised that Vascular surgical on call is currently in place in three networks within Wales, however this is not a fully integrated service, as there is not full vascular anaesthetic support, nor is there a facility for ultrasonic imaging in the event of a complication. 24/7 provision serving the populationwould be the ideal, however this would place an undue strain on scarce ultrasound resource. A pragmatic approach could provide sufficient ultrasonographic cover (e.g. 4 hours cover on Saturday and Sunday mornings) would allow for diagnosis and either planning for cases to be done within 48 hours and also cover for emergency cases required to be done during the weekend.
Agreed: LF to develop and deliver regular updates at future meetings.
Action: LF to invite AF and AJ to Welsh Vascular Surgeons meeting in September. / LF
LF
11 / Any Other Business
AP – for information
There will be a Stroke Association rebrand soft launch in Cardiff on the 4 April at the College of Music and Drama, anyone wishing to attend should contact r further information.
AF – for information
The Welsh Stroke Conference 2012 will take place on 22ndJune at the Newport Riverfront Centre, details for enrolment and payment can be found on the new website at
CS - WSNA
The WSNA has recently been re-launchedand CS now holds the position of Chair. Each LHB has been requested to provide 3 representatives and a work program is currently in development.
12 / Agree Key Messages (all)
To be completed by Bev and forwarded to AF for approval
13 / Meeting Dates for 2012
All meetings to be held at The Stroke Association National Office for Wales, Cardiff from 14:00 – 16:00 unless advised otherwise.
Wed 18th July
Wed 14th November

Minutes approved by Chair:

………………………………..…………………………..

Dr Anne Freeman Date

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