Agenda item

This report sets out the case for change and the proposals developed by Trust clinicians for improving the current acute medicine and chest pain patient pathways.  The Trust wishes to engage as widely as possible on the proposals during a planned engagement period.

The Chair welcomed Mick Fisher, Head of Public Affairs and Dr William Oldfield, Deputy Medical Director, from Imperial College Healthcare NHS Trust. Dr Oldfield outlined plans to adjust acute medical and chest pain patient pathways.  Currently, patients would be admitted and could wait several days before seeing a specialist doctor.  With specialisms becoming increasingly hi-tech, the aim was to ensure that delays were reduced and that the patient accesses appropriate treatment more efficiently.  To illustrate, following initial assessment a renal patient will be seen by a renal specialist, without the buffering through an acute medical assessment stage, maintaining the same level of intervention but without any delay.  Dr Oldfield stressed that the number of beds will remain static.  In Hammersmith Hospital, in the cardiology station there would be an additional 15 beds and 8 beds for renal and haematology patients, he confirmed there would no bed closures. Dr Oldfield commented that the hub and spoke model was already operational in terms of cardiology at Hammersmith Hospital.  Councillor Joe Carlebach commented that it would be helpful to receive detailed information on bed numbers and allocation indicating the previous position and how this changed. 

ACTION: ICH

Debbie Domb, Disabilities Campaigner, enquired whether the length of time for treatment would be longer if she were to be admitted on a Saturday.  Dr Oldfield confirmed that this was a 7 day a week, 24 hours a day service and would not impinge on the availability of the service.  He reiterated that no beds would be lost.  In response to a point raised by Councillor Hannah Barlow, Dr Oldfield replied that staff rotas would become more robust as a result of the changes, removing any delay to specialist treatment will also mean greater long term resilience for service delivery and patient care.  Councillor Brown, enquired about stroke services and Dr Oldfield confirmed that this was already operating under this model, the difference being that London Ambulance Service (LAS) would transport an acute stroke patient directly to the nearest hyper acute stroke unit.  This will continue to be the case for suspected heart attack patients conveyed by LAS to the heart assessment centre at Hammersmith Hospital whilst the new chest pain pathway establishes itself.  Eventually, it was hoped LAS will also  transport other cardiac-origin chest pain patients directly to the nearest specialist unit. 

Responding to a query from Councillor Andrew Brown, Dr Oldfield confirmed that the 10% of patients were referred by GPs (outpatients), and approximately 10-15% were seen by emergency services.  Developing this point further, Councillor Holder asked what would happen to a patient that presented themselves (without chest pain) to a hospital and Dr Oldfield explained that they would be transferred to the appropriate site. Councillor Holder requested an assurance that the consultation process would actively engage the public and how this would be managed.

Councillor Vaughan sought additional assurance that the consultation would be of sufficient length as well as fully engaging a range of patients that might be affected by the proposed changes.  An inclusive consultation process would alleviate any concerns and clearly explain how the service works going forward. Confirming that the consultation had been launched on 13^th June, comments would be sought from Healthwatch, staff, CCGs, cardiac and renal patient groups and external stakeholders up to 15^th July before a decision was taken at the Trust Board public meeting at the end of the month. 

Councillor Vaughan thanked the Trust for the presentation and recognised the rationale that, in terms of Cardiology, this was an extension of current practice so that those who are both at risk or are in the process of having heart attacks are going straight to the specialist site, potentially eliminating any delays.  The Committee was supportive of the proposal going forward and plans to grow the service but would like to see the baseline figures in terms of how the number of beds might be configured at each site.  In addition, it would also be useful to know Cardio mortality rates to produce comparative before and after data, during the change implementation period.   Similarly, to see if the cost predictions from the changes materialise as anticipated.  Councillor Vaughan asked that an update as to progress on the service changes be reported back by the end of 2016, early 2017.