Graham's letter to Jeremy Hunt regarding Stroke care changes in Nottingham

Posted on 13 January 2017 (Permalink)

This is the letter the three Nottingham MPs wrote to the Secretary of State for Health:

Dear Jeremy,

We are writing to you regarding our urgent concerns with 30 Commissioning changes to local NHS provision in Nottingham, which will affect the rehabilitation of stroke patients in our constituencies from 1st April 2017. We are worried that pushing stroke patients back into the community and closing specialist stroke beds will mean many who are not fit enough to leave hospital will be left without a specialist stroke ward for them to stay in.  The Nottinghamshire Clinical Commissioning Groups have indicated that Nottingham University Hospitals NHS Trust (NUH) will be expected to close over 30 beds.

We understand that a letter sent in August by Mr Sam Walters, the Chief Officer of NHS Nottingham North and East (County) CCG, to Mr Rupert Egginton, the Director of Finance & Procurement at NUH, indicates that the 4 local CCGs have collectively decided to decommission inpatient stroke rehabilitation at NUH in favour of community-based provision.  County CCG then put the provision of Early Supported Discharge service (rehabilitation at home as it were) out to tender with a submission date of 30th November.  This was awarded to County Healthcare Partnerships and by now the process should be finalised.

While Nottingham City CCG are also expanding their existing community provision, they accept that some patients will have to stay in hospital 7 days after their stroke and will not be able to go home. County CCG on the other hand seem to be of the opinion that their new private provider, County Healthcare Partnerships, will somehow deliver inpatient rehabilitation if it is required after 7 days.  There was no mention of inpatient provision in the original tender description and we believe that the successful bidder has no plan to offer it for the money available (£1.5pa for up to 4 years).

Staff are already being advised that their jobs are at risk.  There could be quite a disparity between what is offered to patients from the City CCG compared to that available for the County CCG patients.  City comprise about 30% of NUH throughput and County the remainder.

There is a real risk that the new provider will not have been able to develop a viable service by 1st April 2017, in which case there is likely to be a disastrous hiatus.  Bear in mind that 'at risk' staff will begin to leave ahead of the date, even if NUH are instructed to maintain beds after 1st April by the CCGs, which will exacerbate existing nursing staff and allied health professional shortages and excessive reliance on agency staff.  What can be offered after 1st April is already likely to be compromised.

Can you please address our concerns outlined above and please tell us what actions your department are taking to ensure, first of all, that stroke patients in our constituencies won’t be left without adequate care from 1st April 2017, and what subsequent actions you will be taking to remove the disparity of care available between patients in the 4 CCGs within which the Nottingham University Hospitals NHS Trust operates?

We look forward to hearing back from you soon,

Yours sincerely,

Graham Allen MP, &

Lilian Greenwood MP, &

Chris Leslie MP


Graham has also collected the following quotes from stroke clinicians today who are deeply concerned about the impact of the Local NHS (CCG) cuts to the Stroke service in Nottingham:

“We have to accept that this purely about saving money and nothing about quality or outcome.”

“It all sounds highly unsatisfactory, there is a risk that many of the gains made in stroke care over the last 20 years will be lost.”

“The policy makers in the CCGs clearly don’t understand the evidence that specialist stroke care is not just about the initial acute event but even more importantly about the longer term management.”

“The local CCGs want to decommission stroke rehabilitation from NUH, i.e. take it out of hospital, leaving just the first 7 days (hyperacute and acute). The idea is for patients to be seen via Early Supported Discharge. What is meant to happen to more severe patients (e.g. those requiring tube feeding) is not clear - presumably stay in hospital but through what contract? One possibility is that such severe patients will be outlied throughout the hospital, i.e. we will return to the dark historical days where stroke patients were cared for on non-specialist wards. [This means that Beeston Ward, one of the two wards in the world that showed independently in a trial that rehabilitation improves outcome and reduces death and length of stay in hospital, may well be lost.]. Alternatively, only one of the rehabilitation wards may be kept.”

“I understand that there will be little role for stroke consultants in the new system, i.e. beyond the first 7 days - they may well be moved to Geriatrics or Acute Medicine thereby losing much stroke expertise.”

“Hospital-based rehabilitation staff are already being approached about their futures. Suffice to say, staff are very concerned and we will lose many, including some of the best staff who will not want to work in a service that focuses only on acute, and possibly very severe rehabilitation, patients.”

“The negative implications on Nottingham’s rich history of clinical research have not been considered (although this has been pointed this out to NUH and UoN). This will negatively impact on both acute and rehabilitation research. Suffice to say the clinical researchers are very concerned.”

Also Elaine Roberts, Director North of England- Life After Stroke Services, for the Stroke Association commented:

"Stroke is a devastating condition. Two-thirds of stroke survivors are left with a disability after their stroke, so timely access to high quality rehabilitation is vital to ensure that all stroke survivors can make their best possible recovery. Unfortunately, we hear every day from stroke survivors who feel abandoned as they have not received the support they need to help them recover.

We’re therefore very concerned to hear about these potential changes to stroke rehabilitation and support services in Nottingham, which local clinicians worry could leave stroke survivors without access to the right care and the support they so desperately need if they are to have the best chance of recovery.

We are investigating this situation locally and would urge the CCG to clarify what rehabilitation and support services will be available to stroke survivors in Nottingham without delay.”