CCG to centralise acute service in long-awaited reconfiguration

Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group is proposing to centralise nearly all acute stroke services at North Bristol Trust’s Southmead Hospital. This will involve removing services from Weston Hospital and Bristol Royal Infirmary.

The centralisation would mean all stroke patients in the integrated care system, which matches the CCG, transported by ambulances would be sent to Southmead Hospital, except for a very small number of residents in the south of the ICS who are closer to Somerset Foundation Trust’s Musgrove Park Hospital.

According to the business case, the commissioners hope their preferred option for centralisation will be completed by November 2022.

The reconfiguration is estimated to save the ICS around £3m annually through reductions in long-term care costs for patients whose outcomes would otherwise have been worse. However, the savings will “predominantly” be realised in social care, the business case said.

The proposals come five years after the then Sustainability and Transformation Partnership created a stroke reconfiguration programme board to lead the redesign of the region’s stroke care pathway.

Under the plans, Southmead Hospital would host a hyper acute stroke unit and an adjacent acute stroke unit. Bristol Royal Infirmary, run by University Hospitals of Bristol and Weston, would only treat patients whose specialist needs rendered them unable to be transferred to Southmead.

Weston Hospital, also run by UHBW, would only retain a “sub acute rehab unit”, which would treat patients undergoing rehabilitation from strokes.

The centralisation has been drawn up in response to widely acknowledged variation in the quality of stroke services across the ICS. Although all three hospitals currently provide acute stroke care, including thrombolysis, there is variation in operating hours, service provision and workforce.

North Bristol Trust, which runs the biggest service, is outperforming the other two hospitals in the Sentinel Stroke National Audit Programme, which measures the quality of NHS stroke services.

The CCG’s business case referred to centralisations of stroke services in other areas such as Greater Manchester, London and Northumberland which it said had improved patient outcomes.

The plans are currently subject to a public consultation. The consultation includes a second set of proposals which would centralise most services  at Southmead but with Bristol Royal Infirmary retaining an acute stroke unit.