Agenda and draft minutes

Dr Robert Luder

John Murray

The Chair will consider the admission of any late items of urgent business.  (Late items will be considered under the agenda item where they appear.  New items will be dealth with at Item 9 below).

None

A Member with a personal interest in a matter who attends a meeting of the authority at which the matter is considered must disclose to the meeting the existence and nature of that interest at the commencement of that consideration, or when the interest becomes apparent.

A Member with a personal interest in a matter also has a prejudicial interest in that matter if the interest is one which a member of the public, with knowledge of the relevant facts, would reasonably regard as so significant that it is likely to prejudice the Member’s judgement of the public interest and if this interest affects their finanicial position or the financial positions of a person or body as descibed in paragraph 8 of the Code of Conduct and/or of it relates to the determining of any approval, consent, licence, permission or registration in relation to them or any person or body descibed in paragraph 8 of the Code of Conduct.

None

To approve the minutes of the meeting held on 3^rd September 2008.

Approved

To receive a presentation from Homaira Khan, Stroke Prevention Officer, Stroke Association on the work of the organisation and key messages for stroke prevention work.

Work currently being undertaken is funded by a Section 64 Department of Health statutory grant.

Funded for 3 years.

Project is about getting people to act on their risk factors.

Four pilot areas: Brent, Ealing, Hillingdon and Tower Hamlets.  These areas were chosen due to their ethnic diversity and the fact that they have divides in outcomes.

Starting point is mapping local Wards and working out which Wards have a higher prevalence.

Partnership working is key to success in stroke prevention.

Need to find out what health promotion work is going on in the area and ensuring that stroke is covered.

Any targeting needs to be specific and and people need to be careful not to group ethnicities together based on false assumptions.

Some areas have ‘Health Trainers’ which sit under the Public Health umbrella.  The role of the Health Trainers is to educate the population on health and aspects of their lifestyles which impact their health by going into the Community.  This is a different role to that of Community Matrons.

It is important to have local ownership to projects.

Examples of Projects:

Healthy Recipe Cards.

·        These recipes were put together by students of Thames Valley University.

Patient Toolkit from April 2009.

·        This feeds into the forthcoming Vascular Checks.  

·        Patients will be given a toolkit after they have had their Vascular Check. 

·        The toolkit is locally owned e.g. it has the PCTs mission statement on it.

·        Will include a card with information on Blood Pressure, for example what is ‘good’ and what is ‘high’.

·        Will have a range of contact numbers in for example smoking cessation, dietary advice etc.  Local GPs are engaged in the process and start by picking out which contact numbers of relevant for each patient.

All projects aim to be sustainable – they will be available regardless of which posts are in place at the Stroke Association.

Strategic Development

•         “Assessing need and prioritising

•         Engaging with local community organisations, existing networks and the third sector

•         Setting up focus groups; talking to stroke survivors and at risk groups about gaps in stroke prevention

•         Training:- The recent publication of the National Stroke Strategy talks of the role of primary care and highlights the lack of knowledge even amongst health professionals

•         A shift from an NHS centred approach to more involvement from local authorities, with a more “pro-active approach to preventing ill health” (commissioning framework for health and well being)

•         Use of terminology:- The difference between ‘hard to reach’ and ‘don’t know how to reach’

•         Don’t expect people to come to you

•         What do you/they do once you’ve reached them?”

(Stroke Association Slide 8)

Nationally 62% of people are able to identify what a stroke is from a multiple choice list.  This is believed to be lower in London.

Sickle Cell Aneamia is a big risk factor for stroke.  This is especially the case for children aged 2-10years where there is a big risk of multiple strokes.

Teachers should be aware  ...  view the full minutes text for item 14.

To receive a presentation from Jinty Wilson, North Central London Cardiac and Stroke Network.

The Panel received a presentation from Jinty Wilson, Director of North Central London Cardiac and Stroke Network.

The North Central London Cardiac and Stroke Network (NCLCSN) is part of the National Improvement programme and aims to assist in the implementation of the Nations Stroke Strategy.

NCLCSN covers Barnet, Enfield, Haringey, Islington and Camden.

The NCLCSN has links with a wide variety of organisations for example the London Ambulance Service, Voluntary and community groups, commissioners, primary care, local authorities etc.

Eager for Primary Care engagement to ensure that there are local solutions to take forward national policy.

Noted that men between the ages of 40yrs and 74yrs are difficult to reach.

Strokes are more likely to happen whilst a person is sleeping.

The London Ambulance service is engaged with an 8 minute target for reaching possible stroke patients.

The reaction for strokes needs to be faster than that for heart attacks.  Two hours to get a cardiac patient to treatment e.g. angioplasty is good, but there is a need to faster for stroke patients.

For an ischaemic stroke you have a three hour window for effective treatment – therefore the decision as to whether to thrombolyse needs to be taken within 2 hours.

Need to keep the wider Healthcare for London work in mind for this review as the review will need to complement this.

A bidding process is currently taking place for Trusts.  Some are bidding to become Transient Ischaemic Attack Treatment centres and some for Hyper Acute Stroke Unit Status.  The closing date for these applications is 17^th November 2008.

Outcomes for Strokes in London are worse than those outside London.

Vascular Risk Assessments are being implemented by PCTs in early 2009.  These checks are for 40-74yr olds.

Concern that Older People may be slipping off the radar.

Jinty attended a Health Screening event in Brent Cross which was unundated with people.

Points of Discussion

GPs do not necessarily know where the TIA clinics are, the information is not readily available and it is therefore not clear where they can send patients.  Having TIA clinics on Choose and Book would help GPs considerably.

To receive a presentation from Adrian Hosken, Senior Commissioning Manager, Haringey Teaching Primary Care Trust.

The Panel received a briefing from Adrian Hosken, Senior Commissioning Manager, Haringey TPCT.

Haringey has high mortality rates for strokes at the same time there is only 2218 patients on the Stroke Register.  With an expected prevalence of 8-9% it would be anticpated that this number would be higher.

Main target for Haringey is VSA14 – Quality Stroke Care (outcome: reduction in stroke related mortality and disability).  Haringey is currently rated as red on this target and therefore needs to improve.

Noted that VSA14:06 (proportion of people with TIA who are scanned and treated within 24rs) has a target of 25%.  Query as to what the current performance is given that the target appears quite low.

Vascular Risk Assessments (VRA)

The TPCT is currently working on plans for the roll out of the Vascular Risk Assessments with a local implementation group currently being pulled together.

How will people know about them?  There needs to be an awareness raising campaign which tells people what exactly they need to do in order to get a VRA.

What is the timetable for the roll out?

Noted that an article in Haringey People would be beneficial and that it should be in at least three key community languages.

Need to carefully consider how to market the VRAs.

Agreed that regular updates would be receievd by the Panel from Adrian.

Points of discussion

To improve outcomes for people who have had a stroke it is anticipated that the acute spend for the NHS would need to increase from £65 million per annum to £85 million per annum.  Therefore prevention is important to keep overall costs down in the first place.

Mapping of QOF data may enable people to see whether there are geographical areas with problems.

Noted the difficulties with getting men to attend primary care.  Men generally want to be able to access health care ‘then and there’ when they need it.

To receive a briefing from Lisa Redfern, Assistant Director, Adult Services, on the stroke prevention work currently undertaken by Adult, Culture and Community Services.

The Panel received a briefing from Lisa Redfern, Assistant Director for Adults, Adult, Culture and Community Services Directorate (ACCS).

Haringey ACCS is in receipt of a Stroke Grant of £92,000 per annum for three years.  This funding will include the recruitment of a Stroke Care Co-ordinator which will be a joing post with the TPCT.

            Noted that there needs to be sustainability with this post so that it does not go at the end of the three years.

ACCS is a wide directorate which is able to combine resources e.g. it has parks and leisure under its unbrella as well as social care.

Strong multi-disciplinary pathways are needed for stroke care in Haringey – this is an area which needs to be worked on.

There are a number of projects and initiatives being supported by ACCS, information on these can be found in the attached briefing.

Training

Importance of training staff on FAST and stroke is noted.  This needs to be more than a one off training session.  There needs to be a mechanism for following up the training e.g. through a Work Force Development plan, jointly with the TPCT. 

The training should be about more than recognising symptoms, should also cover recognising risk and knowing what needs to be done in a potentially emergency situation.

Training could include Meals on Wheels staff as they have regular contact with those who are at a high risk.

None

19^th November 2008

18:30-20:30