WASP Meeting 2012

Minutes of the Welsh Association of Stroke Physicians Meeting
20th September 2012
Newport Hilton

In Attendance

Dr Richard Dewar (Chair) DD    Dr D Benjamin    Dr A White
Dr Phil Jones (Secretary and Vice Chair) PJ    Dr G Ramadurai    Dr T Hasan  TH
Dr M El Khatieb    Dr J Thomas    Dr P Khanna
Dr A Freeman  AF    Dr S Chenna    Dr H Shetty  HS
Dr M Wani  MW    Dr A Haden  AH    Dr Y Bhat
Dr A Verma    Dr P Thomas  PT    Dr C James
Dr B Richard    Dr A Dunn    Dr T Hughes  ToH
Dr S Ramakushna    Dr A Jafar  AJ    Dr T Bayer
Dr S Aithal    Dr S Ahmad  SA    Dr J Hewitt
Dr V Koppula    Dr V Adhiyan   

Apologies

Dr D Mukhopadhyay

The committee members were confirmed as:

Dr R Dewar, Chair
Dr P Jones, Vice Chair (secretary for this meeting)
Dr Y Bhat, SE Wales Representative and lead for Welsh Stroke Bulletin
Dr D Mukhopadhyay, SW Wales Representative
Dr Krishnamurthy Ganeshram, Secretary
Dr H Shetty, Education and Training
Dr M Wani, Outgoing Chair
Dr A Freeman,

Dr Ailsa Dunn was nominated and seconded and accepted the role of Mid Wales representative. The current terms of reference will need to be reviewed to incorporate this welcome change.
Dr Ganeshram was to confirm acceptance of secretarial role as reported to the meeting and to look at a new N Wales representative.

Action: ToR to be reviewed and amended by chair and secretary with respect to a new Mid Wales rep and the duration of posts and succession planning.
By: End of October 2012
PJ to write to Dr Ganeshram (email 25.9.12, KG confirms his role as secretary).

The minutes of the last WASP meeting were reviewed and agreed for accuracy. The last meeting was noted to be September 2011.

Dr Dewar in his inaugural meeting as Chair welcomed members and asked to set the agenda aside for the meeting so that he could outline his two year plan against the backdrop of the various groups involved in stroke improvement in Wales.

Dr Dewar’s slides are appended as attachment 1.
There was an explanation of where we were in terms of the all Wales picture and the various achievements that had been made across Wales (notably the institution of 24/7 stroke thrombolysis in all health boards and TIA clinics) plus the challenges that lie ahead (timely carotid surgery for example).

Finally DD presented his “Wish List” of those areas where we should look to improve over the next few years. There was much debate from members and support for the list plus suggestions for additions:

Action: Regional representatives to collate regional views on the “Top 5” local issues that we need to focus on over the next few years. Collated views to be returned to DD.
By: End of October 2012

TH    Need to prioritorise stroke rehabilitation and the early supported discharge teams.
PJ    All Wales data set to facilitate research
AF    ? align with SSNAP to facilitate uptake in due course (although there was not yet a commitment to SSNAP in Wales)
HS    Congratulated DD on his vision, highlighted the need for equity of services, the need for accurate data collection, the benefits of newer agents for stroke risk reduction in AF (a conflict of interest was also declared in this regard). He also highlighted progress in the acquisition of stroke trainees – 3 currently with a fourth looking likely for ABM. Highlighted the value of the AWSM, congratulated Dr Bhat on the development of the WSB website (a sentiment widely echoed by the members) and the need for an academic stroke unit in Wales.
AH    Noted the need to reduce the delay to admission following stroke, the limitations of rtPA with regards to proximal MCA events and need for a contracted clot retrieval service for Wales. HS noted that the recent case for this had been declined
PT    eloquently expressed concerns over political leadership and the need for public education to improve access to rtPA.

A debate over the range of eligible stroke patients was held (ie the percentage who arrive in time for rtPA) and ways to improve the figure.

AF    Highlighted the need to keep getting the good news stories in the local press to maintain awareness and public knowledge.
MW    Noted that once over the public FAST campaign had seem little continued benefit – reiterating the need for continuous local stories.

The debate shifted to the issue of hemicraniectomy.

Action: DD to write to neurosurgeons including agreed criteria for this procedure to try and advance the argument. The need to include an accurate estimation of impact was also highlighted.
By: End of October 2012
AJ    noted that the need to improve prevention was at least as important as the role of hemicraniectomy – particularly with regards to primary stroke risk reduction in atrial fibrillation.
DD    agreed but also expressed the view that warfarin should remain the drug of first choice in this regard – we know how to use it and the side effects whereas newer drugs often seem to have unexpected side effects which come to light after a year or two of widespread usage.

Problems with the TIA database were widely acknowledged and a feeling that the tool was not fit for purpose.

AF    asked for feedback from WASP members to help improve the tool

Action: All – to consider issues of data collection in general and TIA in particular. Views to chair please.
By: End of October 2012



YB    Raised the confusion of groups linked with the stroke programme and asked if they could be rationalised.
AF    responded with a more streamlined approach under consideration. This design will be considered by policy leaders.

Outcome Indicators

AF outlined the rationale for the proposed outcome indicators – they need to be comparable to those used in other disease areas and other geographical areas. Equally the rationale for the supporting evidence behind each indicator was noted. The overlap (and potential to integrate) with SSNAP in due course was evident.

A debate over SSNAP took pace with AF noting that the sign up to SSNAP was of the order of 20% among English trusts with a very large number of data points required for the programme.

ToH     Highlighted the value of participating in RCP audits in terms of the comparisons available and the organisation being done for us.

It was proposed that comments on the proposed outcome indicators were collated.

Action: All via lead of regional representatives – to comment on proposed outcome indicators.
By: End of October 2012

SA    Raised the issues with regards to clot retrieval around costs and the need for LHB’s to commission an all Wales service.
MW    expressed the need to get an idea of numbers involved to inform the case