WASP Meeting 2011

 

Minutes of WASP meeting

Hilton Hotel, Newport

08 September 2011

 

 

In Attendance

Tom Hughes

Mushtaq Wani

H G M Shetty

S Ahmad

Harish Bhat

Susan White

A Verma

P Thomas

T Anjum

N Davis

Pradeep Khanna

Taj Hassan

A Jafar

S Ramakrishna

A Hoff

Granville Morris

Bella Richard

Manju Krishnan

A Freeman

 

 

 

1. The evening began with a presentation from Alex Hoffman from the RCP. Her connections with Wales and Cardiff go back to her days as a student of speech and language therapy in Llandaff.  She was given a warm welcome and then delivered an interesting and relevant lecture which provoked much comment!

“I enclose the presentation for which I am very grateful to Alex.” 

The discussion that followed revolved around the problems of trying to improve services by reconfiguration rather than with new investments.  Attention was drawn to the funding disparity between England and Wales.  The commitment shown to service improvement was described but it was also pointed out that individuals working unsustainable hours is not good for long-term service development.

Dr Wani thanked Alex for travelling to Wales to speak to us, and for her informative presentation.


2. Andrew Jones presented an update of the acute bundle (presentation enclosed).

The improvements since April are obvious with recent averages reaching 93% for the first hours bundle and 81% for the first day bundle and the first 7 day bundle.

 

Access to an acute stroke unit continues to be a barrier.

For the TIA and Rehabilitation bundles the reporting has been poor and the Executive heads should be made aware of this.

Regarding the data some familiar points were raised including problems with data entry, duplication of data entry on to existing departmental databases, and the hours of manpower required ensuring that the data is of high quality.

Further generic comments were made about the importance of influencing Chief Executives and of attending meetings during which executive members can be informed about the potential savings resulting from well organized stroke care e.g. length of stay etc.

The difficulty of ensuring that any savings resulting from changes in things like length of stay were put back in to stroke services, rather than used as justification for ward closure, was mentioned.

We were informed that the Intelligent Targets will be publicly reported in the future and this can be used as leverage, particularly for service development following reporting by the local press.


3. Minutes of the last meeting

Despite being sent out very promptly and being a most detailed account with a number of interesting enclosures, there were no comments or amendments and these were duly signed off.


4. Stroke Risk Reduction (Health & Social Care Committee enquiry)

Mark Drake is chairing this committee and due to a clerical or administrative error it seems that BASP were invited to submit written and/or oral evidence (a task given to Pradeep Khanna) but WASP and the WSA were not!

Disappointment was expressed by many members, many of whom felt that representation by WASP was very important.  It was decided that Anne Freeman should accompany Pradeep Khanna to the enquiry.  All members were invited to submit written evidence.


5. RCP Outpatient records survey

Dr Shetty urged all members to complete this survey.


6. NICE consultation on Rehabilitation

It is expected that the WSA will respond to this, as well as executive leads and the SDG.  It was also suggested that the Chairman of WASP should respond.  Dr Wani asked Dr Susan White if she could collate the opinions of WASP members and reply on behalf of WASP.


7. Thrombolysis and Telemedicine

Dr Freeman gave a brief update on the progress with installation, the governance framework and the importance of registering all thrombolysis cases on a common database such as SITS.

Tele-medicine training is planned during September and clinical teaching is planned to promote the early use of the equipment.


8. Thrombolysis Window

It was proposed that WASP support on extension of the thrombolysis window from 3 hours to 4.5 hours, a proposal supported by a number of guidelines, including SIGN.  A show of hands confirmed that the majority of those presented supported this idea.

It was suggested that a draft document be put together to help clinicians engage their health boards.

A first draft is enclosed.

It was pointed out that to protect the clinician some form of information sheet and/or a consent form would have some merits.

 

9. Interventional radiology

A new neuroradiologist, Dr Yogish Joshi, has started in UHW and it is proposed that a thrombectomy service model be developed so that patients with large artery occlusion could be considered for clot retrieval as well as, or instead of, intravenous thrombolysis.

If this becomes routine practice, or if a trial (e.g. the PISTE trial) is done to kick-start the service, it will have considerable implications for service design in South Wales (particularly if Swansea are not set up to take part), and will probably involve patients from North Wales travelling to Liverpool.


10. Decompressive craniectomy

A lack of clarity about the role of craniectomy following acute cerebral infarction prompted a discussion which led to Dr Wani suggesting that Dr Freeman write to the neurosurgeons to seek a consensus.


11. Workforce documents

Wales continues to be under-resourced and the BASP workforce planning document has helped to highlight this.  We are probably 15 consultants short, with two posts unfilled.


12. SpR training

A discussion with Professor Tom Robinson is required to clarify on-call issues in the proposed job plan of the one year stroke training program.  Discussions closer to home are planned for 14 October 2011 with Dr Mike Page.

Dr Peter Thomas raised an important issue about stroke training needing to be embedded in general medicine, particularly in Wales where rural hospitals require physicians with a sound grounding in all specialties.  The repertoire of skills required by a stroke physician in a metropolis in England are different to those required in a rural hospital.


13. Education framework

Dr Shetty has arranged an excellent training day on 3/11/11.  It will be held in the Village Hotel.  Attendance will be “free”.

 

14. Auctions

On the basis of the votes received Dr Phil Jones will be the new secretary.  It was suggested, and accepted, that there be two vice-chairs of WASP, one with responsibility for rehabilitation (Dr Susan White) and one for acute (Dr Bella Richards).

Dr Shetty suggested that job descriptions be written for each of the Vice-Chairs, and Phil Jones was nominated to do this!


15. Associate membership

It was suggested that the membership be expanded by inviting all medical professionals who are involved with stroke to become members.  Dr Wani asked for all suggestions to be sent to him.


16. WASP & BASP

It seems that the executive of BASP will discuss the nature of the relationship between BASP & WASP, and Martin James will let us know the outcome.  Dr Peter Thomas urged members to help preserve the independence of WASP so that we can make the most of access to the Health Minister.

 

17. Welsh Stroke Conference

This is always superb.  The next one is planned for 22 June 2012, in the Newport Centre.


Date of the next meeting :  To be confirmed

 

Tom Hughes

Secretary of WASP