North Bristol NHS Trust
NHS / Health Body
Action Planned
North Bristol NHS Trust will explore with University Hospitals Plymouth and Royal Cornwall Hospital Trust what support they can offer for out-of-region referrals as UHP transitions to a 24/7 thrombectomy service in October 2023. (AI summary)
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Dear Mr Davies,
Re: Regulation 28 following the Inquest into the Death of Mr Anthony John Reedman
I write further to the Regulation 28, dated 22nd November 2022, issued as a result of the inquest into the death of Mr Anthony John Reedman. The Regulation 28 raised two key concerns, namely:-
1) There is no thrombectomy service available 24/7 for Royal Cornwall Hospital Trust (RCHT) patients. Over the last year it is estimated that 75 stroke patients in Cornwall who would otherwise be suitable for thrombectomy procedures did not receive this procedure because it is not available 24/7 in Cornwall, unlike for example those who live in Bristol.
2) The nearest 24/7 thrombectomy service is at North Bristol NHS Trust. However, there is no service level agreement between Southmead and RCHT for the treatment of patients from Cornwall when the UHP service is available. This limits the options available to RCHT clinicians in considering treatment for stroke patients. Firstly, we would like to express our sincerest condolences to Mr Reedman’s family for their loss. Background to the thrombectomy service at North Bristol NHS Trust and thrombectomy services nationally The clinical benefits of providing a mechanical stroke thrombectomy service are well supported by evidence and thrombectomy has been formally recognised by NHS England (NHSE) as a priority for Specialised Commissioning. The NHS Long Term Plan outlines the rising demand for stroke and in particular the improvement for stroke services and requirement for thrombectomy Trust Headquarters Gate 3 Level 2, Brunel Building Southmead Hospital Westbury-on-Trym Bristol BS10 5NB
Website: www.nbt.nhs.uk
A University of Bristol Teaching Trust. A University of the West of England Teaching Trust. Information Classification: CONFIDENTIAL expansion. Funding and commissioning of mechanical stroke thrombectomy in England is managed through the local NHS England Specialised Commissioning team. Mechanical thrombectomy is an established service at North Bristol NHS Trust and we are the second biggest (as per the SSNAP report 20/21) provider of mechanical stroke thrombectomy procedures in England. In October 2020, North Bristol saw the introduction of a 8am – 8pm seven day thrombectomy service. Despite challenges over the last few years, our thrombectomy service has continued to make significant progress, and from December 2022 this service expanded to 24/7, seven days a week funded and supported by NHSE Specialised Commissioning. This service is staffed by a combination of the following: resident nurse practitioner, resident middle grade doctor, stroke/neurology Consultant, interventionalists, neuroscience doctors, radiographers, nursing staff and anaesthetists. North Bristol is part of the Integrated Stroke Delivery Network and our thrombectomy service currently covers patients residing in the Severn region (Gloucester, Bath, Taunton, Bristol, Yeovil and Cheltenham) and Swindon and our commissioning responsibility is aligned to that geography. We recognise that out of region referrals will occur and our services will support such referrals if clinically and operationally possible. NHSE Specialised Commissioning teams are deciding on the roll out of the funding and commissioning of 24/7 mechanical stroke thrombectomy services in England. University Hospitals Plymouth NHS Trust (UHP) are responsible for tertiary stroke services for Treliske Hospital, Truro and we understand that in line with this roll out UHP are working towards offering a 24/7 seven days a week thrombectomy service from 1st October 2023. Next steps On an interim basis, as University Hospitals Plymouth transition to a 24/7 seven days a week thrombectomy service in October 2023, we will explore with them and RCHT what support North Bristol can offer by way of out of region referrals in an attempt to mitigate the risk of patients that are suitable for thrombectomy procedures not receiving this procedure. We apologise we are unable to assist any further than this given the NHSE commissioning arrangements are outside of North Bristol NHS Trust’s control. I hope you will take some assurance from this letter that we have taken seriously the concerning points you made in your Regulation 28 report.
Re: Regulation 28 following the Inquest into the Death of Mr Anthony John Reedman
I write further to the Regulation 28, dated 22nd November 2022, issued as a result of the inquest into the death of Mr Anthony John Reedman. The Regulation 28 raised two key concerns, namely:-
1) There is no thrombectomy service available 24/7 for Royal Cornwall Hospital Trust (RCHT) patients. Over the last year it is estimated that 75 stroke patients in Cornwall who would otherwise be suitable for thrombectomy procedures did not receive this procedure because it is not available 24/7 in Cornwall, unlike for example those who live in Bristol.
2) The nearest 24/7 thrombectomy service is at North Bristol NHS Trust. However, there is no service level agreement between Southmead and RCHT for the treatment of patients from Cornwall when the UHP service is available. This limits the options available to RCHT clinicians in considering treatment for stroke patients. Firstly, we would like to express our sincerest condolences to Mr Reedman’s family for their loss. Background to the thrombectomy service at North Bristol NHS Trust and thrombectomy services nationally The clinical benefits of providing a mechanical stroke thrombectomy service are well supported by evidence and thrombectomy has been formally recognised by NHS England (NHSE) as a priority for Specialised Commissioning. The NHS Long Term Plan outlines the rising demand for stroke and in particular the improvement for stroke services and requirement for thrombectomy Trust Headquarters Gate 3 Level 2, Brunel Building Southmead Hospital Westbury-on-Trym Bristol BS10 5NB
Website: www.nbt.nhs.uk
A University of Bristol Teaching Trust. A University of the West of England Teaching Trust. Information Classification: CONFIDENTIAL expansion. Funding and commissioning of mechanical stroke thrombectomy in England is managed through the local NHS England Specialised Commissioning team. Mechanical thrombectomy is an established service at North Bristol NHS Trust and we are the second biggest (as per the SSNAP report 20/21) provider of mechanical stroke thrombectomy procedures in England. In October 2020, North Bristol saw the introduction of a 8am – 8pm seven day thrombectomy service. Despite challenges over the last few years, our thrombectomy service has continued to make significant progress, and from December 2022 this service expanded to 24/7, seven days a week funded and supported by NHSE Specialised Commissioning. This service is staffed by a combination of the following: resident nurse practitioner, resident middle grade doctor, stroke/neurology Consultant, interventionalists, neuroscience doctors, radiographers, nursing staff and anaesthetists. North Bristol is part of the Integrated Stroke Delivery Network and our thrombectomy service currently covers patients residing in the Severn region (Gloucester, Bath, Taunton, Bristol, Yeovil and Cheltenham) and Swindon and our commissioning responsibility is aligned to that geography. We recognise that out of region referrals will occur and our services will support such referrals if clinically and operationally possible. NHSE Specialised Commissioning teams are deciding on the roll out of the funding and commissioning of 24/7 mechanical stroke thrombectomy services in England. University Hospitals Plymouth NHS Trust (UHP) are responsible for tertiary stroke services for Treliske Hospital, Truro and we understand that in line with this roll out UHP are working towards offering a 24/7 seven days a week thrombectomy service from 1st October 2023. Next steps On an interim basis, as University Hospitals Plymouth transition to a 24/7 seven days a week thrombectomy service in October 2023, we will explore with them and RCHT what support North Bristol can offer by way of out of region referrals in an attempt to mitigate the risk of patients that are suitable for thrombectomy procedures not receiving this procedure. We apologise we are unable to assist any further than this given the NHSE commissioning arrangements are outside of North Bristol NHS Trust’s control. I hope you will take some assurance from this letter that we have taken seriously the concerning points you made in your Regulation 28 report.