Improving stroke services in , North and South Gloucestershire

Have your say: 7 June to 3 September 2021 Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group – who are we?

Bristol, North Somerset and Over the last two years we have worked This booklet summarises the changes South Gloucestershire Clinical with more than 500 people to look at ways to BNSSG CCG proposes and why. improve stroke services. These include: You can find out more about who we Commissioning Group (BNSSG are at https://bnssgccg.nhs.uk/ CCG) is responsible for planning • People who’ve had a stroke, their carers and families You can read more about the consultation and buying health services for • Doctors, nurses, therapy staff, and at bnssghealthiertogether.org.uk/ the 1 million people who live health and social care professionals stroke-services/ in our area. BNSSG CCG • Local councils is carrying out this public • Charities like The Stroke Association consultation on behalf of and Bristol After Stroke our wider Healthier Together • Members of the public.

Partnership of ten local health Research and insight has informed the and care organisations. proposals set out in this booklet and now we would like people to have their say as part of this public consultation.

02 | Improving stroke services in Bristol, North Somerset and South Gloucestershire Contents Introduction 04

1. What is a stroke? 05

2. Why do we need to change stroke services in our area? 11 This document sets out proposed changes to Improving emergency treatment 13 stroke services in Bristol, Improving ongoing acute treatment 19 North Somerset and South Gloucestershire. It focuses on Improving rehabilitation services 24 services at Weston General Hospital, 3. Integrated Community Stroke Service 28 and Southmead Hospital. 4. What would the changed stroke journey look like? 30 Following consultation and once a decision has been made by the Governing 5. How would our proposed changes improve 33 Body of BNSSG CCG; the changes could treatment and care? be put into place over a 12-month period.

6. Have your say 35

7. References 39

03 | Improving stroke services in Bristol, North Somerset and South Gloucestershire Introduction

Stroke is a serious, life- With the right specialist treatment, care and services staff, people who have experienced threatening condition that support, people can go on to live full and stroke, and those from partner organisations. independent lives. We are proposing to affects around five people change the way stroke services are The proposals support the NHS Long Term in our area every day. One organised and run in our area, so that Plan to make the NHS fit for the future, and everyone in Bristol, North Somerset and to get the most value for patients. These in eight people who have a South Gloucestershire will have the best proposals also build on the stroke prevention stroke will die within a month, opportunity to survive and thrive after stroke. and longer term rehabilitation programmes already underway, and represent an exciting and two thirds leave hospital Our vision – designed in partnership with opportunity to improve survival and recovery with a disability1. people and communities – is an ambitious rates for people affected by stroke in Bristol, one. Under our proposals, we would bring North Somerset and South Gloucestershire. our specialist teams and resources together, to improve people’s care and outcomes and Now we need to hear from you on the proposed achieve the latest clinical quality standards. changes. This is the opportunity to have your Everyone would have access to highly say and help us to transform stroke care for specialised treatments immediately on everyone in our area and ensure a high-quality arrival in hospital, 24 hours a day, 7 days and sustainable service for the future. a week, wherever they live. Dr Jonathan Hayes Julia Ross Over the last two years, we have reviewed Clinical Chair Chief Executive the latest national evidence, and engaged of BNSSG CCG of BNSSG CCG with more than 500 people in our community. Our proposals have been co-designed with people including senior doctors, frontline stroke

04 | Improving stroke services in Bristol, North Somerset and South Gloucestershire What is 1 a stroke? A stroke is a life-threatening medical condition that occurs Stroke is a when the blood supply to part serious condition. of the brain is cut off, either th It is the 4 from a clot or if a blood vessel biggest killer in the brain bursts (also known in the UK as a haemorrhage).

Stroke is a life-changing event, and a leading cause of death and disability in the UK. The NHS Long Term Plan set outs With advances in treatment becoming the ambitions for the NHS over the next increasingly specialised, we can improve the 10 years, identifying stroke as a national way our services are organised, preventing clinical priority. more stroke deaths each year. We can also reduce time spent in hospital so that We share this ambition and want everyone more people can get home and live more in our area to have the best opportunity independently, faster. Our aim is to ensure to survive and thrive after stroke. that everyone receives high-quality hospital care and ongoing help to live with the lasting physical, emotional and psychological effects of stroke.

05 | Improving stroke services in Bristol, North Somerset and South Gloucestershire Did you know? Around 1 in 50 people (approx. 18,700) 1 in 8 in our area live with the people who have 1 in 4 die within long-term effects of a a stroke die within a year stroke, such as physical a month disability or cognitive impairment.

South

Gloucestershire Each year, around Bristol 1,500 people in Bristol, North Somerset and South Gloucestershire (BNSSG) have a stroke. That’s around 5 people each day and this number is set to rise as North Somerset the population continues to grow and people live longer. Stroke affects people of all ages

06 | Improving stroke services in Bristol, North Somerset and South Gloucestershire Around Stroke has 2 in 3 significant long people who have 3 in 4 a stroke leave stroke survivors term impacts hospital with have weakness in a disability an arm or leg 2 in 3 have problems seeing and half find it hard to 1 in 3 swallow find it hard to speak 1 in 2 have problems with vision2

Thanks to a combination of better prevention, and earlier and more advanced emergency treatment and care within 72 hours of a stroke, many more people are surviving and making a good recovery. There are also things we could do differently to give everyone in our area the best opportunity to survive and thrive after stroke.

07 | Improving stroke services in Bristol, North Somerset and South Gloucestershire The Ambulance Service and hospital teams saved my life when I had a stroke. We have first class doctors, nurses and paramedics. I had to stay in hospital much longer than I needed and I didn’t get much help after I left except from the voluntary sector. It felt like I fell off the edge of a cliff.”

Stephen, stroke survivor

08 | Improving stroke services in Bristol, North Somerset and South Gloucestershire How does the NHS currently care for people who’ve had a stroke? There are five recognised stages of treatment and care for stroke.

Emergency We’re already taking action on prevention Prevention treatment and improving community care and life focuses on for people with a after stroke. You can read more about our reducing factors that suspected stroke or new Integrated Community Stroke Service put people at risk of immediately after a stroke, on page 28. having a stroke, usually in the first 72 like high blood hours, and where people We are seeking the public’s views on pressure. have surgery if emergency treatment, ongoing hospital needed. Ongoing acute treatment and inpatient rehabilitation hospital treatment services as part of this consultation. and care for those who need it with specialist staff who are experts in stroke and supporting people until they are well enough for the next Community care Inpatient stage of care. and life after stroke rehabilitation ongoing treatment and care (on a hospital site or in the can be provided at home (or a community) for those who care home) and at a variety of need additional specialist community based facilities, such as treatment and rehabilitation physio centres, gyms or community after the emergency hubs, in the area where people and acute hospital live, and depending on the stages. support required.

09 | Improving stroke services in Bristol, North Somerset and South Gloucestershire How do we currently care for people who’ve had a stroke in our area?

At the moment, hospital stroke care differs • We don’t have a specialist HASU unit in • Due to increasingly specialised treatments across a number of locations in Bristol, our area, and instead people who have and advances in care, as well as the North Somerset and South Gloucestershire, a stroke or a suspected stroke are taken limited number of specialist staff available, depending on where people live and when to the closest hospital: it is not possible for a specialist stroke team they require care. to be on three sites, 24 hours a day, 7 days – Bristol Royal Infirmary a week. Therefore, after 11pm, Bristol Not all services are available all of the (8am – 11pm 7 days a week) Royal Infirmary automatically redirects time and this can impact on an individual’s ambulances with people who have had a long-term recovery. – Southmead Hospital suspected stroke to Southmead Hospital. (24 hours a day / 7 days a week) Weston General Hospital does the same • National guidelines3 say everyone should after 5pm and at weekends. be able to get emergency treatment and – Weston General Hospital the most advanced care immediately (9am-5pm Monday – Friday) • After receiving emergency treatment, at a specialist Hyper-Acute Stroke Unit people are usually moved to an acute (HASU). • People who need advanced emergency stroke ward to continue short-term treatments, such as brain surgery, are treatment and care. A HASU provides emergency treatment always treated at Southmead Hospital. for people with a suspected stroke or This means that while some people • Once well enough, rehabilitation (rehab) immediately after a stroke, usually in the are taken to Bristol Royal Infirmary or plays a significant role in helping people first 72 hours. Patients have surgery in Weston General Hospital first, once they to regain their independence and live the HASU if needed. are assessed, they could need to transfer well after stroke. The length and type to Southmead for specialist treatment. of rehab available currently varies. The availability of hospital and home-based rehab varies by location, and no area of Bristol, North Somerset and South Gloucestershire is able to provide 7 day a week access currently.

10 | Improving stroke services in Bristol, North Somerset and South Gloucestershire Why do More people are at risk of • Everyone could have access to having a stroke because our our specialist teams and treatments 2 we need to 24 hours a day, 7 days a week. population is growing, getting This would happen regardless of where change stroke older and living with more people live or what time of day or week they require treatment and care. services in long-term health conditions. • We could meet the National Standards our area? Our healthcare teams work hard to provide for stroke care. Increasingly, there are high quality care. By organising our new and specialised treatments to reduce specialist care and resources into specialist brain damage and disability after a stroke. units, we can give everyone the best These require highly skilled staff, and opportunity to survive and thrive after stroke: the latest technology and services. As our expertise is currently spread over three • We could save more lives and help sites, we’re unable to offer this level of more people live well after stroke. service at all three . The UK The evidence shows that when emergency national audit programme grades our treatment and care is centralised into a hospitals between B and D at the centre of excellence, (as mentioned in the moment, with A being the best grade. NHS Long Term Plan and also known as We want to change this and improve the a Hyper-Acute Stroke Unit), more people quality of care for everyone in our area. survive a stroke, get home quicker and go on to live fulfilling lives.4

11 | Improving stroke services in Bristol, North Somerset and South Gloucestershire

What changes are we proposing? 3. Improving rehabilitation Our vision is that everyone in Bristol, North services Somerset and South Gloucestershire has the To provide specialist stroke rehab best opportunity to survive and thrive after 7 days a week, whenever people stroke, wherever they live. To achieve this, are ready, ideally at home or when we’re proposing three changes. necessary in a specialist inpatient stroke rehab facility near to where they 2. Improving live. This would give everyone the ongoing acute best chance of fulfilling their goals hospital treatment and being as independent as For everyone who needs it, to receive possible after stroke. ongoing hospital care in an Acute Stroke Unit (ASU). This is a specialised stroke For people who unit with staff who are specialists in caring need additional for and supporting people who’ve had a specialist treatment and stroke until they are well enough for the next rehabilitation after the emergency 1. Improving stage of care. We are proposing and acute hospital stages but are emergency treatment that there are one or two Acute not ready to return to where they live, For everyone to be able to Stroke Units in our area. we propose two specialist inpatient access highly specialised treatments Stroke Sub-Acute Rehabilitation straight away, 24 hours a day, Units (SSARU) in different 7 days a week. We propose taking locations in our area. everyone who has a stroke or a suspected stroke to a single Hyper-Acute Stroke Unit (HASU). This is an emergency unit with specialist staff, equipment and technology. We’re already doing more to prevent stroke and improve care after people leave hospital or a inpatient rehab unit. Whilst not part of this formal consultation, we are also seeking feedback about the new Integrated Community Stroke Service. You can read more about this on page 20.

12 | Improving stroke services in Bristol, North Somerset and South Gloucestershire Proposal 1:

Improving emergency treatment

13 | Improving stroke services in Bristol, North Somerset and South Gloucestershire What would change?

Currently, ambulances take • Anyone who had a stroke while they were people who have a stroke in another hospital in our area would be transferred to Southmead Hospital, unless or suspected stroke to their they needed to stay at their original hospital nearest hospital. for another medical reason. These people would be cared for by local teams who would have direct communications with Not all hospitals have the latest specialist the specialist stroke team at the HASU. equipment and resources to provide the very best initial, emergency treatment and • Anyone who walks-in to Accident and care. We would like to change this so that Emergency (A&E) at the Bristol Royal everyone who has a stroke or suspected Infirmary or Weston General Hospital stroke is taken by ambulance to a Hyper- would still be assessed and treated. Acute Stroke Unit (HASU) with specialist If a stroke was confirmed, they would be treatment and care available immediately. transferred to Southmead Hospital where specialist treatment would be provided. We propose Southmead Hospital as the location for our HASU, as: People living in Sedgmoor District (North of Somerset) are currently taken to Weston • Southmead Hospital already has General Hospital. Under our proposals, the latest neuroscience facilities Sedgmoor residents would be taken by and equipment. ambulance to their nearest HASU, which is at Musgrove Park Hospital, . • More people in the area would have This would affect around 30 people a year. immediate access to a specialist team More information is in the Sedgemoor District and the latest stroke treatment. Factsheet which accompanies this document.

14 | Improving stroke services in Bristol, North Somerset and South Gloucestershire Why do we need to change? “The proposed changes are in keeping with the NHS’s intention to deliver the right care, in the right place, at the right time. National evidence Research shows that people’s health shows the immediate transfer of patients to a specialist Hyper-Acute and quality of life improves when the most Stroke Unit, where specialist clinicians are able to provide the latest stroke specialised stroke services are all in one treatments, improves patient outcomes such as minimising brain damage place. A Hyper-Acute Stroke Unit (HASU) and reducing levels of disability. would provide immediate emergency treatment, 24 hours a day, 7 days a “This single transfer to the proposed HASU would mean more patients week, regardless of where people live. have faster access to specialist emergency treatments, while significantly reducing the number of patients who require a transfer for specialist • Evidence shows that survival rates emergency treatments from one of the existing acute hospital sites. could improve by 1%, meaning around In addition, a single transfer would increase efficiency and the quality 15 fewer deaths each year.5 of services for the whole patient pathway – and ensure ambulances and paramedics are available for other 999 calls in the community.” • Neurological (brain and nervous system) and vascular (blood vessels) treatments Rhys Hancock, Senior Clinical Lead are often required as part of emergency South West Ambulance Service NHS Foundation Trust stroke treatment. Southmead Hospital is already the area’s centre of excellence for treatment for these specialisms.

• Stroke survivors would be able to leave hospital quicker and live more • An increase in provision of a specialist • Around 57 people each year would avoid independently after their stroke. Around treatment such as a ‘thrombectomy’7 living permanently in a care home.9 thirteen people each year would be more would mean around 23 people leave independent a few months after stroke.6 Southmead Hospital with the same level • The creation of a HASU would enable of independence they had before stroke.8 staff to develop specialist knowledge and keep their skills up to date to help deliver the latest treatments and care.

15 | Improving stroke services in Bristol, North Somerset and South Gloucestershire Factors to consider:

• Southmead Hospital can manage more • In order to provide specialist treatment people needing emergency treatment at a Hyper-Acute Stroke Unit for everyone Everyone for stroke. Each week, around 19 people in our area, some family and friends would get the latest who would have gone to Bristol Royal would need to travel a little longer to visit life-saving care and Infirmary, and around 5 people who someone who has had a stroke. However, would have gone to Weston General under the proposals, people will spend 7 in 10 Hospital, would go directly to Southmead less time in hospital and go home with people can reach Southmead Hospital to start treatment immediately. the right support more quickly. More Hospital by ‘blue light’ Currently, these people are transferred information is available in the Stroke ambulance in just 30 to Southmead Hospital following Consultation Travel Times Factsheet. minutes for immediate assessment. specialist care. • It would mean changes for our staff. • It would take longer for some people Some staff would need to work differently to get to Southmead Hospital, but or in a different location as part of a Analysis shows that they would benefit from receiving specialist stroke team. ambulances can get those specialist care immediately, rather who need emergency treatment than being assessed and transferred • Under the proposed changes, the number to Southmead Hospital within for emergency treatment. of beds dedicated to supporting people with stroke in North Somerset would stay 45 minutes • About 30 people per year would attend the same as now. However instead of which is within the Musgrove Park Hospital in Taunton. providing care immediately after a stroke, recommended guidance a new SSARU on the Weston General of 60 minutes. • The best place for care may not be at Hospital site would provide specialist the hospital closest to where people live. inpatient stroke rehabilitation instead.

16 | Improving stroke services in Bristol, North Somerset and South Gloucestershire What other options are there?

During the pre-consultation phase, we also explored having a Hyper-Acute Stroke Unit (HASU) at Bristol Royal Infirmary or Weston General Hospital, and whether we could have a HASU at multiple locations.

Based on the number of people in our area who have a stroke, one HASU would provide the best treatment and care. Two or more HASUs would not meet the guidelines for the number of admissions required to make the units sustainable. In addition, one unit Due to the specialist staff and equipment enables the increasingly specialised range required, it is not possible to provide multiple One unit of stroke treatments to be available in a units across the area. would mean the increasingly single place for people needing emergency specialised range of stroke treatment and reduces the number of As part of wider improvements to stroke treatments available in a single transfers between hospitals. services, we would like to further invest place, for those who require in rehabilitation and community-based emergency care. Much of the technology and highly services. This would support a greater specialised neurological (brain and nervous number of people home to live independent system) and vascular (blood vessels) lives, more quickly. Sustained support technology and equipment, often required following hospital care is a critical part as part of emergency stroke treatment, is of long-term stroke recovery. already provided at Southmead Hospital. Southmead is considered to be the area’s centre of excellence for stroke treatment.

17 | Improving stroke services in Bristol, North Somerset and South Gloucestershire “One thing I found when I was meeting people who had experienced a stroke was that care really varied. It was very dependent on where they were taken that first day by ambulance and which hospital they were taken to. That had a complete knock-on effect to the care they were given and the rehab they were offered which very often led to different outcomes for that individual.”

Claire, stroke survivor

18 | Improving stroke services in Bristol, North Somerset and South Gloucestershire Proposal 2:

Improving ongoing acute hospital treatment

19 | Improving stroke services in Bristol, North Somerset and South Gloucestershire What would change?

After emergency treatment We are proposing having one Acute Stroke in a Hyper-Acute Stroke Unit Unit (ASU) at Southmead Hospital serving everyone in our area. The unit would be part (HASU), people receive their of a centre of excellence situated alongside ongoing acute treatment the HASU. and care in hospital. Some specialist stroke staff would continue to be based at the Bristol Royal Infirmary. At the moment, with services spread across They would care for anyone who has a three hospitals, smaller stroke wards can stroke while they are in that hospital and become full and people might need to stay who cannot be moved for medical reasons on a general ward. In addition, access to to the HASU or ASU at Southmead Hospital. stroke specialists 24 hours a day, 7 days This includes people receiving treatment in a week is not possible for everyone. the heart hospital, or for cancer.

Under our proposals, more people would For the small number of people living in receive ongoing hospital treatment in an Sedgemoor District (North of Somerset) Acute Stroke Unit (ASU), where staff are currently taken to Weston General Hospital, National specialists in stroke care. This would reduce their nearest HASU and ASU is at Musgrove evidence shows the number of people admitted onto general Park Hospital, Taunton. Therefore, once people are more likely to wards, and ensure continuity of care following emergency treatment has finished, ongoing emergency treatment in the HASU. treatment and care on an ASU would continue live well at Musgrove Park Hospital. This would affect less than one person per week (about 30 per and thrive year). More information is available in the after a stroke if they get Sedgemoor District Factsheet. ongoing treatment and care on a specialist Acute Stroke Unit (ASU).

20 | Improving stroke services in Bristol, North Somerset and South Gloucestershire Why do we need to change?

• National evidence shows people are more • This proposal represents an efficient likely to live well and thrive after a stroke use of our specialist team and This proposal if they get ongoing treatment and care resources. By prioritising one ASU, would mean some on a specialist Acute Stroke Unit (ASU). we would be able to make further people from Bristol and investment into community-based North Somerset travelling further • Overall, our current care is not meeting treatment and care so that more people to visit friends and family in hospital. National Standards which means not could leave hospital quicker and live However, with specialist hospital stroke everyone is getting the same high quality more independently after their stroke. services and Integrated Community care. We would like everyone in Bristol, Stroke Services, people would receive North Somerset South Gloucestershire to ongoing care and support where they have all their specialist ongoing hospital live more quickly. This is likely to stroke care in one place (an ASU), with reduce the length of time equal access to the latest treatments people spend in and specialist staff. an ASU.

• Southmead Hospital already has advanced and highly specialised equipment, and the latest treatments.

• Having one ASU at Southmead Hospital where the HASU would also be based, allows for several benefits. Firstly, it would reduce patient transfer between hospitals. It would also potentially reduce delays in treatment and care and would lead to an overall decrease in time spent in hospital.

21 What other Factors to consider A single options are there? ASU would mean a larger staff team on a single site, • Another possibility is to have one Acute increasing training Stroke Unit (ASU) for ongoing care and In both options, and development treatment at Southmead Hospital and an people being treated opportunities. additional Acute Stroke Unit (ASU) at Bristol at the Bristol Royal Royal Infirmary - meaning that there would Infirmary for other primary be a number of dedicated stroke beds on conditions, e.g. cardiac care A single ASU the site. Having an additional ASU means or cancer, would receive An additional ASU would support there would be a number of dedicated outreach care from could provide greater standardisation of stroke beds on the BRI site. specialist stroke resilience to bed treatment and care and staff. pressures, as stroke enable the development • Following clinical evaluation, Weston General patients could be of strong links with Hospital would not be a viable additional accommodated on more community services. ASU location. Patients using this hospital than one hospital do not typically have other complex site. conditions that require specialist care on site. This means they can be safely transferred A second ASU in order to receive specialist stroke care, would cost £500,000 About 400 people a in line with national best practice. more per year to run, as a year would require an result of dividing the specialist additional ambulance transfer • Bristol Royal Infirmary is the proposed team across two locations. This from Southmead Hospital, to the potential second location, because it has would be in addition to the overall second ASU at Bristol Royal infirmary other specialist services for conditions with £3m investment being made following their first few days of links to stroke. For example, common heart to improve stroke care out emergency treatment. This would disorders can increase the risk of stroke and of hospital and in the bring people back to their local sometimes requires a patient to continue to community. hospital, but could increase be managed under a cardiac specialist. This the amount of time spent in is also true for specialist cancer treatment. hospital overall.

22 | Improving stroke services in Bristol, North Somerset and South Gloucestershire “Before the stroke I was just a normal, fit bloke but when I left hospital to continue my rehab and therapies at home, I still couldn’t move my right arm at all and I couldn’t stand for any length of time. I would have benefited from more physiotherapy sooner in hospital and with that, potentially, I could have been less disabled.“

Chris, stroke survivor

23 | Improving stroke services in Bristol, North Somerset and South Gloucestershire Proposal 3:

Improving rehabilitation services

24 | Improving stroke services in Bristol, North Somerset and South Gloucestershire What would change? People who’ve had a stroke often require rehabilitation from a specialist team of therapists, such as physiotherapy, speech 1 in 3 people who have and language or occupational a stroke live in therapy, to help improve North Somerset independence and develop ways to live well with disability.

This can start in hospital and continue where Given the needs of our communities, we People from Sedgemoor District would people live10 and at a variety of community would place one 12-15 bed SSARU on the continue their recovery at one of the specialist based facilities. Weston General Hospital site in North inpatient rehab units on the Weston General Somerset because: Hospital site in Weston-super-Mare once Currently, we have rehab units in large emergency and acute treatment at Musgrove hospitals or community venues where people • 1 in 3 people who have a stroke live Park Hospital had finished. You can read more can stay for a few weeks if they aren’t ready in North Somerset. about this in the Sedgemoor District Factsheet. to go back to where they live after their emergency and acute hospital care. • We know it is difficult for visitors to travel The second SSARU would be based in from North Somerset to other areas and Bristol or South Gloucestershire to spread We are proposing to change this and create public transport is limited. the services across the area and keep travel two specialist inpatient rehab units called times as low as possible for as many people Stroke Sub-Acute Rehabilitation Units • On average, people around Weston are as possible. We would have 27-30 beds in (SSARU). These units would bring together more economically disadvantaged and this second unit and need your help to plan a range of services and therapies. more likely than others in North Somerset where it should be. We’ve suggested some to have a stroke. options on page 27.

25 | Improving stroke services in Bristol, North Somerset and South Gloucestershire Why do we Factors to consider need to do this?

Our aim is for more people to continue their Research Some family and recovery at a Stroke Sub-Acute Rehabilitation undertaken during friends may need to Unit (SSARU) because with specialist the pre-consultation phase travel a little longer to visit support, more people are able to return shows three units as unviable, someone who has had a to where they live more quickly, and live due to the numbers of specialist stroke. More information more independently after their stroke. staff available. Stretching staff is in the Stroke resources in this way could lead to Consultation Travel • Two units would ensure enough beds delays in care and affect the quality of Times Factsheet. are available to meet the needs of the the service we could offer. To meet local population. In addition, we would the same standards, it would cost have the specialist support and staff £1m more to run three units in needed to deliver good quality, timely comparison to two units. and effective care.  It may be a little • The SSARU’s would be located in two harder to coordinate different areas to help address inequalities with Local Authority social in health. For example, older people, Some health services from two units. those from deprived areas and Black and care staff However, we are setting up an and South Asian people are all more at would need Integrated Community Stroke risk of having a stroke. This would help to travel to work service to ensure that to address inequalities in health and in another unit. coordination takes means everyone would get access to the place. specialist rehab they need more quickly, wherever they live, and bring our services in line with National Standards.

26 | Improving stroke services in Bristol, North Somerset and South Gloucestershire Where are the options for a second rehab unit?

We’re carefully considering the best place for the second SSARU. The location would need to have a gym, therapy space, quiet areas and private consultation rooms, parking and good public transport links. Options include:

Location Benefits Considerations

Elgar Unit at • Situated on the Southmead Hospital site, close • Alternative general rehab services Southmead Hospital, to the Hyper-Acute Stroke Unit (HASU) would need to be established Bristol • North Bristol location, accessible to people in both Bristol and South Gloucestershire • Unit already has facilities for providing rehab but is not stroke specific

Frenchay site, • Site being redeveloped. Potential for purpose-built • Interim arrangements would be South Gloucestershire facilities to support stroke care needed until new facility available • North Bristol location, accessible to people in both Bristol and South Gloucestershire

Skylark Unit at • Current provider of community care with general rehab • Alternative general rehab services The Meadows • Central South Gloucestershire location, improves would need to be established care home, Yate, geographical spread of rehab units • Limited gym and therapy space South Gloucestershire • Limited parking

South Bristol • Purpose-built stroke rehab unit and already has good facilities • South Bristol is closer to Weston General Hospital Community Hospital, • South Bristol location, close to centre of Bristol (compared to other options), so rehab units not as Hengrove, Bristol well spread out across the area as they could be • Good parking available and further from people in South Gloucestershire

27 | Improving stroke services in Bristol, North Somerset and South Gloucestershire New Whilst not part of the formal 4 Integrated consultation, we thought it might be useful to know a bit Community more about new, wider services Stroke Service being developed to support people with their longer-term rehab after a stroke once they leave hospital or a inpatient rehab unit (SSARU).

Co-designed with people affected by The service would help people in Bristol, stroke, we’re investing in a new Integrated North Somerset and South Gloucestershire Community Stroke Service, where leave hospital and get the care they need You can read all services (NHS, local authorities and more quickly, including rehab at home more about this at: voluntary organisations such as charities) and in the community, seven days a week. work together more effectively. The service It would include emotional and psychological bnssghealthiertogether.org.uk/ would include teams with occupational support, empower people and their families stroke-services/ therapists, physiotherapists, speech to manage their own health and wellbeing, and language therapists, nursing, rehab and be as independent as possible. We’d really like your feedback, support workers, psychologists, dietitians, please see page 25 voluntary sector workers and social workers. We estimate that every person will have about for more details. four times as many contacts or interactions with community teams as they do now.

28 | Improving stroke services in Bristol, North Somerset and South Gloucestershire “An integrated community stroke service will pull together the many different aspects of care and treatment that people need when recovering from stroke. It will ensure that the right support - from physio, speech and language therapy, dietetics, occupational therapy, psychology, nursing and key workers - is delivered where and when most needed. Support can be in people’s homes, work and leisure places and for as long as required to support the best possible quality of life after stroke.

With one integrated community stroke service, there will be less need for people to tell their stories to different therapy providers again and again, and more tailored support wrapped around the individual. We are really excited to be working with acute, community, social care and voluntary sector colleagues to achieve this vision.”

Phillipa Cozens, Specialist Services Manager Sirona care & health

29 | Improving stroke services in Bristol, North Somerset and South Gloucestershire What would your stroke 5 journey look like? 11 2. Ongoing acute hospital treatment: 3. Inpatient Rehabilitation: People would For people in Bristol After treatment on the HASU, people start rehab as soon as they are ready. would continue their specialist care on an Once emergency and acute hospital 1. Emergency treatment: The Ambulance Acute Stroke Unit (ASU). We’re proposing care had ended, people who needed Service would take anyone in Bristol this unit to be at Southmead Hospital. additional specialist treatment or rehab, suspected of having a stroke directly and were not ready to return home, to the Hyper-Acute Stroke Unit (HASU) If there is a second ASU at Bristol Royal would go to the Stroke Sub-Acute at Southmead Hospital for emergency Infirmary, the ambulance would take Rehabilitation Unit (SSARU) in Bristol specialist treatment and care. people11 there after their treatment on or South Gloucestershire. the HASU at Southmead Hospital.

Southmead Hospital if needing thrombectomy/neurosurgery Current state

Person has Sub Acute Care South Discharge home with early Emergency Care BRI Acute Care BRI a stroke Bristol Community Hospital supported discharge Future state

Person has Emergency HASU Care Acute Care Discharge home SSARU Care Location TBC a stroke Southmead Hospital Southmead Hospital with ICSS

Discharge home Acute Care BRI SSARU Care Location TBC with ICSS

30 | Improving stroke services in Bristol, North Somerset and South Gloucestershire For people in North Somerset12

1. Emergency treatment: The Ambulance 2. Ongoing acute hospital treatment: 3. Inpatient Rehabilitation: People would Service would take anyone suspected of After treatment on the HASU, people start rehab as soon as they are ready. having a stroke directly to the Hyper-Acute would continue their specialist care on an Once emergency and acute hospital care Stroke Unit (HASU) at Southmead Hospital Acute Stroke Unit (ASU). We’re proposing had ended, people who needed additional for emergency specialist treatment and care. this ward to be at Southmead Hospital. specialist treatment or rehab, and were If there is a second stroke ward at Bristol not ready to return home, would go to Royal Infirmary, the ambulance would the Stroke Sub-Acute Rehabilitation Unit take people12 there after their treatment (SSARU) on the Weston General Hospital Current state on the HASU at Southmead Hospital. site, North Somerset. (9-5pm)

Person has Emergency Care Acute Care Weston Sub Acute Care Weston Discharge home (often significant delay a stroke Weston General Hospital General Hospital General Hospital to discharge; limited home support)

Southmead Hospital if needing Current state thrombectomy/neurosurgery (out of hours)

Person has Emergency Care Acute Care Sub Acute Care Bristol Royal Infirmary a stroke or Southmead Hospital BRI / Southmead BRI / Southmead

Future state

Person has Emergency HASU Care Acute Care SSARU Care Weston Discharge home a stroke Southmead Hospital Southmead Hospital General Hospital site with ICSS

SSARU Care Weston Discharge home Acute Care BRI General Hospital site with ICSS

31 | Improving stroke services in Bristol, North Somerset and South Gloucestershire For people in South Gloucestershire13

1. Emergency treatment: The Ambulance 2. Ongoing acute hospital treatment: 3. Inpatient Rehabilitation: People would Service would take anyone suspected After treatment on the HASU, people start rehab as soon as they are ready. of having a stroke directly to the Hyper- would continue their specialist care in an Once emergency and acute hospital care Acute Stroke Unit (HASU) at Southmead Acute Stroke Unit (ASU). We’re proposing has ended, people who needed additional Hospital for emergency specialist this ward to be at Southmead Hospital. specialist treatment or rehabilitation, treatment and care. and were not ready to return home, would go to a Stroke Sub-Acute Rehabilitation Unit (SSARU) in Bristol or South Gloucestershire.

Current state

Person has Emergency Care Acute Care Sub Acute Care Discharge home with a stroke Southmead Hospital Southmead Hospital Southmead Hospital early supported discharge

Future state

Person has Emergency HASU Care Acute Care SSARU Care Discharge home a stroke Southmead Hospital Southmead Hospital Location TBC with ICSS

32 | Improving stroke services in Bristol, North Somerset and South Gloucestershire How would 6 the proposed We’ve described each of our proposed 3. People would be able to get the best hospital and rehab changes separately so stroke care, no matter where they live. changes you know what we propose to do and why. We would have a Hyper-Acute Stroke The three main changes are all designed Unit (HASU) for the whole area, alongside improve care? to work together to improve stroke care everyone would be able to have rehab and integrate with existing prevention and therapy 7 days a week. community-based rehab programmes: 4. Local people would have care that 1. More people would survive, live meets National Standards. We would independently and have a better have a Hyper-Acute Stroke Unit (HASU) experience. Evidence shows that survival providing the best care. We would be able rates could improve by 1%, meaning to consistently support people all the way 15 fewer deaths and 57 fewer people from having a life-changing event through living permanently in a care home after to a more independent future. a stroke each year. People and their families would have a much better 5. In line with the NHS Long Term Plan, experience of care. we would make best use of taxpayers’ money to serve our whole population. 2. We would have enough specialist We spend about £30 million per year on stroke staff to help everyone having a stroke services now. Our proposals would stroke. Our specialist doctors and nurses increase this by another £3 million per would be able to provide a range of year to improve care outside of hospital treatments, 24 hours a day, 7 days a week. and in the community while improving quality and effectiveness.

33 | Improving stroke services in Bristol, North Somerset and South Gloucestershire “One of the things the stroke programme tries to address is that everybody in Bristol, North Somerset and South Gloucestershire no matter where they are, are all able to access the best stroke care immediately and that stroke care and rehab is offered for as long as they need it.”

Claire, Stroke Survivor

34 How can We want to know what you – Having our team of expert staff think before we decide what and services at one stroke ward 7 you have at Southmead Hospital happens next. Have your say by your say? 12pm on 3 September 2021. • where you think we should have a second inpatient rehabilitation unit (SSARU) for people who aren’t ready As part of this formal public consultation, to return home You we want to know: can take part – We know we need one rehab unit on in our survey here • whether you see why we think it’s a good the Weston General Hospital site to idea to change stroke services meet the needs of the population Have Your Say About Stroke Services Survey • what you think about having emergency – We’d like to know your thoughts about (surveymonkey. specialist treatment at one Hyper-Acute the location of a second rehab unit. co.uk) Stroke Unit (HASU) at Southmead Hospital to support everybody who has a suspected In addition, we’d like to get your feedback on stroke or immediately after a stroke our wider ideas for stroke services including the Integrated Community Stroke Service. • what you think of the different options for ongoing acute treatment in hospital You can also let us know if you have any (ASU) in the first week after a stroke alternative proposals or ideas for the delivery of stroke services in our area. – Having our team of expert staff and Either fill in the survey or contact us services across two stroke wards at directly. See page 36 for details. Southmead Hospital and at Bristol Royal Infirmary

35 | Improving stroke services in Bristol, North Somerset and South Gloucestershire Get in touch

Learn more Joint us at an event • Register your interest: To register your interest in any of our We have more information on We’re holding a range of informal events online or face-to-face events, please email bnssghealthiertogether.org.uk/stroke- where you can learn more, ask questions and us at [email protected]. services/. You can also email, telephone share your thoughts. We can provide extra If you’re interested in an online event, or post a letter if you have any questions support at these discussions for people who please provide your name the date of your or want to tell us what you think. find it hard to speak, those who have preferred event. If you’re interested in a eyesight or hearing difficulties and people face-to-face event, please provide your • Email us : who speak various languages. name and let us know if you would prefer [email protected] to attend an event in Bristol, North • Online events: Somerset or South Gloucestershire. • Call us: 16 June - 6pm to 8pm 0117 900 3432 24 June – 12pm to 2pm 30 June – 6pm to 8pm • Write to us: 07 July – 12pm to 2pm Freepost STROKE CONSULTATION 26 August – 12pm to 2pm You don’t need a stamp • Face-to-face events: We need to hear from you by Subject to Government restrictions, we 12pm on 3 September 2021. will be holding a number of face-to-face events across Bristol, North Somerset and South Gloucestershire. More Invite us to speak with your group information will be available at bnssghealthiertogether.org.uk/ If you belong to a group for people affected stroke-services/ soon. by stroke, a community group, support group, charity or staff group, we can attend one of your meetings by video or in person. Use our email or phone number to contact us.

36 | Improving stroke services in Bristol, North Somerset and South Gloucestershire What happens next? Learning from your feedback Deciding on the next steps We’ll be We’ll be listening to and reading all the Your feedback will be one of the things the listening to and ideas you give us. Have your say between BNSSG CCG’s Governing Body considers reading all the 7 June and 3 September 2021. when they decide the next steps. ideas you give us. After the consultation ends, an independent The purpose of a public consultation is to organisation will summarise the main ideas ensure the views of local people have been Have your say from everyone’s feedback and we’ll: considered before a final decision is made between on changes to stroke services. The public 7 June and 3 • publish the summary on our website consultation also seeks to identify any September 2021. information or evidence that hasn’t already • use the summary as one piece of been considered and could impact on the evidence to help plan next steps proposals. This is not a vote or referendum.

• let you know how we’re responding The Governing Body members to what we’ve heard will meet in early 2022. They will look at all the information and evidence, including the independent summary of consultation feedback.

37 | Improving stroke services in Bristol, North Somerset and South Gloucestershire If we decide to The Governing Body will Deliverability: make a final decision on the how easy it will be to make changes, new make changes, what services would begin configuration of acute stroke else is needed and services for the population of how services fit with towards the end other plans. Bristol, North Somerset and of 2022.

South Gloucestershire. Value for money: how much services will cost to change and run, and the longer term Workforce: costs and benefits. how changes may affect staff skills, recruitment and retention.

Equality: how the Quality of care: proposed changes Access to care: making sure care impact equality of travel time, opening is safe, effective and access to treatment hours and whether good quality. and health people have inequality. choices.

38 | Improving stroke services in Bristol, North Somerset and South Gloucestershire

8 References 1 Stroke Association, State of the Nation, 2018. 2 Stroke Association

3 https://www.strokeaudit.org/SupportFiles/Documents/Guidelines/2016-National-Clinical- Guideline-for-Stroke-5t-(1).aspx

4 https://evidence.nihr.ac.uk/alert/centralising-stroke-services-can-save-lives/

5 https://evidence.nihr.ac.uk/alert/centralising-stroke-services-can-save-lives/

6 https://www.cochrane.org/CD000197/organised-inpatient-stroke-unit-care

7 A type of surgery to remove a blood clot from inside an artery or vein

8 Stroke pathway – Evidence Base Commissioning: An Evidence Review for NHS England and NHS Improvement, March 2020

9 Local assessment based on national evidence of best practice outcomes

10 At home, in a carer’s home or in a care home

11 Who would usually go to the Bristol Royal Infirmary or Southmead Hospital for treatment

12 Who would usually go to the Weston General Hospital for treatment

13 Who would usually go to Southmead Hospital for treatment

39 | Improving stroke services in Bristol, North Somerset and South Gloucestershire NHS Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group South Plaza, Marlborough Street, Bristol BS1 3NX.

0117 900 2583 [email protected] This information is available in Easy Read, bnssghealthiertogether.org.uk/ Aphasia-friendly or large print formats. stroke-services/ In addition, it can be made available in alternative languages for those whom English is a second language. See page 36 for how to contact us.