North Wales Planning Forum

NORTH WALES NEUROSCIENCES REVIEW

Stroke Workstream

~ Charter for 3 Phase Project ~

1 INTENT AND AIM

1.1 Why is the project needed?

In autumn 2007 the Minister for Health and Social Services commissioned an Independent Review of adult neurosciences led by James Steers. This External Expert Review Group published its first stage report dealing with North Wales in July 2008 with all Wales recommendations and source documents following in September 2008.

The overarching finding was that the North Wales population requires enhancement of neurological, neurorehabilitation, neurophysiology, stroke management and diagnostic facilities.

The main recommendations for North Wales were:

 A North Wales Neurology Service should be established within an appropriate location for patient access from which Medical Neurology, stroke management and neurophysiology would be delivered with enhanced services at the other main sites.  A managed clinical network for neurosciences for North Wales should be established linking Bangor, Glan Clwyd, Wrexham together with the existing tertiary centres.  An in-patient neurorehabilitation centre should be established in North Wales.  A non-complex spinal injury surgery service should be established in North Wales. Evidence for these recommendations is contained in the External Review Groups September documents. The Expert Group also gave a range of other more detailed recommendations.

These recommendations accord broadly with Welsh Assembly Government policy that services should be developed within Wales whenever it is safe and appropriate to do so.

The implementation of the recommendations within this Government policy framework, will mean that a high quality service for the people of North Wales will be delivered. The Minister has asked the North Wales Regional Director for the Department for Health and Social Services to co-ordinate the development of a costed implementation plan (with timescales) for the consideration of the Minister.

1 0bdfce9251bb48b4c0e862902128d053.doc 1.2 How will the project be done?

The project is led by Dr Salah Elghenzai, Chair of the North Wales Stroke Forum, Consultant Physician with special interest in Stroke. The Stroke Forum will be the advisory Body for this Work Stream. Membership of the Forum will be revised and restructured to enable wider consultation and delivery of a strategic long lasting Stroke network across North Wales.

Membership:

Due to the complexity of Stroke services covered by this work stream, the Forum membership is likely to be large. This will require a smaller steering group, which will be responsible for preparing the agenda and Implementation of the Forum recommendations. The Group and the Forum will be accountable to North Wales Planning and partner ship forum

Forum Member ship ( under revision) Name Organisation E-Mail Attendance Vedamurthy YGC [email protected] Adhiyaman (Consultant Physician/stroke) Shirley Williams Sec Wxhm [email protected] for Dr White Dr A.Sayed Wxhm [email protected] (Consultant Physician/Elderly Medicine) [email protected] Rhian Owen (Stroke YG [email protected] Specialist Nurse) Peter Liptrot Gwynedd LHB [email protected] Paul Carter Conwy LHB [email protected] Anthony White Wxhm [email protected] (Consultant Physician/Elderly Medicine Michael Greenway YGC [email protected] (Consultant Physician/Elderly Medicine Chris Burton Bangor Uni [email protected] [email protected] Emad Abood Wxhm [email protected] (Consultant Physician/stroke) Ffion Johnstone YG [email protected] (DGM MEDICINE) Gareth Davies Flintshire LHB [email protected] Geoff Lang (planning Wrexham LHB [email protected] Forum CEO) Brian Green DHSS-RO [email protected] (Regional office) Janice Lavelle YGC [email protected] (Therapy SALT) John Hindle Llandudno [email protected] (Consultant Hospital Physician/Elderly Medicine) 2 0bdfce9251bb48b4c0e862902128d053.doc Jon Falcus (DGM Wxhm [email protected] MEDICINE) Judith Rees Wxhm [email protected] Khalid Saeed YG [email protected] (Consultant physician/stroke) Margaret Austin Wxhm [email protected] (Sec to Dr Abood) Lyn Siebenmann Voluntary [email protected] (Stroke Organisation ASSOCIATION) Dr Ganesh Ram YGC [email protected] (Consultant physician/stroke) Caroline ADAMS YG [email protected] (CONSULTANT Radiologist) Martyn Bracewel Bangor [email protected] University Neurology Dr Salah Elghenzai YG [email protected] (Forum Chair) Patients TBC TBC repressentative Clincal Psychology TBC TBC TBC PHYSIOTHERAPY TBC Amanda Occupational [email protected] CHESTERTON Therapy YG Dafydd Jones Morris WAST Dafydd.Jones- [email protected]

Forum Steering Group Members Dr S Elghenzai Dr Chris Burton (Project Director) Mr Damion Heron (Support Administration) Mr Brain Green (Regional office) TBC (Finance support) TBC (North Wales LHB Executive lead)

Scope:

Following from the recommendations of the Welsh Neuroscience External Review Group to establish an appropriate location for patient access, from which Stroke management would be delivered as per UK and European Stroke organisation standards. This work stream will map out existing Stroke services and cost a development plan in the following themes

 Service Improvement (including advising on service reconfiguration)  Workforce strategy, education and training  Patient and public involvement  Service development (including evidence implementation and practice standardisation)

3 0bdfce9251bb48b4c0e862902128d053.doc Areas excluded:

Areas already covered by the other workstreams specifically;  Brain Injury  Neurosurgery

1.3 What is the ‘big picture’ goal?

To develop Stroke services Improvement plan for -Short and medium terms -Long term

The question to be answered by this project is:

What is the model of care for Stroke,( including Rehabilitation), in North Wales in light of the James Steers Report?

2 BACKGROUND

2.1 Other reviews and existing plans that feed into this project:

- North Wales Demonstration project for Stroke service Development - Royal college of Physicians Sentinel Audit For Stroke 2004/2006/2008 - NSF for Older People In Wales 2005 - NICE Guidelines for acute Stroke 2008 - AOF 2008/2009 - Royal College of Physician guidelines for Stroke care 2008 - Regional Acute Stroke services Plans Sept 2008

2.2 Context, Current landscape and Present Issue

The latest sentinel Audit by RCP London (2008) pointed out major gaps and non- equality in Stroke services provision across North Wales especially Acute stroke care (Lack of acute Stroke Units) Welsh Assembly Government made stroke services development a priority this project will help to plan future stroke care across the region taking in to account the James Steers Report, Design for North Wales and restructure of NHS in Wales as well as all other literature available. 4 0bdfce9251bb48b4c0e862902128d053.doc The Current Service Gaps

 There are no common Pathways or Protocols to manage Stroke victims in North Wales.

 All existing Acute Stroke Services fall short of the current UK and European Standards for acute Stroke care.

 Coordination between primary and secondary care for Stroke care is patchy and weak.

 There is a need to develop specialist stroke rehabilitation facility in North Wales.

 No services provision for young strokes.

 Lack of Work force planning and other issues like training and education at regional level.

 Lack of Stroke network funding.

2.3 Clearly articulate the ‘why’?

There is currently a great need to elevate Stroke Care in North Wales up to the national and international standards, this has shown to improve mortality after strokes, and proven to reduce financial, disability burdens on NHS and society as a whole (reduction in ALOS).

2.4 Clearly articulate the performance gaps

Please refer to RCP sentinel audit results 2006

Development of acute stroke units is more extensive in England than Wales or Northern Ireland.

Wales has changed little since 2004. Emphasis must now be placed on quality, not just on quantity.

Median bed numbers have increased in England but reduced in Northern Ireland and Wales.

5 0bdfce9251bb48b4c0e862902128d053.doc 3 LITERATURE RESEARCH

There is a need to undertake a full literature search to identify relevant evidence in order that the workstream has all available, up to date, evidence available to allow them to undertake a full review.

 Report of the Welsh Neuroscience External Expert Review Group - Recommendations for North Wales

 Designed for life: quality requirements for adult critical care in Wales. Welsh Assembly Government 2006.

 The Future Delivery of Diagnostic Imaging Services in Wales

 NICE Guidelines 68 July 2008

 WHC 2007 (058) Implementation of National Standards for Stroke Services in Wales - action for Commissioners and Providers by March 2008

 National Sentinel Stroke Audit 2004,2006,2008

 Royal College of Physicians Stroke Guide Lines July 2008

 Frank Burns report Use of Llandudno Hospital

 Stroke strategy for England Department of Health 2007

4 POTENTIAL CONTACTS

5 KEY DELIVERABLES AND INTENDED RESULTS

5.1 Changes and Design Concepts

The methodology will be discussed with the Steering group and a plan submitted to the Stroke Forum for agreement and advice th eplan will be finalised by the steering group after further consultation as directed by the Forum

5.2 IT and Information Implications

IT will be represented in the Forum group, their may be further need to have IT input which will be determined by the steering group.

6 0bdfce9251bb48b4c0e862902128d053.doc 5.3 Engagement – Internal and external

The Communications Group, led by Anglesey CHC, will advise Workstream Leaders on the approach to engagement, Public and Patient Involvement (PPI) and ensure conformity to the Welsh Health Circular (WHC) and best practice. They will co-ordinate on behalf of the Implementation Group all external communications and advise on an appropriate communications strategy.

5.4 Final Report

repeat previous

6 PROJECT TIMELINES

Dates and venues of meetings.

Jan 2009 Steering group second meeting prepare agenda for the Forum meeting

Feb 2009 Forum re launch with consultation on the revised membership, draft terms of reference and Service plans

March 2009 Steering Group review outcome of first Forum Finalise the Plans as directed by the Forum Costing of the plans sought

April 2009 Final Plans agreed

The group will use IT facilities to minimise the number of meeting and complete the process in the time scales planned.

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