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For Approval Board Meeting 16 October 2013 Agenda Item FOR APPROVAL BOARD MEETING 16 OCTOBER 2013 AGENDA ITEM 2.2 POWYS STROKE ANNUAL REPORT 2012/13 Report of Director of Therapies and Health Science Paper prepared by Consultant Therapist for Stroke and Neurorehabilitation Purpose of Paper To present the draft Powys Stroke Annual Report 2012/13 to the Board Action/Decision required The Board is asked to APPROVE the draft Powys Stroke Annual Report 2012/13 so it can be submitted to WG and be published on the Health Board’s internet site in line with WG guidance Link to ‘Doing Well, This paper supports Standards Doing Better: Standards 2,3,5,6,7,8,9,10,15,18,21,24,26 for Health Services in Wales’: Link to Health Board’s Promotes Health & Wellbeing Corporate Plan Continuously Improves Safety, Effectiveness & Patient Experience Captures the Benefit of Integration Empowers our Staff Lives within our Means Acronyms and abbreviations Stroke Annual Report 2012/13 Page 1 of 3 Board Meeting 16 October 2013 Agenda Item 2.2 FOR APPROVAL POWYS STROKE ANNUAL REPORT 2012/13 Purpose The purpose of this paper is to present the draft Powys Stroke Annual Report 2012/13 to the Board of Directors for approval. Background The Health Board approved the Powys Stroke Delivery Plan 2013/16 in April 2013. It was published on the Health Board’s internet site in August 2013 in line with Welsh Government (WG) requirements. An interim report was submitted to WG in July 2013. WG provided a template for Health Boards to use when submitting their annual plans and also an outcomes scorecard to be included in the report. This annual report was collated based on reports submitted and presented to the Stroke Steering Group in August 2013. Public Health and Primary Care teams as well as the teams based in Bronllys and Newtown Hospitals and the Life after Stroke project group have all contributed to this report, which reflects the work that has been taken forward to improve stroke care for Powys residents. It also incorporates data supplied by WG in the score card along with additional data collected internally and provided by our commissioned providers of acute stroke services. The draft Powys Stroke Annual Report 2012/13 is attached as Appendix One. Progress in 2012/13 The Annual Report identifies progress that has been made in the last 12 months which includes: • Establishment of a Tobacco Control Strategic Group • The percentage of people with hypertension who are given lifestyle advice has increased to 84% • Several initiatives have taken place in Powys in the last 12 months to increase public awareness of stroke and the need to seek medical attention immediately • By the end of 2012 ambulance teams in Powys were consistently achieving observation bundle compliance rates of over 80%, up from below 60% • We have been working hard to ensure that there are effective pathways in place. Powys tHB has taken an active part in the NHS Midlands and East Stroke Review. These reviews were supported by an External Expert Advisory Group (EEAG) and affected stroke services in England in both Shrewsbury and Hereford. • In the past year North and South Powys rehabilitation teams have made changes to their goal planning meetings to ensure that the stroke survivors are involved in the planning of their rehabilitation, while maximising the amount of time the therapists have to provide therapy • Work is underway to develop education frameworks for nurses, physiotherapists and occupational therapists to ensure that Powys tHB has an Stroke Annual Report 2012/13 Page 2 of 3 Board Meeting 16 October 2013 Agenda Item 2.2 FOR APPROVAL appropriately trained workforce working with stroke survivors both in hospitals and in the community. • Powys now has a Service Level Agreement with the Stroke Association to provide a Stroke Support Coordinator for Powys Stroke Survivors • Over the past 12 months Powys Teaching Health Board has refined the process of obtaining timely information on Powys patients who have had a stroke from its five main acute stroke providers. This has allowed us to develop a stroke register to enable us to coordinate follow up for people discharged straight home from the acute stroke units as well as from our own stroke rehabilitation beds. Conclusions The report reflects the progress that has been made over the past 12 months in implementing the Powys Stroke Delivery Plan and sets out priorities for the next 12 months. Recommendation The Board is asked to: • Approve the Powys Annual Stroke Report 2012/13 for submission to Welsh Government • Approve the Powys Annual Stroke Report 2012/13 for publication on the Health Board’s webpages. Report prepared by: Presented By: Michelle Price Amanda Smith Consultant Therapist for Stroke and Director of Therapies and Health Neurorehabilitation Science Background Papers Powys tHB Stroke Delivery Plan 2013-16. Financial Consequences As determined by the report Other Resource Implications As determined by the report Consultees Powys tHB Stroke Steering Group Stroke Annual Report 2012/13 Page 3 of 3 Board Meeting 16 October 2013 Agenda Item 2.2 Stroke Annual Report- Draft 4 Powys Health Board September 2013 1.0 Executive Summary 2.0 Introduction Powys tHB is responsible for providing and commissioning stroke services for approximately 132,000 people over a geographical area of 5,179 km², which equates to 4% of the population of Wales in 25% of the total landmass of Wales. It has the lowest population density in Wales and England. The mountainous terrain makes travel by road slow. The low population density and long travel times, often on minor roads, are a challenge to ensuring timely access to acute services and potential life-saving treatment, such as thrombolysis. The rurality presents a further challenge in maintaining a skilled workforce to provide high quality rehabilitation for patients in the community after discharge and access to long term stroke support services and groups. Development of these services will require a flexible and innovative approach and close working relationships with social care and third sector partners. In Powys, planning and oversight of the implementation of the local stroke delivery plan is the delegated responsibility of the Director of Therapies and Health Science and discharged through the Stroke Steering Group. This is a multi-agency group which is accountable to the Powys tHB Board of Directors and provides regular progress reports to the Board through the Quality and Safety Committee. Membership includes representatives from the teaching Health Board executive, the clinical teams, primary care, third sector, including the Stroke Association, social services, Welsh Ambulance Service Trust (WAST), the Community Health Council and the Delivery and Support Unit arm of Welsh Government. Representatives from acute stroke service providers are also invited to attend. The Powys tHB Stroke Delivery Plan was developed to reflect the organisational priorities for securing and delivering high quality and safe care for the population of Powys, as set out in the overarching Powys teaching Health Board Three Year Plan. 1 3.0 Stroke Incidence, Mortality and Survival in Powys Overview Stroke incidence, mortality and survival rates are a simplistic way of measuring the effectiveness of the stroke delivery plan in Powys. Stroke incidence is the number of strokes that occur each year. Primary prevention is a large part of our delivery plan and it is really important that we manage the risk factors associated with having a stroke. However Powys has an older population and age is one of the risk factors for stroke that we cannot influence. As the population in Powys gets older we expect to see more strokes happening while we continue to do everything we can to support the people of Powys to live healthier lives. Stroke mortality is the number of people who die as an immediate effect of a stroke and reflects the effectiveness of acute stroke management as well as the prevention of complications such as pneumonia. There are many ways of measuring this and it can be complicated by things like the average age of the people having a stroke. Older people are more likely to die from a stroke than a younger person as they often have other health issues. Stroke survival is a simple measure of the effectiveness of stroke rehabilitation. Stroke Incidence Rates Graph 1 shows the number of emergency admissions for stroke over the past 4 years. It is calculated based on coding done once the patient has been discharged from hospital. It has increased to nearly 240 strokes per year since the 2009/10 data. This may be due to an actual increase in the number of strokes in Powys, an increase in the number that are taken to hospital following stroke, or an improvement in coding so strokes are coded more accurately. It is more likely to be a combination of the three. As the average age of the population in Powys increases the number of strokes in Powys is likely to increase. Maintaining a stable incidence rate in the future would reflect that despite the average age of the population in Powys getting older, they are being supported to live healthier lives. 2 Graph One: number of emergency admissions for strokes. Source: Public Health Wales Observatory, using PEDW (NWIS), May 2013. Stroke Mortality Rate Graph two shows the stroke mortality rates for Wales and for Powys. This is the number of deaths per 100,000 population after the data has been age standardised. The graph is based on data collected during hospital admissions. It does not collect the number of people who die following a stroke once they have gone home. It is reassuring that the number of people who die in hospital following a stroke is consistently going down.
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