County Durham and Darlington Improving stroke care for the people of County Durham and Darlington: A public consultation on proposed changes to hyperacute stroke services 2 1.0 Foreword Stroke remains a major cause of death and disability across County Durham and Darlington with around 1,100 people suffering a stroke each year. These patients need access to high quality, specialist hospital care to give them every opportunity to make a full and speedy recovery. Services for stroke patients at the point they are most seriously ill – known as hyperacute services - are currently provided from two hospitals in County Durham and Darlington. Local clinicians and managers are telling us that centralising all stroke hyperacute services onto a single hospital site is the best way to ensure that more patients have access to first-rate care, without having to travel outside of County Durham and Darlington. As the organisation responsible for paying for and planning local health, we are committed to striving to achieve the best possible care for people across County Durham and Darlington. An ageing population, staffing and recruitment pressures and variable access to specialist services all make the case for changing local stroke services a convincing one. However, we know that the views of local people are essential in helping us to make a fully informed decision. This public consultation is therefore designed to listen to your views on the proposals. No decision will be made until the end of the consultation. This document will summarise the proposed changes to stroke hyperacute services and inform you about the many ways in which you can have your say. We look forward to hearing your views on the proposals. Lady Ann Calman Yasmin Chaudhry Chair Chief Executive 3 2.0 Executive Summary Background Benefits of the preferred option Starting with the National Stroke Strategy in By having a single stroke hyperacute service at the 2007, there has been a national, regional and University Hospital of North Durham, patients will local drive to improve services and outcomes for specifically benefit from the following: patients suffering a stroke. Despite significant • Shortest travel times service improvements within County Durham and • Emergency access to diagnostic services Darlington in recent years, more needs to be done to secure a 24 hour-a-day, 7 day-a-week hyperacute • Improved TIA services stroke service that secures and makes the most What this will mean for patients of the currently available skills and resources of specialist clinicians. Consolidation of the two current hyperacute sites onto a single site at University Hospital of North The focus of the consultation Durham will mean patients suffering a suspected Hyperacute stroke services are those that a patient stroke anywhere in County Durham and Darlington should receive when they are at their most seriously being taken by ambulance directly to UHND. Analysis ill and in need of quick assessment and treatment of ambulance travel times confirms that this will not by a stroke specialist. delay arrival at hospital for the vast majority of stroke patients. Paramedics will alert the University Hospital The current hyperacute model is unsustainable for of Durham stroke unit to the patient’s anticipated three reasons: arrival to enable appropriate preparations to be 1. Pressures in staffing and recruitment made. 2. Too few direct admissions to stroke units The patient will be directly admitted to the stroke ward, without waiting in Accident and Emergency 3. To ensure service provision for TIA patients is or admission via the Medical Admissions Unit, also delivered 7 days a week which can delay stroke treatment. He or she will be immediately assessed by a specialist stroke Following engagement events with patients, carers consultant before having the required tests, such as and clinicians and supported by all the evidence a CT scan, to confirm diagnosis. Any further tests available to us at this time, NHS County Durham will be performed by a team of clinicians who will and Darlington believes that: be specialists in using and interpreting scanning and • The current split-site model cannot continue imaging equipment. • A new single site is the best model The consultation process • Specialist care is more important than care closer to home This is a formal public consultation running for 12-weeks from Monday 20 June to Sunday 11 • The preferred option (at University Hospital September, 2011. It is being carried out in line with North Durham) is the best option the HM Government Cabinet Office Code of Practice The proposed changes ONLY affect the hyperacute on Consultation. stroke services provided by County Durham and The responses and outcomes will be presented to Darlington NHS Foundation Trust i.e. the hyperacute both Durham County Council’s Adults Wellbeing stroke services at the University Hospital of North and Health Overview and Scrutiny Committee and Durham and Darlington Memorial Hospital. The Darlington Borough Council’s Health and Wellbeing proposed changes mean that the hyperacute Overview and Scrutiny Committee. element of the pathway would be delivered at one site whilst rehabilitation phases would be delivered No decision will be made until after the consultation from Bishop Auckland General Hospital. has closed on 11 September, 2011. 4 3.0 Introduction and overview Improving the quality of stroke services remains a national and local priority. Patients have the right to expect fast access to first-rate, specialist services which will prevent death and disability. 1% of all strokes nationally occur in County Durham and Darlington, with stroke more common locally than in many parts of the United Kingdom. National Drivers As a follow up to the Stroke Strategy, the National Audit Office (NAO) published a report (February, The National Stroke Strategy was published in 2007, 2010) on the progress made by the NHS against the following a review which found that there were quality framework set out in the Stroke Strategy. The huge inequities in stroke provision across England. report stated that a lot of progress had been made The aim of the strategy was to provide a quality with regards to stroke services, but that there was framework to enable the NHS to improve existing still more to do to ensure the best possible care for services against these standards. patients. The document echoed the guidance of The document also set out key guidance for the 2007 paying particular attention to the advances local health economy to enable service design made in hyperacute services and the need to through the effective commissioning of stroke ensure that all provision was available 24 hours a services. The strategy follows the journey of a typical day, 7 days a week. This reinforcing message only stroke patient, highlighting each milestone in the strengthened the case for change for hyperacute pathway with a series of quality markers which NHS stroke services across the North East of England. providers are encouraged to achieve. Regional Drivers The hyperacute element of the pathway forms a The North of England Cardiovascular Network has major part of the document with extensive guidance used the principles set out in the Stroke Strategy on how such services should be improved. This and the NAO Report to shape its agenda over recent includes the ability to provide specialist stroke years and these objectives have been translated services at the point of emergency 24 hours a day, 7 to a local level. To help support these service days a week. improvement projects, a set of indicators were In 2008, the National Institute for Health and introduced in February 2010 under a programme Clinical Excellence (NICE) introduced clinical called ‘Accelerating Service Improvement’. These guidelines for the diagnosis and initial management indicators were developed nationally to help local of stroke. Two key messages which were highlighted health economies drive through service improvement in this guidance were advising on direct admission in a timely manner. Five of these nine indicators to a specialist stroke unit and quick access to brain specifically related to the improvement of hyperacute imaging to establish suitability for thrombolysis. stroke services. 5 Local Drivers services are one of the most critical components of stroke care that patients need when they are at their As a result of ‘Seizing the Future’ (2009) County most seriously ill. National standards say that these Durham and Darlington Foundation Trust now should be available around the clock with patients operate a two site acute model with planned being directly admitted to a stroke unit where care and specialist rehabilitation based at Bishop specialist stroke consultants and quick access to Auckland Hospital. This followed an extensive essential tests such as brain scans are available. period of consultation with stakeholders to establish the best possible model for the future of health In County Durham and Darlington, hyperacute care across County Durham and Darlington. The stroke services are provided from the University consultation for hyperacute stroke services will be Hospital of North Durham and Darlington Memorial carried out in the context of this wider model. Hospital by County Durham and Darlington NHS Foundation Trust. Unfortunately, services are still NHS County Durham and Darlington’s Five Year not achieving key quality standards, with patients Strategic Plan set out priority areas to be delivered to experiencing varying quality of services. Not enough improve the overall health of the local population. patients are being directly admitted to a specialist One of these priorities is to improve cardiovascular stroke unit, leading to unnecessary delays in related mortality through a number of work diagnosis and treatment. initiatives which includes the development of stroke services locally. During normal working hours hyperacute stroke services are currently available at two sites, however All of the work to date both nationally and staff alternate between sites to provide out of hours regionally has shaped commissioning plans for NHS provision.