Cardiology at the Limits Cape Town, April 2005

1

The National Stroke Strategy and the nursing
contribution
Professor Roger Boyle National Director for Heart
Disease and Stroke London, June 2008
2
Why stroke matters

• Burden of disease
• gt110,000 strokes each year (rule of thirds)
• gt20,000 Transient Ischaemic Attacks (TIAs or
  mini strokes)
• At least 300,000 living with significant
  post-stroke disability (single largest cause of
  adult disability)
• Third most common cause of death
• 1 in 4 people affected are under 65
• People of South Asian and African Caribbean
  origin at significantly higher risk
• Costs
• 2.8 billion direct care costs
• 1.8 billion due to lost productivity and
  disability
• 2.4 billion informal care costs
• 2.6 million bed days per year

3
Positioning

• Ministers (particularly Secretary of State)
• NHS Board
• NHS Chief Executive
• Directors of Commissioning and Performance
• Chief Executives and medical directors of the
  Ambulance Trusts
• All Party Parliamentary Group
• Stakeholders

4

What had been done already

• Commissioning Guide
• ASSET for providers
• ASSET for commissioners
• Mending Hearts and Brains
• Payment by Results for Stroke and TIA services
• NHS Institute Focus on Acute Stroke
• UK Stroke Research Network

5
Over 1,000 responses Over 800 of these from
stroke survivors or carers
6
(No Transcript)
7
(No Transcript)
8
Twenty Quality Markers

1. Public and staff recognise the symptoms of stroke
2. Assessment and management of vascular risk
   factors
3. Improve information and advice
4. Involvement of individuals and carers in
   developing and monitoring services
5. High-risk TIA seen and scanned within 24 hours
   others within seven days
6. TIA patients followed up at one month

9
Twenty Quality Markers

• Acute stroke
• Immediate ambulance transfer to a..
• Hospital providing hyper-acute services (triage
  systems, expertise, timely imaging and ability to
  thrombolyse throughout a full 24 hour period)
• Assessment
• Immediate structured clinical assessment
• Urgent scanning (next slot within hours and
  within 60 minutes OOH) with skilled radiological
  and clinical interpretation
• Early multidisciplinary assessment including a
  swallowing assessment within 24 hours

10
Twenty Quality Markers

• Treatment
• Prompt access to an acute stroke unit where they
  should spend most of their hospital stay
• Ongoing access to scanning and rapid availability
  of more specialised neuro services
• Specialist nursing is available for monitoring
  patients
• Appropriately qualified clinicians to address
  respiratory, swallowing, dietary and
  communication issues

11
Twenty Quality Markers

• Life after stroke
• Stroke-specialised rehabilitation
• Active end of life care
• Planning for transfer of care
• Support for long-term needs of people who have
  had a stroke and their carers
• System that provides review of their needs at six
  weeks, six months and then annually

12
Twenty Quality Markers

• Opportunities to participate in community life
• Opportunities to return to work
• Establishment of stroke networks
• Ensure appropriate skills, competence and
  leadership
• Review, plan and develop a stroke-skilled
  workforce
• Need to develop further research and audit

13
Impact per SHA - outcomes
14
Impact per SHA bed days
15
(No Transcript)
16
(No Transcript)
17
Supporting the strategy

• Mandated for every PCT within the Operating
  Framework
• Central finance over 3 years (105 million)
• Training (16 m)
• Raising awareness (12 m)
• Developing innovative practice (77 m)
• 32 m to the NHS
• 45 m to social care

18
Operating Framework p16

• There are four areas where PCTs will need to take
  particular action in 2006/09 to ensure progress
• Cancer going further on our existing
  commitments.
• Stroke Driving up standards of care to reduce
  mortality and morbidity through implementation of
  the Stroke Strategy
• Children
• Maternity

19
Operating Framework

• The National Stroke Strategy is a comprehensive
  10-yr framework aimed at driving up
  standards.All PCTs are expected to set out, in
  plans for 2006/09, how they intend to improve
  stroke services.
• Early specific priorities for 2006/09 include
  supporting the development of stroke networks and
  redesigning services across networks to ensure
  appropriate urgent care for stroke and TIA and to
  meet needs for the long term.

20
Operational Plans2008/09 2010/11(Implementing
the 2008/09 Operating Framework)

• National Planning Guidance and vital signs
• Published 31st January 2008
• National Requirements

21
National Requirements

• PCT Operational Plans will need to reflect the
  requirements will be performance managed
• MRSA, C. diff.,18 weeks, improving access to
  primary care, implementation of the cancer
  strategy and.
• Implementation of the stroke strategy
• Patients who spend 90 of their time on a stroke
  unit
• of higher risk TIA patients who are treated
  within 24 hours

22
STROKE
STROKE
23
www.dh.gov.uk/en/Publicationsandstatistics/ Public
ations/ PublicationsPolicyAndGuidance/DH_082542
24

Variable performance within SHAs
25
Stoke Stroke Register Data Discharge Destination
2001-2007 (April-March, 2007 to August)
25 30 35 28 79 85
of strokes adm. to ASU
Home Institution (NH, RH,CC) Death
26
And by the way

• The National Audit Office will be doing a further
  review of stroke in 2009/10
• This inevitably leads to another hearing at the
  Public Accounts Committee

27
Requirements to deliver change

• Change accepted
• Collaboration
• Clinical engagement
• Clinical leadership
• Co-operation
• Collective commissioning

Stroke mailbox stroke_at_dh.gsi.gov.uk
28
Greater Manchester Cheshire Cardiac and Stroke
Network Structure
Primary Care Practice Based Commissioning
Education Training
Audit
Standard setting
Clinical engagement
Clinical Governance
Networking
Workforce Delivery Planning
Service Improvement
Working Groups
Working Groups
SERVICE DELIVERY
Shared vision
Commissioning Advice
Network support Team
HYPER ACUTE STROKE PROJECTS
PATIENT CARER
STROKE BOARD
CARDIAC BOARD
Working Groups
Pathway Development
INDIVIDUAL ORGANISATION PROVIDERS
Working Groups
Sharing Best Practice and information
PCPI
Supporting implementation of national and local
guidance
Pooling knowledge, skills and resources
ORGANISATIONAL BOUNDARIES
10 / 11 PCTs
Association of Greater Manchester PCTs
COMMISSIONERS