Transcript Cardiology at the Limits Cape Town, April 2005

“The National Stroke Strategy
and the nursing contribution”
Professor Roger Boyle
National Director for Heart Disease and Stroke
London, June 2008
Why stroke matters
• Burden of disease
– >110,000 strokes each year (rule of thirds)
– >20,000 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
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
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
Over 1,000
responses
Over 800 of these
from stroke survivors
or carers
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
Twenty Quality Markers
7. 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)
8. 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
Twenty Quality Markers
9. 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
Twenty Quality Markers
10. Life after stroke
•
Stroke-specialised rehabilitation
11. Active end of life care
12. Planning for transfer of care
13. Support for long-term needs of people
who have had a stroke and their carers
14. System that provides review of their
needs at six weeks, six months and then
annually
Twenty Quality Markers
15. Opportunities to participate in community
life
16. Opportunities to return to work
17. Establishment of stroke networks
18. Ensure appropriate skills, competence
and leadership
19. Review, plan and develop a strokeskilled workforce
20. Need to develop further research and
audit
Impact per SHA - outcomes
Numbers of Patients with better outcomes per annum through adopting 4 key stroke interventions
900
Number of Patients per annum with better outcomes
Specialist Stroke Unit 2006
800
Thrombolysis
Early Supported Discharge Team
TIA Clinics (strokes avoided)
700
600
500
400
300
200
100
0
East
Midlands
Eastern
London
North East
North West
South
Central
South East
Coast
South West
West
Midlands
Yorkshire &
Humber
Impact per SHA – bed days
Numbers of Beddays Saved through adopting 4 key stroke interventions
80,000
231
beds
Equivalent Beds Saved (Text)
Specialist Stroke Unit 2006
Thrombolysis
Early Supported Discharge Team
TIA Clinics (strokes avoided)
70,000
Number of Beddays Saved
60,000
169
beds
184
beds
156
beds
50,000
40,000
165
beds
137
beds
121
beds
102
beds
83
beds
30,000
56
beds
20,000
10,000
0
East
Midlands
Eastern
London
North East
North West
South
Central
South East South West
Coast
West
Midlands
Yorkshire &
Humber
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
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…
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.
Operational Plans
2008/09 – 2010/11
(Implementing the 2008/09 Operating
Framework)
• National Planning Guidance and “vital signs”
• Published 31st January 2008
• National Requirements
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
www.dh.gov.uk/
en/Publications
andstatistics/
Publications/
PublicationsPoli
cyAndGuidance
/DH_082542
Variable performance within SHAs
Stoke Stroke Register Data
Discharge Destination 2001-2007
(April-March, 2007 to August)
25%
30%
35%
28%
79%
85%
of strokes adm. to ASU
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Home
Institution
(NH, RH,CC)
Death
1
2
3
4
years
5
6
7
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
Requirements to deliver change
•
•
•
•
•
•
Change accepted
Collaboration
Clinical engagement
Clinical leadership
Co-operation
Collective commissioning
Stroke mailbox:
[email protected]
Greater Manchester & Cheshire Cardiac and Stroke
Network Structure
Primary Care & Practice Based
Commissioning
Education &
Training
Clinical
engagement
Clinical
Governance
Standard
setting
Networking
Service
Improvement
Shared vision
Audit
Working
Groups
Workforce Delivery
& Planning
Working
Groups
SERVICE DELIVERY
Commissioning
Advice
Network support
Team
PATIENT
&
CARER
CARDIAC
BOARD
Pathway
Development
PCPI
Working
Groups
STROKE
BOARD
Working
Groups
INDIVIDUAL ORGANISATION
PROVIDERS
Pooling knowledge,
skills and resources
ORGANISATIONAL
BOUNDARIES
COMMISSIONERS
Supporting
implementation of
national and local
guidance
Sharing Best
Practice and
information