Public Engagement on Enhancing Acute Stroke Care Services in Lancashire and South Cumbria

This page contains:

  • The background and summary of enhancements to acute stroke care services
  • Detailed information about the proposed enhancements to acute stroke care services (referred to as the business case for the enhanced network model of acute stroke care)
  • Opportunities to provide your feedback on any difficulties or concerns you may have about implementing the approved proposals via a survey and/or via discussion with those involved
  • Frequently Asked Questions section to answer some initial queries and concerns
  • Opportunity to view the stroke service specification (in full or in diagrammatic summary)
  • Easy read versions of the proposals (business case) and our engagement around the stroke service pathway specification
  • Information on the specific proposals for stroke patients at Royal Lancaster Infirmary

In order to provide your feedback, we are asking you to consider the proposed enhancements to acute stroke services across Lancashire and South Cumbria, which have been approved by your local NHS organisations for significant funding and development over the next three years.

We recommend that you read the background and summary below and, if you wish, the more detailed information (the business case), which supports this proposal, before getting involved, completing the survey and providing your feedback.

Stroke is the fourth leading cause of death in the UK and the single biggest cause of complex adult disability. Over 2,000 patients are admitted to hospitals across Lancashire and South Cumbria with a stroke each year and at least half of these will have some form of disability for the rest of their lives, many of which are severe and mean the stroke survivor can no longer live independently. This number is rising. Over twice this number attend Emergency Departments with the symptoms of a stroke, but which do not require specialist stroke care. Stroke costs the UK around £26 billion a year and the cost of urgent and acute stroke care in local hospitals is approximately £20 million a year.

These are huge and disturbing numbers, especially when taking into account the fact that a stroke, for the majority of cases, is a preventable disease. If it is possible to reduce the number of deaths and the number of people living with the impact of a stroke, then this should be done. We believe this is possible, and we are now seeking your feedback and support on the approved way forward to making this happen.

To make this happen, a full-scale review of the stroke service pathway (the journey someone who may have a stroke or who has had a stroke, from prevention through to long-term survivorship/end of life) has been underway since 2015. Its aim was and is to reduce deaths and disability by improving all stroke care and related services for the whole population of Lancashire and South Cumbria and ensure everyone has access to the same level of high-quality care, no matter where they live.

A new specification for the stroke care service pathway has been established which is in line with national guidance on stroke and has been co-created and endorsed by stroke survivors, professionals and other groups with an involvement or interest in stroke and stroke care. Some elements of the pathway, including prevention and integrated community stroke teams, are already seeing developments take place.

One of the major areas for enhancement is the acute stroke care provided in the stroke centres located in 5 hospitals within Lancashire and South Cumbria – Royal Preston Hospital, Blackburn Royal Infirmary, Blackpool Victoria Hospital, Lancaster Royal Infirmary and Furness General Hospital. A crucial factor in providing effective stroke care is the availability of qualified and experienced doctors, nurses and therapists throughout the care of a stroke patient. This is especially the case in the initial hyper-acute and acute phases of care and recovery, which are required during the first 72 hours after a stroke takes place. It is during this period that more recent medical advancements have taken place, such as thrombectomy and thrombolysis, which have a major impact on the effects of a stroke.

The proposals for improving acute stroke care services, which take into account these needs and developments, were originally considered in 2019 and the preferred option for how and where these services will be delivered was supported by stroke survivors, carers, stroke care professionals, the Stroke Association, and commissioners of these services.

Unfortunately, the arrival of the COVID-19 pandemic seriously impacted upon the development of the full business case for enhancing acute stroke care services, which, if agreed, would have allowed the proposals to be implemented. In stroke care, such delays impact upon the saving of lives and the level of lifelong disability stroke survivors can face. 


Where are we now

As we emerge from the worst of the pandemic efforts have been made to progress the enhancement of acute stroke services at pace. As a result, the full business case identifying the proposals to enhance the acute stroke and rehabilitation services provided in Lancashire and South Cumbria was approved by the Strategic Commissioning Committee at their meeting in public on 15 July 2021.  This commits the local NHS to a multi-million-pound investment in staff, facilities and equipment and we are now entering a three-year period of implementation.

Although the proposed enhancements to acute stroke care services are widely supported by stroke care survivors, their carers, the Stroke Association and professional staff involved in stroke care, they have not been shared with the wider public and others who will have an interest in any changes.  We are therefore, launching a period of public engagement to inform you of the approved option for acute stroke care across Lancashire and South Cumbria and get your feedback on any difficulties or concerns you may have about implementing these proposals.

In brief (for more details please see the detailed information on the proposed improvements to acute stroke care [business case] tab below), to maximise the resources available, including the limited availability of a fully qualified and trained stroke care workforce and deliver the best possible stroke care service for all our population, the main proposals are

Enhanced Network Model of Acute Stroke Care

Strengthen the front door (Emergency Department of the hospital):

  • Ensure the presence of stroke triage nurses in Emergency Departments 24/7, 365 days a year, to meet the patient, assess for stroke, including brain scanning and ensure timely stroke treatment takes place – time is brain.
  • Establish ambulatory emergency care services in all stroke receiving hospital sites to triage suspected stroke patients and ensure both stroke and none stroke patients move from the hospital emergency department to the right care pathway, as appropriately and as quickly as possible

Enhance acute services:

  • Increase thrombolysis and thrombectomy rates towards the national target for these services
  • Establish a network model of one Comprehensive Stroke Centre* (CSC) at Preston, two Acute Stroke Centres (ASC) at Blackburn and Blackpool and Stroke Recovery Units (SRU) at all local acute hospital sites to be compliant with the national stroke service specification
  • All existing stroke centres in the system (Blackburn, Blackpool, Furness, Lancaster and Preston) will remain open
  • Clinical processes will be created for Morecambe Bay/South Lakes residents with a suspected stroke taken to Furness General Hospital to ambulance, following initial triage and treatment, to the Comprehensive Stroke Centre in Preston for 24 hour care for up to 3 days
  • Morecambe Bay/South Lakes residents with a suspected stroke normally bound for Royal Lancaster Infirmary to be taken directly to the Comprehensive Stroke Centre in Preston for initail triage and treatment and for 24 hour care for up to 3 days - non-stroke patients are triaged and returned to Royal Lancaster for relevant treatment
  • A return transfer policy will be created to ensure a safe return from Preston for Morecambe Bay residents to their local Stroke Recovery Unit for inpatient stroke rehabilitation or home with community rehabilitation

Strengthen community services:

  • Ensure Lancashire and South Cumbria wide coverage of community stroke rehabilitation teams in place to provide intensive therapy services to stroke survivors in their homes following hospital discharge.

*The comprehensive stroke centre will offer all the services provided by the other acute stroke centres but will have additional specialist stroke service for the regional provision of thrombectomy and neurosurgery.


Implementation of the proposals for enhanced Acute Stroke Care

Following the approval of the proposals and the huge investment in acute stroke services this represents, the focus has changed to the implementation of these proposals. A phased implementation plan will run over a three-year period to achieve the following priorities:

 

Priorities for 2021/22

 

Strengthen stroke specialist staffing at the front door of our acute hospitals*

Complete the community stroke rehabilitation teams roll out across the patch

Increase hyper-acute stroke beds at Royal Preston for additional thrombectomy activity

 

Priorities for 2022/23

 

Invest in estates and equipment in preparation for becoming Comprehensive and Acute Stroke Centres

Ensure all stroke wards are providing a 6 day rehab service

 

Priorities for 2023/24

 

Expansion of Acute and Comprehensive Stroke Centres – total estate and staffing

Ensure all stroke wards are providing a 7 day rehab service

 

* The strengthening of stroke specialist staff at the front door has now become a priority for 2022/23 to align with budgetary allocations for the current financial year. 

As the implementation process develops, we are reaching out to the wider public to inform you of the proposed enhancements and to gather feedback on any issues or concerns you may have about their implementation.

This may be of particular interest to those of you with a greater risk of having a stroke. This includes people with high blood pressure (hypertension), an irregular heart rate (atrial fibrillation), high cholesterol, diabetes, obesity or other long-term condition.


The public engagement will continue over the next few months whilst the implementation period develops and progresses. Members of the public, patients and staff can continue to provide feedback during this period. Please use the survey tab below to complete the survey and provide your feedback.

Any groups or individuals who wish to discuss the implementation of these proposals, in addition to completing the survey, can make arrangements to do so by contacting mlcsu.haveyoursay@nhs.net or ring 07825 823335.

 

Operational Implementation Group 

The implementation of the proposed enhancements will be driven by a dedicated Operational Implementation Group. It is anticipated that the group will consist of representatives from each of the hospital Trusts, patients and carers, the Stroke Association, NWAS, commissioners and community services. This is in keeping with the main groups involved in the development of these proposals.


The following documents have been developed to be printed and are not fully accessibile. These are presented as they have been produced for Board and Committee meetings for transparency.

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