WHY this is important for people in Suffolk and North East Essex
Preventing strokes, and high quality treatment, care and support to recover after a stroke, are essential if everyone in Suffolk and North East Essex is to live well.
As an Integrated Care System we will ensure that:
- People know how to stay health and avoid a stroke
- People receive the best quality treatment and care following a stroke
- People have the best experience of recovery after a stroke
What do we know about people’s local experiences?
- Stroke Association – “Having a ‘go to person’ that always had time for them was the single most important point post discharge.”
- Early Supportive Discharge Service – “I was very pleased to get home. My walking isn’t too good. I feel very tired most of the time, but your care staff have all been very helpful by answering my questions and put my mind at rest. Your Service has been very good, I feel a lot better now and looking forward to being able to walk better (and so is my dog). The team to help me with my conversation after my stroke were very early in my recovery and helped in a most efficient way. I have been given regular sessions. These have been very beneficial with helpful comments. Very prompt service.”
- “There is always room for progression and patients should be able to move fluidly through a pathway when improvements or declines in need.”
For further information see www.healthwatchessex.org.uk and www.healthwatchsuffolk.org.uk
NHS England highlights that:
- Stroke is the leading cause of disability and the fourth largest cause of death in the UK.
- A stroke is a serious life-threatening medical condition that occurs when the blood supply to part of the brain is cut off. The damage this causes can affect the way your body works, as well as how you think, feel and communicate.
- Around 80,000 people a year are admitted to hospital with a stroke, and there are over 1 million stroke survivors in England, more than half of whom have a disability resulting from their stroke.
- Some causes of stroke are genetic, however up to 70% of strokes could be prevented by the detection and effective management of hypertension, atrial fibrillation, diabetes, cholesterol and lifestyle factors. Stroke becomes more likely with age but 1 in 4 stroke survivors are working age adults.
For further information see https://www.england.nhs.uk/ourwork/clinical-policy/stroke/
HOW we plan to make a difference
1.1 People are able to minimise the risk of stroke. We will enable this by:
- Increasing public awareness of the risks of stroke. Knowing the risk factors and keeping healthy will help avoid stroke as well as other related conditions.
- In primary care, improving uptake of health checks and improve awareness of stroke for high risk groups. For people at heightened risk every contact in primary and community-based care should encourage stroke prevention and healthy lifestyles.
- Maximising training and education opportunities in acute trusts, community-based services and primary care networks, with consideration of use of technologies such as the current screening for Atrial Fibrillation in community pharmacies
- Supporting employers to enable their employees to access testing for atrial fibrillation and the other risk factors for stroke. People should have a range of opportunities to identify their risk of stroke and long-term conditions so that they can take action early.
2.1 People recognise at an early stage when they or someone around them may be having a stroke.
- Promotion of information on the ‘FAST’ symptoms enables people to recognise when someone may be having a stroke and seeking urgent help. This in turn enables early treatment and helps improve recovery.
2.2 People receive treatment at the earliest opportunity.
- To help people access diagnostic tests more quickly, we will use technologies such as stroke app and build on our recent mobile stroke unit trial. This specially modified ambulance with trained crews can deliver urgent treatment, diagnose stokes and screen for ‘mimics’ to ensure they only transfer people needing stroke treatment to hospital.
2.3 People who have a stroke receive high quality treatments and care in hospital. We will enable this by:
- Modelling Integrated Stroke Delivery Units providing high quality support from emergency care to Early Supported discharge and longer term support. Linking neuro rehabilitation and patient advocacy services will facilitate more holistic care.
- Enhancing access to acute clinical care out of hours, using virtual technology.
- Meeting the NHS seven-day standards for stroke care and the National Clinical Guidelines for Stroke in all stroke units by 2022. Pathways will ensure people receive the right care for their needs in the right setting.
- Procuring services locally that will provide a tiered approach to care from prevention, self management, with community/outpatient Specialist Rehabilitation, more Level 2 inpatient rehabilitation locally and highly specialist rehabilitation that can support any change to the regional configuration of Hyper Acute Stroke Units (HASUs).
- Delivery of high quality hyper-acute stroke care, including brain scanning and thrombolysis in dedicated units as part of a networked 24/7 service. 50% of people with strokes arrive at the Emergency Department individually and not by ambulance. One specialist stroke team will work across three hyperacute units open to ensure no one is disadvantaged by having to travel to a single central unit. Our three units will work much more closely together through the planned Suffolk and North East Essex Integrated Stroke Delivery Network.
- Provision of mechanical thrombectomy and thrombolysis on specialist stroke units, by December 2022. These treatments can significantly reduce the severity of disability caused by a stroke. 90% of people who have had a stroke will receive care on a specialist unit. All those who could benefit from thrombolysis will receive it (up from 50% now). We will develop a business case for thrombectomy, drawing on data in particular in our deprived communities where there is high need for specialist stroke services.
- Use of CT perfusion scans to assess the reversibility of brain damage, improved access to MRI scanning, and potential use of artificial intelligence to interpret scans for suitability for thrombolysis and thrombectomy. This scaling of technology will assist the expansion of life-changing treatments to more people.
- Modernising the workforce focusing on cross specialty and cross-profession competencies, including training and accreditation for hospital consultants from a variety of disciplines in mechanical thrombectomy, beginning in 2019. Training staff across specialties and professions provides a more flexible workforce who can respond to changing patient needs and levels of demand. We want a sustainable workforce to support stroke services that addresses the current national scarcity in this specialty.
3.1 People recovering from stroke receive high quality integrated care to improve their rehabilitation. We will enable this by:
- Providing more integrated and high intensity community-based rehabilitation, including community-based therapies and home adaptations where appropriate, beginning in 2020. Integrated care delivered in partnership with the voluntary sector, including the Stroke Association, will support improved outcomes at six months and beyond. We are working with a range of organisations, including Livability, ICANHO, Headway and Sue Ryder on new models of care of neuro rehabilitation with increased capacity for inpatient provision.
- Interoperable information systems supported by telehealth. Interoperability aids more timely transfer of information between providers. This enables more effective hyper-acute pathways, and improved access to, and intensity of rehabilitation. Telehealth supports people to monitor their health and identify changes early so that care and support can be obtained.
- Improving support for people with dysphasia. Community-based care should be available to people in their homes and in care homes.
3.2 People with long term health problems following a stroke have support with their wellbeing.
- We will continue to improve access to Improved Access to Integrated Therapies for people with long term conditions. Integrating mental and physical health support for long term conditions supports self-care and improved quality of life.
- We will help people to return to work and meaningful activities. This helps rehabilitation, enables people to maximise their income and reduces the impact of stroke on wellbeing. We are working with a group of organisations, including the Stroke Association to provide an in-depth advocacy role to the stroke survivors across Suffolk. This service will signpost individual stroke survivors and their carers to services most appropriate to them to enhance their recovery and providing equity and parity for our patients across our ICS and with our neighbouring CCGs. The aim of these services is to support each individual stroke survivor, their carers and families through their recovery/ rehabilitation journey; by providing a single point of contact to help survivors and their families navigate through existing services to achieve optimal recovery.
3.3 Carers of people who have had a stroke have support to stay well. • Carers will receive information and support.
- Supporting carers helps them in their role and also helps them maintain their own good health and wellbeing.
3.4 People’s stroke care is based on best practice.
- An update to the national stroke audit - the Sentinel Stroke National Audit Programme (SSNAP) will describe quality of care from onset of symptoms to rehabilitation and ongoing care. The comprehensive dataset will meet the needs of clinicians, commissioners and patients.
- We will use population health data to support the targeting of stroke services where they are most needed. Targeting services effectively helps to reduce unwarranted variations in care.
We will know we are making a difference because we will see:
- Lower Under 75 mortality rate from stroke
- More people with hypertension who have blood pressure <= 150/90 mmHg
- An increase in the proportion of patients with a stroke who are directly admitted to a stroke unit within 4 hours, from 73.6% in 2018/19 to 81.1% in 2023/24
- Increased uptake of NHS health checks
- More people with Atrial Fibrillation and CHADS2-VASc score >=2 who are anti-coagulated effectively
Roger was a managing director of a large company, when he had a stroke in 2016, which resulted in significant physical and cognitive impairment. He wanted to return to driving, and walking as before, but his stroke caused a lack of insight and disinhibition. He was in hospital for 3 months, with a multi- disciplinary rehabilitation programme, but he was unaware that he could behave inappropriately, lack empathy and make errors, and therefore struggled to appreciate the help he needed. At the point of planned discharge, after 6 months, his insight was beginning to emerge, so his treatment was extended for 3 months to developing his insight and awareness of cognitive impairments, aid physical recovery, support his relationship with his wife, to maintain a role at work, and to manage his fatigue. By the time he was discharged, Roger had passed his specialist driving assessment and was having adjustments made to his car; had a specialist aids to facilitate walking, and had support to mobilise from a personal trainer. The burden of caring on Roger’s wife reduced significantly to only a few hours a week, and they were signposted for relationship counselling, alongside the individual psychology Roger received at Icanho. Roger can now identify when his behaviour/comments are not appropriate and take steps to rectify this. As Roger says, ‘I understand more about it all now’.