The Royal Stoke MS Centre - hub and spoke model Leighton Hospital Nantwich County MS Clinic Royal Stoke MS Centre Macclesfield Leek Cannock Northwich Rugeley

Suggested MS diagnosis and treatment pathway Current MS diagnosis and treatment pathway Referrals (GPs & others) Referrals (GPs, others) Admin Triage Collect all relevant info from GP/patient format/ previous assess and tests 9-13 weeks MS diagnostic clinics/neurology clinic Request diagnostics 6 weeks Within 1 week MS neurologist triage Arrange diagnostics MRI/LP/bloods MRI 4-6 months One no face- face episode MS nurse contact to collect info/ advise LP Consultant follow-up clinic Communicate diagnosis Significant % need LP If confirmed 4-6weeks Newly diagnosed MS nurse clinic MRI/LP/ bloods Within 5 weeks Lumbar puncture 4-6 months One Stop MS Diagnostic Clinic Communicate diagnosis MS nurse newly diagnosed clinic Same day Consultant F/U after LP to communicate diagnosis 2 weeks 2-6 months One Stop Treatment assessment (DMT) MS Consultant & MS nurse On-going care Treatment decision MS consultant/MS nurse DMT assessment clinic   On-going care

The Royal Stoke MS Centre Tele health – continuing support for MS patients into the future Telemedicine involves the provision of health care and sharing of medical knowledge using telecommunications technologies. Preventive, diagnostic, and therapeutic services, as well as patient education and assistance with self-management of health, can be provided via telemedicine. PRESS RELEASE   University Hospitals of North Midlands has launched a new Royal Stoke MS Centre for Multiple Sclerosis patients. The Trust is launching the Centre of Excellence, with an increased number of specialist Multiple Sclerosis (MS) staff, at a time when the service is increasing year on year. Multiple sclerosis affects nerves in the brain and spinal cord, causing a wide range of symptoms including problems with muscle movement, balance and vision. The service now cares for 2,500 patients, which has increased by 60% in the last decade. Dr Adnan Al-Araji, Consultant Neurologist and Clinical Lead for the service, said: “Each nerve fibre in the brain and spinal cord is surrounded by a layer of protein called myelin, which protects the nerve and helps electrical signals from the brain travel to the rest of the body. In MS patients, the myelin becomes damaged and this disrupts the transfer of these nerve signals, causing a wide range of symptoms, such as loss of vision, uncontrolled muscle movements, difficulties with balance and fatigue. “What this new centre of excellence will allow us to do is give patients fast diagnostic and treatments. We will be appointing a clinical nurse specialist on-call service to improve rapid access and management of disease relapses, which will help patients avoid A&E and hospital admissions. Evidence shows that early diagnosis and treatment will result in less long term disability, improved quality of life, and the progression of the disease may be halted or delayed.” The team will be expanding the service into Cheshire, Derbyshire, Burton, and South East Staffordshire. This will further improve diagnostic and treatments and access to consultants and nurses at satellite clinics. Dr Al-Araji said: “These satellite services will see MS specialised nurses providing a network of clinics offering services, closer to home. This is important because 20-25% of patients require disease modifying treatments, regular consultant and nurse specialist follow up. Around 130 patients need a monthly Tysabri infusion. I believe that by creating this centre of excellence, across a wide network of communities, we will give these patients the very best care.” STAKEHOLDER LETTER Dear colleague, As you may be aware, together we have seen an increase of 60% in patients with multiple sclerosis over the past decade. This is a patient group that many of you will have long experience with and have striven to get the very best care for. The Trust has decided to create a centre for excellence based here at the Royal Stoke University Hospital, but with satellite units across the region. This new network, named the Royal Stoke MS Centre, will allow us to do is give patients fast diagnostic and treatments. We will employ an increased number of specialist Multiple Sclerosis staff and create a clinical nurse specialist on-call service to improve rapid access and management of disease relapses, which will help patients avoid A&E and hospital admissions. The team will be expanding the service into Cheshire, Derbyshire, Burton, and South East Staffordshire. This will further improve diagnostic and treatments and access to consultants and nurses at satellite clinics. This is important because 20-25% of patients require disease modifying treatments, regular consultant and nurse specialist follow up. Around 130 patients need a monthly Tysabri infusion. I believe that by creating this centre of excellence, across a wide network of communities, we will give these patients the very best care. Please don’t hesitate to contact me should you require further information about this new service.

The Royal Stoke MS Centre - Pioneering Tele health Patients who attended a Tele-health Focus Group felt that it had a place in the management of: Newly Diagnosed Relapse DMT Symptom management areas of MS  Would support self-management May reduce direct nurse contacts May prevent them from waiting for return phone calls or clinic slots     Would provide reassurance, realistic goal setting, emotional support  Many patients use Facebook for information Patients like the idea of online learning resources especially at early diagnosis

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