Regional Challenges South East Wales

10.00am Welcome and introduction –Cerilan Rogers 10.05am Feedback from expert panel process –Paul Tromans 10.20am Update on project workstreams –Anne Freeman 10.40am Stroke audits in Wales –Sarah Jones 11.00am Coffee 11.20am Developing an integrated stroke service –Chris Burton 11.30am Developing a stroke unit –Pradeep Khanna 11.50am Issues in proving imaging services to stroke patients –Shawn Halpin 12.10pm Questions and discussion –Chris Burton 12.35pm Appraisal of stroke care maps –Chris Burton

1.45pm Feedback of maps –Chris Burton 2.15pm Regional issues - thrombolysis in South East Wales –Tom Hughes 2.30pm Regional stroke forum development update –Sam Crane 2.40pm Coffee 3.00pm Discussion on regional network development –Chris Burton 3.30pm Evaluation and Close –Chris Burton

Stroke Services Audits (Last, current and next) Dr Sarah J Jones

Last, current and next Results of the RCP Organisational Audit Profession Specific Audit process AOF audit RCP interim audit

RCP Organisational Audit 2008 “There is reason for optimism” Stroke now high on the political agenda Effective acute stroke units providing ‘basic’ stroke care Do not rush into providing thrombolysis before other components of the service are functioning well

RCP Organisational Audit 2008 (ii) “Stroke care in Wales is now high on the list of political priorities and it can be expected that major improvements will be seen over the next two years” Need to live up to this expectation

Key findings Hyper acute care –Need to have good quality basic care –Provision of thrombolysis in Wales remains very low –Paramedic services integral to acute stroke services Imaging –Access outside normal working hours and at weekends is a problem –Need to meet new imaging standards for the management of TIA –No problems highlighted in Wales

Key findings (ii) Stroke units –The single most beneficial intervention –Small increase in provision in Wales since 2006 –All stroke patients should be managed on a stroke unit

Key findings (iii) Staffing –Nursing improving –Psychology, orthotics, podiatry, dietetics poor –Likely lack of physiotherapy, OT, SALT –Social Worker, specialist training Community care –ESD saves resources and improves outcomes –Only 10% of services in Wales have ESD

Key findings (iv) Discharge planning –Patients need more information, including their primary care discharge summary Training –Need to meet training needs for all staff Research –Not well developed in Wales –Research should be an integral part of all stroke services

Key findings (v) – Wales specific Specialist community team –at 14 sites, previously 1 Early supported discharge –at 2 sites, previously 4 Thrombolysis –provided at 2 sites

Key findings (vi) – Wales specific CT scanning (weekdays) –At 16 sites within 24 hours, previously 9 CT scanning (weekends) –At 6 sites within 24 hours, previously 4 Neurovascular / TIA clinic –At 14 sites, previously 9 –Seen within 7 days at 8 sites, previously 3 –High risk cases seen within 24 hours at 6 sites, previously 0 –Low risk cases seen within 7 days at 6 sites, previously 0

Key findings (vii) – Wales specific Patient / carer views sought at 19 sites, previously 16 Report of patient views produced at 7 sites, previously 3 Organisational scores –12 sites improved scores, 5 stayed within 2 points of previous score, 3 sites had lower scores –1 unit now in the upper quartile, previously 0 –6 in middle quartile, previously 5

Conclusions This is the marker by which progress in Wales will be measured Efforts need to continue

Profession specific audits 2 nd Pilot Aim to incorporate the profession specific audits into the main RCP audit in the future RCP / professional colleges involved in the development of Nursing, Physiotherapy, Nutrition and Dietetics, Speech and Language Therapy, Occupational Therapy SSIP Programme of work –Clinical psychology, social work, podiatry Focus on in-patient care

Profession specific audits (ii) Pilot –Contribute to understanding of stroke services in Wales –Test the web based approach Protocols –Developed by WAG –On the website at News and Events Audits

Location, location, location All of the audits sit on the Stroke in Wales website nww.stroke.wales.nhs.uk Looks like this…

Profession specific audits (iii) Audits were available on-line from 14 th October Pass key needed to access the audits section of the website Due to be completed by 30 November 2008

Annual Operating Framework Target outlined in WHC (2007) 058 Implementation of National Standards for Stroke Services in Wales Action plan process was intended to focus on stroke unit development to achieve the target

Annual Operating Framework (ii) “By March 2009, all patients suspected of having a stroke are assessed and treated in specialist stroke units which comply with the following 5 characteristics identified by the Royal College of Physicians: –Access to continuous physiological monitoring –Access to scanning within 3 hours of admission –Access to brain imaging within 24 hours of admission –Policy in place and adhered to for direct admission from A and E –Access to specialist ward rounds at least 5 times a week

Annual Operating Framework (iii) An audit tool is being developed Nevill Hall Hospital Likely to be more consultation Audit to be carried out in April Via the stroke website

Conclusions Lots going on Audits help to monitor progress Positive signs “Keep up the good work”