Regional ChallengesSouth 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• 2nd 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 14th 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”