Analysis

Northern Ireland looks to consolidate stroke care into hyper acute units

Proposed stroke care models to offer 24/7 expert care and career development for nurses

Proposed stroke care models to offer 24/7 expert care and boost career development opportunities for nurses

  • NI stroke services to adopt hyper acute model as pioneered in London and Manchester
  • Consolidated services will offer ongoing expert care, including thrombolysis and thrombectomies
  • The hyper acute units will offer opportunities and career development for nurses
Stroke
Picture: iStock

Northern Ireland has become the latest UK country to look at redesigning its stroke services.

Eight hospital sites provide stroke services, but health department permanent secretary Richard Pengelly says this has left services spread too thinly.

Proposals put forward by the NI Department of Health suggest there should be between three and five hyper acute stroke units operating by 2022.

Mr Pengelly says the creation of hyper acute units will mean expert care can be made available 24/7, calling it a ‘once-in-a-generation opportunity to make stroke care better’.

He predicts it will save lives and reduce long-term disability – research cited by the department’s consultation suggests the hyper acute model could double the numbers surviving disability-free.

Stroke treatments

2,800

stroke-related hospital admissions each year in Northern Ireland

(Source: Northern Ireland Department of Health)

Every year there are around 2,800 stroke-related hospital admissions in NI and nearly 1,000 deaths.

At some sites only 40% of patients get the clot-busting thrombolysis treatment within the recommended window of one hour. 

Thrombectomy – a powerful new treatment that can remove large clots from the brain and can benefit one in ten patients – is only available Monday to Friday from 8.30am to 5.30pm at Belfast’s Royal Victoria Hospital. 

What is being proposed?

Six potential models have been put forward in the 12-week consultation, which began at the end of March.

Each involves consolidating services into a smaller number of centres to ensure access to rapid assessments and scans, and clot-busting thrombolysis therapy if needed.

They all include designating Belfast’s Royal Victoria Hospital, Craigavon Area Hospital and Altnagelvin Area Hospital as hyper acute units with Antrim Area and/or South West Acute hospitals as options too.

Royal Victoria would also be able to start offering thrombectomies 24/7 because of the greater concentration of resources.

‘Faster diagnosis, quicker access to better treatment, ongoing rehab for survivors and 24-hour specialist units will make the NHS even more effective at tackling strokes’

Professor Stephen Powis, stroke lead at NHS England

The move is being supported by clinicians and the Stroke Association in NI.

'Clear evidence' of the benefits

Stroke Association head of influencing and communications in Northern Ireland Brenda Maguire says reform is urgently needed.

She says there is clear evidence the hyper acute model will benefit patients and create more sustainable services.

The model is based on learning from what has worked in England where reorganisations of stroke services in London and Manchester have pioneered a new way of working.

London established hyper acute units in 2010 followed by Manchester five years later.

Rather than be taken to their local hospital, stroke patients are transferred to one of the hyper stroke units.

2 times

as many patients will survive disability-free if changes are introduced

(Source: Northern Ireland Department of Health)

Life saving 

A recent study by University College London suggested the changes across the two regions could save 170 lives a year. 

NHS England’s stroke lead Professor Stephen Powis says the research proves the time has come to ‘roll-out the model across the whole country’.

‘Faster diagnosis, quicker access to better treatment, ongoing rehab for survivors and 24-hour specialist units will make the NHS even more effective at tackling strokes.’

Hyper acute units nationwide

Stroke was highlighted as a priority in NHS England’s long-term plan published earlier this year with the National Stroke Programme.

Areas are being encouraged to set up integrated stroke delivery networks to help oversee reorganisations.

Some places, including Northumbria and the West Midlands, are already well on their way to being established.

‘The evidence in terms of better outcomes for patients is clear. We are going to be hearing a lot about reconfigurations in the coming years’

Rachael Jones, National Stroke Nursing Forum vice chair


Rachael Jones

The hope is this structured approach will smooth the process – previous attempts to reorganise services have become mired in legal and political challenges, leaving services too stretched and not always available 24/7.

National Stroke Nursing Forum vice chair Rachael Jones says it is understandable that such changes cause controversy – particularly in rural areas where the travel distances are likely to be greater. 

‘People do not like the idea of losing services that are local to them. But the evidence in terms of better outcomes for patients is clear. We are going to be hearing a lot about reconfigurations in the coming years.’

Staffing challenges

Ms Jones says a challenge for NI – and other places pushing ahead with reconfigurations – will be staffing.

‘There is no point buying the equipment and reorganising services without having the staff in place to treat the patients. Like many areas of nursing, there are significant vacancies. Most units are short of staff and that means even in hyper stroke units the ratios of nurses to patients is not what you would want it to be.’

But she says reforming services presents a host of opportunities for nurses and stroke care should be seen as an option for nurses of all grades.

‘Stroke care used to be unfashionable, but it is now a really exciting place to be given what can be achieved for patients and how you can develop your skills.’

The future of stroke care in Northern Ireland

  • Services centred around hyper acute units where patients can get continuous access to assessment, scans and thrombolysis treatment
  • Patients should be no more than 60 minutes away from these units and will be taken there rather than to their local emergency department
  • Some of these hyper acute units will be the region’s neuroscience centre where thrombectomies can be performed
  • Patients will be moved to acute stroke units after a few days to receive care from a multi-disciplinary expert team, including nurses and therapists
  • These units will arrange long-term rehabilitation from community therapists when the patient is ready for discharge

Stroke care ‘exciting’ career development for nurses


Ismalia de Sousa

Ismalia de Sousa, a clinical nurse specialist in stroke care at Imperial College Healthcare NHS Trust, has worked in London ever since the hyper acute units were set up.

‘The hyper acute units have offered exciting opportunities for nurses and for their career development,’ she says.  

‘We have staff nurses with expertise in stroke care providing 24/7 nursing care and patient rehabilitation, stroke nurses who coordinate patient flow and admission and discharge from stroke units and senior stroke nurses who assess patients for thrombolysis or thrombectomy treatments.

‘There are also nurse consultants in stroke as clinical leads of their services and networks, and clinical nurse specialists supporting patients, assessing patients independently in rapid access transient ischaemic attack (TIA) clinics and at the forefront of service development.

‘Where we can improve is in the community, supporting the hidden impairments of a stroke. The psychological support is not always available in a timely manner. Stroke care is still very much a postcode lottery.

‘I would also like to see more specialist nurses in the community or providing an outreach service in a similar way to specialist nurses in neurological conditions such as multiple sclerosis or Parkinson’s disease.’

 


Nick Evans is a freelancer writer

Find out more

The consultation Reshaping stroke care in Northern Ireland closes on 2 August: www.health-ni.gov.uk/reshaping-stroke-care 

NHS England Long Term Plan and the National Stroke Programme www.stroke.org.uk/get-involved/campaigning/nhs-long-term-plan

This article is for subscribers only

Jobs