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Improvements to Stroke Services in Northern Devon

Improvements to stroke services at Northern Devon Healthcare Trust

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Press release – Proposal to co-locate stroke services at North Devon District Hospital November 9th, 2016

What is being proposed?

The Northern Devon Healthcare Trust (NDHT) is making improvements to stroke services by developing a co-located Acute and Rehabilitation stroke unit at North Devon District Hospital (NDDH). This change is due to take place at the end of January 2017.

This change is separate and has no bearing on the upcoming review of Hyper Acute Stroke Services taking place as part of the Devon wide Acute Services Review work stream of the Devon Sustainability and Transformation Plan (STP).

This briefing note outlines the clinical reasons for this move, how it will improve our stroke services and our planned engagement activity to ensure people are informed about the change.

The case for change

The current stroke pathway

Currently, when someone in Northern Devon has been identified as having a stroke they are admitted directly to the Acute Stroke Unit at NDDH where they receive specialist care immediately after or during their stroke. As they move into the rehabilitation phase of their recovery, they are discharged either:

–     Back home

–     To the Early Supported Discharge Service (ESD) (intensive rehabilitation in their own home)

–     Or to the rehabilitation unit on Elizabeth ward at Bideford community hospital.

The picture below shows the data for October 2015 to November 2016.

stroke-services-graphic

Having the Acute and Rehabilitation units in different places results in a number of disadvantages for our patients, namely:

  • The pathway of care is fragmented for those patients who go to the rehabilitation unit in Bideford. It causes delay and duplication to our care as we have to wait for transport to Bideford and complete a second clinical assessment on arrival.
  • Due to the geographical challenges of Northern Devon some patients (living in or east of Barnstaple) do not find Bideford convenient and choose to be transferred from the ASU at NDDH to an alternative community hospital of their choice, closer to where they live. This means that they do not have access to specialist stroke rehabilitation services.
  • The success of the ESD scheme means increasingly people are coming straight home after a stroke as the support to recover is now available in their own homes. This means that more complex patients are admitted to Bideford which is causing difficulties for the stroke clinical team in overseeing very unwell stroke patients on two sites.

Whilst we offer a very good quality of service, the stroke service has also had difficulties in consistently delivering against a number of national stroke performance indicators including the 90% stay on a Stroke Unit and direct admission to a stroke unit (see below).

Our performance in 2015/2016 against national targets:

  • 90% of patients should be admitted to a specialist stroke unit (acute) within 4 hours. In 2015-16 we achieved 55%.
  • 80% of patients should spend 90% of their stay on a specialist stroke unit. In 2015-16 we achieved 77%.

Benefits of a co-located Acute and Rehabilitation stroke unit

Clinical

Research has shown that stroke patients treated on a stroke unit do better than those treated on medical wards or general assessment units. Patients are more likely to survive the stroke, have fewer disabilities and be able to live independently if they receive specialist care from dedicated stroke services.

Bringing the Stroke Rehabilitation Unit to NDDH will help ensure that all patients who have a stroke are treated on a specialist ward and we envisage that fewer patients will choose to transfer to a non- stroke community hospital.

Co-locating the acute and rehabilitation stroke services will also benefit the operational running of the stroke service as there will be a greater ability to flex between acute and rehabilitation beds to ensure that all stroke patients are cared for in a stroke bed.

The co-location will also deliver an improved experience for patients whose health deteriorates once they transfer to Bideford. If this happens, patients are transported by ambulance from Bideford to NDDH A&E and usually to the Medical Assessment Unit before being transferred back to Bideford. If stroke services were co-located at NDDH a single, multidisciplinary, team would provide seamless care.

The proposals will deliver a number of benefits to our stroke workforce including:

  • Opportunity to develop more specialist skills in our nursing, physiotherapy, speech and language and occupational therapy professionals
  • Enable us to make more efficient use of our highly skilled staff resource.
  • Efficient use of dedicated social services case manager for the combined stroke unit
  • Opportunity for clinical support workers in therapy and nursing to work generically to ensure 24 hour/7 day per week approach to rehabilitation

Access to services

Patients from North Devon District area who have a stroke and require rehabilitation are significantly disadvantaged compared to those who live in Torridge District as they have much further to travel to reach Bideford. A health inequality is therefore developing whereby patients in North Devon do not have the same access to specialist stroke services as those in Torridge because of the current location of the rehabilitation unit.

NDDH, in Barnstaple is geographically central to both Torridge and North Devon and has the best transport links from all areas. Therefore co-locating the stroke services will ensure more equitable access to this service for patients across Northern Devon.

Impacts of the change

Impact on beds at NDDH

There have been significant improvements in patient flow at NDDH thanks to the embedding of the perfect week methodologies within the Trust. This means we now have the clinical space at NDDH to accommodate both the acute and rehabilitation stroke units.

Impact on Bideford Community Hospital

In 2015 NDHT carried out its Safe and Effective Care within a Budget consultation. The outcome of this was that general medical beds at Ilfracombe and Bideford were closed.

Since November 2015 the only inpatient beds at Bideford community hospital have been the stroke rehabilitation service. Patients who previously would have gone to Bideford for care not relating to stroke have been successfully looked after at home or in another community hospital.

When the rehabilitation unit moves over to NDDH, there will not be any inpatient beds at Bideford Community hospital. This change will not impact on the large number of outpatient clinics or the MIU that will continue to run at Bideford.

Engagement plan

Phase one – internal

Phase one of our engagement activity has been internal. We have been working closely with clinical and non-clinical staff to identify the best place for the new co-located ward at NDDH.

Stroke clinicians across the Trust feel strongly that this co-location is the right thing to do. It will improve their ability to deliver high quality care to stroke patients across Northern Devon.

Over 60 clinicians and professionals have contributed to our plans. The executive team are thrilled at the level of engagement and collaborative working demonstrated by clinicians across the Trust as part of this work. They are also pleased to be able to demonstrate how the valuable feedback received has influenced the final decision.

Phase two – external

This briefing forms the launch of our external engagement about this change.

Engagement objectives

Our engagement has three key objectives:

  1. To ensure key stakeholders, patients and the public understand reasons for the co-location (see case for change above)
  1. Understand what impact this change might have on the local communities across Northern Devon
  • North Devon: positive as access to stroke rehabilitation service will be improved
  • Torridge: negative as people will need to travel further for their stroke rehabilitation
  1. Discuss the impact on Bideford hospital
  • Remind people of the 2015/16 consultation outcome (closure of medical beds in Bideford community hospital)
  • Reassure about MIU and outpatient services

We plan to attend local council meetings and patient and carer groups to discuss the above topics. If you would like us to attend a meeting, please contact Nellie Guttmann, our Engagement Lead on: or by phone on 01271 313 971

The Trust believes that it is not necessary to carry out a formal consultation on these proposals for the following reasons:

1)  This is not deemed a significant service change, just a small and local change in the location of a service which will benefit a large number of patients

2)  There are no other viable options

a. We cannot do nothing as we need to improve our services for our stroke patients

b. There is nowhere else a co-located ward could move to