Greater Manchester hospital stroke care keeps getting better

Strokes are the fourth biggest killer in the UK, and one of the main causes of disability. Time is brain, as 1.9 million neurons die every minute a stroke is untreated – over 6,000 people a year have a stroke in our region.

Research shows that people do better if taken rapidly – usually by ambulance – to a specialist stroke unit called a Hyper Acute Stroke Unit (HASU) where they may receive clot busting drugs and will be cared for by a team of stroke healthcare experts.

Our region re-organised its hospital stroke services in 2015 to ensure that even more stroke patients receive urgent treatment at a specialist centre. We now have three HASUs – Salford Royal, Stepping Hill and Fairfield General Hospitals – that between them provide specialist stroke care 24/7, seven days a week to people in Greater Manchester and Eastern Cheshire.

The changes have now been in place for two years with significant improvements in the care provided to stroke patients – we now have the best rated hospital stroke care pathway in the country.

We were set up in 2015 to help support further improvements in local stroke care. Our most recent review of hospital stroke services showed:

  • Stroke patients living in all 13 boroughs of Greater Manchester and Eastern Cheshire now receive ‘A’ rated care (see below in table 1) – elsewhere in England there is a postcode lottery of care
  • Four of our stroke units are rated ‘A’ – the rest ‘B’
  • Fairfield General is the highest rated stroke unit in the country with Salford Royal in 2nd place and Trafford General 4th – 3 of our 9 stroke units are in the top 10 (out of 228)
  • Our ambulances take people with a suspected stroke to the right type of hospital every time – this ensures they get the right specialist care as quickly as possible
  • 93% of people with a stroke are admitted to a Hyper Acute Stroke Unit – the remainder are treated at their local hospital’s stroke unit as this is the right place for their medical needs
  • More people are being taken to a Hyper Acute Stroke Unit within 4 hours of the start of their stroke symptoms– this means even more people may get clot busting drugs which save lives
  • 94% of Greater Manchester and Eastern Cheshire stroke patients are admitted to a stroke unit. Research shows this means they will do better – the 6% on a non-stroke ward are there mostly for medical reasons
  • Stroke can be hard to diagnose. Stroke teams and stroke wards can be tied up treating people who haven’t had a stroke if the condition isn’t recognised well. There was a reduction in people who turned out not to have had a stroke admitted to a Hyper Acute Stroke Unit – our healthcare teams are getting better at diverting people who haven’t had a stroke to more appropriate hospital services, freeing up stroke wards for stroke patients
  • Our 9 stroke units meet around 92% of the national recommendations for stroke care, such as having an urgent brain scan within an hour of reaching hospital

However, there is more to be done. The network is leading improvements in community rehabilitation – services that support stroke survivors when they go home as there is huge variation in what is offered across the region. A new regional service to develop a surgical procedure to extract clots that cause strokes is also being discussed and work is underway to reduce the number of strokes in the region, as around 80% are preventable.

Table 1. Quality of stroke care ratings by Clinical Commissioning Group (CCG) over time. NB: The change to services happened in March 2015


2014
2015
2016
CCG
Apr-Jun
Jul-Sep 
Oct-Dec 
Jan-Mar 
Apr-Jun 
Jul-Sep 
Oct-Dec 
Jan-Mar 
Apr-Jul 
Aug-Nov 
Eastern Cheshire
D
D
D
D
C
C
B
B
B
A
Bolton
D
D
no data
D
B
B
B
B
A
A
Bury
D
C
C
B
A
A
A
A
A
A
Central Manchester 
D
D
D
C
B
B
B
B
A
A
Heywood, Middleton & Rochdale 
C
C
C
B
A
A
A
A
A
A
North Manchester
D
C
C
B
A
A
A
A
A
A
Oldham 
C
C
C
B
A
A
A
A
A
A
Salford 
C
B
C
B
B
A
A
B
A
A
South Manchester
D
D
D
D
C
B
B
B
B
A
Stockport 
D
C
C
D
C
B
B
A
B
A
Tameside and Glossop
D
D
D
D
C
C
B
B
B
A
Trafford
D
D
C
D
B
B
B
B
A
A
Wigan Borough
D
D
C
C
B
B
B
B
A
A

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