An overview of improvements to stroke care in Greater Manchester
Improvements to stroke care in our region have been driven through managed networks; initially the Strategic Clinical Network which established an Operational Delivery Network in 2015. In 2020/21, we evolved to become an Integrated Stroke Delivery Network joining 19 others set up across England as part of the Long Term Plan.
Our work is governed and overseen by a Board and managed through a series of groups. You can find out more in our strategy and view our latest Annual Report. You may wish to learn more about setting up a managed network as the new ISDNs are likely to require a similar structure and approach. You can read our FAQ here. There is also an NHS England document on reconfiguration of services plus appendices.
Work led by the ODN has focused on:
- Preventing stroke
- Re-organisation of hospital stroke services
- Optimising the ambulance pathway
- Improvements to inpatient care
- Implementing integrated community rehabilitation services
If you register on our website (top right) you can access additional resources such as our Pathway Document Pack which includes service specifications and Standard Operating Procedures/policies, as well as our Greater Manchester outcome measure set which will allow us to assess performance across the whole care pathway.
1. Preventing stroke
Most strokes could be prevented, and we are working locally with stakeholders including commissioners, primary/secondary/community clinicians, Health Innovation Manchester, Greater Manchester Health and Social Care Partnership and the voluntary sector to reduce incidence. Find out more here.
2. Re-organisation of hospital services
In March 2015, acute stroke services in Greater Manchester were centralised so that all patients presenting with <48 hours time of onset for stroke are taken by ambulance to a Hyper Acute Stroke Unit, rather than their local hospital. This reconfiguration was based on evidence that these changes would help save more lives and lead to better outcomes.
The network conducted a 12 month review in the summer of 2016, with another review a year later in 2017. Centralisation has led to significant improvements with every resident now receiving ‘A’ rated care (SSNAP), with reductions in mortality and length of stay.
You can find out more on the impacts and lessons learnt from re-designing our inpatient care pathway here.
We have been part of an NIHR research programme evaluating the impacts of re-organisation in our region and London versus the rest of England. You can review the published findings here.
3. Optimising the ambulance pathway
85% of suspected stroke patients arrive at hospital by ambulance. Ensuring ambulance clinicians recognise stroke symptoms and take patients to the correct hospital for their needs has been our a focus, with our Co-ordinator Chris Ashton (a Paramedic) leading our efforts.
Improved education and training helps clinicians make the right decisions more rapidly, however, the professional development of ambulance staff can be challenging due to the constant pressures on the service, with staff turnover another barrier.
We have worked to improve the understanding of ambulance clinicians by:
- Releasing a mobile phone application that supports ambulance clinicians compliance with the Greater Manchester acute care pathway
- Lecturing at local universities to student Paramedics and Technicians
- Collaborating with the Scottish Ambulance Service to produce a local version of their FAST assessment training video
- Working with the College of Paramedics to host a training event for ambulance staff
- Facilitating an improved line of reporting and improved relationships between ambulance and hospital staff so crews can learn from their experiences of caring for stroke patients
We are currently rolling out online training for ambulance staff, with more face to face teaching planned.
4. Improvements to inpatient care
We continue to refine our centralised hospital stroke care pathway using data to drive improvements. We have a Document Pack of agreed Standard Operating Procedures and policies to that help ensure the consistency and quality of care.
We have implemented a new pathway for Intracerebral Haemorrhage, are introducing a regional Intra Arterial Thrombectomy service from 1st April 2018 and are working to extend local TIA services across the weekend using a sector based approach.
5. Implementing integrated community rehabilitation services
We have collaboratively developed a community care model that ensures all stroke patients leaving hospital are supported by a specialised rehabilitation team. We continue to work to implement the model across our region. Find out more here.