Stroke Delivery Plan. March 2015 Refresh. Cardiff and Vale University Health Board

Transcription

1 Stroke Delivery Plan March 2015 Refresh Cardiff and Vale University Health Board 1

2 This delivery plan sets out the high level strategy for stroke care. The implementation of the plan will be progressed within the allocated budgets. Any developments requiring resource beyond those included in the Integrated Medium Term Plan, will be subject to business case development and consideration as part of the UHB prioritisation process. 1. BACKGROUND AND CONTEXT Together for Health a Stroke Delivery Plan was published in 2012 and provides a framework for action by health boards and NHS trusts working together with their partners to improve stroke services. It sets out the Welsh Government s expectations of the NHS in Wales to tackle stroke in people of all ages, wherever they live in Wales and whatever their circumstances. The Plan is designed to enable the NHS to meet the needs of people at risk of a stroke or affected by a stroke. It sets out: The population outcomes we expect. The outcomes from treatment and support to return to health and independence we expect. How success will be measured and the level of performance we expect. Themes for action by the NHS, together with its partners. What do we want to achieve? The Stroke Delivery Plan sets out action to improve outcomes in the following key areas between January 2015 and 2016: Preventing stroke Detecting stroke quickly Delivering fast, effective care Supporting life after stroke Targeting research Improving Information Workforce planning Service user engagement Management and leadership National priorities 2. CARDIFF AND VALE UNIVERSITY HEALTH BOARD S DELIVERY PLAN The Cardiff and Vale University Health Board produced its first delivery plan in September A three year plan is set out in the UHB Integrated Medium Term Plan, this focusses on the plans for the next year. In last year s delivery plan we set the following priorities for 2014: 2

3 Preventing stroke Detecting stroke quickly Delivering fast, effective treatment and care Supporting life after stroke Improving Information Targeting Research Our priorities for 2015/16 are: Preventing stroke To be able to assess all high risk TIAs within 24 hours by Stroke Specialists seven days of the week To be able to assess all low risk TIAs within a week To implement All Wales Anticoagulation guidelines for atrial fibrillation effectively To promote early referral of symptomatic carotid stenosis patients for carotid endarterectomy within 2 weeks of symptom onset. Ensure faster access to echocardiogram and cardiac monitoring in appropriately selected TIA patients with suspected cardiogenic embolism Ensure that all patients with TIAs receive appropriate evidence based treatment Develop plans with the Welsh Stroke delivery group to develop screening services for atrial fibrillation. Detecting stroke quickly Ensure that primary and secondary care and the public treat stroke as a medical emergency Work with GPs to raise their awareness of symptoms Audit the pathway for people diagnosed with a stroke and act on findings to improve services for early detection. Delivering fast, effective treatment and care Work with the Welsh stroke delivery group to explore the reconfiguration of stroke services in Wales including the development of hyper-acute Services in Wales All stroke patients will have prompt assessment, diagnosis and early treatment in EU to achieve relevant performance targets and ensure optimal patient outcome, Code Stroke All confirmed stroke patients will be transferred to the Acute Stroke Unit within four hours of arrival in EU, initially aiming for an interim 12 hour maximum in 100% of cases. All stroke patients will be cared for in the appropriate clinical area to support their needs until discharge Early engagement with families and all stakeholders is key to service delivery 3

4 Identify and develop a process to ensure a prompt and timely response to deliver the same care 24/7 Provide timely access 24/7 to thrombolysis. Deliver thrombolysis within 30 minutes of admission Deliver regional interventional neuroradiology and neurosurgery for appropriately selected stroke patients. Supporting life after stroke Work with the Welsh Stroke delivery group to benchmark community rehabilitation services for stroke Further development of the early supported discharge team, to increase capacity and ensure optimal patient flow through the stroke pathway. Through Goal Planning meetings, develop appropriate care plans to agree care and support, based on the needs of individuals, following a diagnosis of stroke Ensure review of stroke survivors, as needed, with residual impairment Ensure stroke survivors are screened for visual impairment and psychological needs Involve stroke patients and their carers in the development of future services including creative ways of supporting them, listening to what they have to say about decisions that affect them and to provide Provide accessible and meaningful information and training when needed Plan and deliver palliative and end of life care services as locally as possible Improving Information Work with stroke survivors, their carers and the Third Sector to ensure effective signposting to sources of information and support. Assess, record and meet the information needs of people through the use of joint care plans. Publish regular and easy to understand information about the effectiveness of their local stroke services. Record and use clinical information in planning and service provision Monitor performance against stroke clinical indicators and use the results to inform and improve service planning and delivery. Survey the views of stroke patients and their carers in respect of their experience and outcome of treatment. Targeting Research Offer all appropriate patients access to relevant clinical trials. Participate in the Pragmatic Ischaemic Stroke Thrombectomy Evaluation (PISTE) trial a UK research study comparing IV rtpa alone 4

5 with IV rtpa and adjunctive mechanical thrombectomy in patients, eligible for treatment with IV rtpa, that have a large vessel carotid territory arterial occlusion (as confirmed on angiographic imaging) Maximise the use of Welsh Government funding for NHS research. Ensure that the UHB provides effective and efficient research governance processes to enable a speedy start and delivery of clinical trials. Support and encourage protected research time for clinically-active staff. Collaborate effectively with other Local Health Boards and NHS Trusts, Universities and industry in Wales to enable a speedier application of research, and introduction of new technology into the NHS. In delivering our services for patients with stroke, there are a number of service improvements that we have implemented locally that have had a real impact on patient care. Examples of this include: 1. Making stroke care one of the UHB top 5 priorities, with weekly progress reporting via a big room format. Establishing Executive leadership and weekly big room group focus on service improvement and delivery, and redefining stroke strategic and operational groups 2. Refreshing the stroke plan to redefine strategic objectives and actions required for prevention, delivery and audit 3. With partners, delivered a comprehensive range of public health actions including smoking, physical activity, food & obesity, and alcohol consumption 4. Educational programs undertaken for Primary Care Physicians to raise awareness of both risks and symptoms for stroke 5. Leading an out of hours tele-stroke service working jointly with Cwm Taf UHB to enable 24/7 access to thrombolysis 6. Delivering interventional neuroradiology clot retraction/retrieval service at regional level 7. Developing and launching code stroke pathway 8. Developing and implementing IT solution stroke button to enable live tracking of stroke patients in acute care 9. Participating in 1000 lives flow collaborative and IHI programme to review and refine flow in stroke pathway 10. Commencement of integrated workforce planning 11. Completion of a stroke business plan for Participation in national stroke delivery group and progression of work on 3 national priorities of atrial fibrillation, acute care and rehabilitation 13. Participating in two key research projects (PISTE and VIST) 14. Embedding the stroke rehabilitation centre at University Hospital Llandough following it opening in October THE VISION: 5

6 Cardiff and Vale University Health Board s vision for stroke care is: For our population we want: Caring for people, keeping people well. People of all ages to have a minimised risk of having a stroke and, where it does occur, an excellent chance of surviving, returning to independence as quickly as possible. Wales to have stroke incidence and mortality rates comparable with the best in Europe. We aim to: Develop a service whereby people of all ages have a minimised risk of having a stroke and, where it does occur, they have an excellent chance of surviving and returning to independence as quickly as possible. Ensure people who access stroke care in Cardiff and Vale UHB have a stroke incidence, mortality rates and outcomes comparable with the best in Europe. Design a service in line with the best evidence-base including recommendations made by the Sentinel Stroke National Audit Programme (SSNAP) 4. The Drivers: There are clear reasons why stroke remains a top priority for the Cardiff and Vale University Health Board: It is one of the top three causes of death It is estimated that there are around 11,000 stroke events, including 6,000 new strokes, per year in Wales per cent of strokes occur in people who are under the age of 65 It is a leading cause of adult disability 2 It has a higher risk for certain ethnic minorities per cent of people who have a stroke die within a month Stroke incidence There are approximately 1,650 stroke events in Cardiff and Vale, including around 900 new strokes per year (incidence). Figure 1 presents the European age-standardised rates for emergency admissions for stroke by local authority area from 2009/10 to 2011/12. Our rate for Cardiff is lower than the all Wales 1 Estimated figures based on the Welsh population and incident rate. 2 National Audit Office, 2005, Reducing Brain Damage: Faster access to better stroke care, London, NAO Figures relate to England and Wales. 6

7 rate, whereas the rate for the Vale of Glamorgan is higher than the all Wales rate. The Vale rate remains lower than 8 other local authority areas of Wales. Our UHB data show that our annual number of emergency admissions has actually remained constant in comparison with previous years the UHB admits approximately 600 people with stroke every year. It should be noted that this figure includes some patients from other Health Boards in South Wales. Outpatient activity highlights that 35 patients /month, who have a confirmed diagnosis of Transient Ischemic Attack (TIA), are assessed and treated. Stroke prevalence There were 1.3 % of patients on GP practice registers in Cardiff and Vale of Glamorgan in 2012 (age-standardised percentage) with stroke. Morbidity Hypertension and atrial fibrillation are particularly important risk factors for stroke. Recorded hypertension the University Health Board area, at 10.9% of all patients, is lower than Wales at 11.1%. Fig. 1 Stroke emergency admissions, 2009/ /12 European agestandardised rate per 100,000, persons, all ages, Wales local authorities 95% confidence interval Wales = 90 Isle of Anglesey Gwynedd Conwy Denbighshire Flintshire Wrexham Powys Ceredigion Pembrokeshire Carmarthenshire Swansea Neath Port Talbot Bridgend The Vale of Glamorgan Cardif f Rhondda Cynon Taf Merthyr Tydfil Caerphilly Blaenau Gwent Torf aen Monmouthshire Newport

8 Produced by Public Health Wales Observatory, using PEDW (NWIS) & MYE (ONS) Stroke mortality Cardiff and Vale UHB has a standardised stroke mortality of 1.0, which is the national average. 5. ORGANISATIONAL PROFILE Organisational Overview Delivery of clinically effective and evidence based care to stroke patients is a key top 5 organisational priority. There is Board level Executive leadership Chief Operating Officer accountable for delivery, and Director of Therapies and Health Science as Stroke Champion. The stroke pathway crosses several Clinical Boards including Primary Community and Intermediate Care, Medicine, Clinical Diagnostics and Therapeutics, Specialist Services and Mental Health. The stroke pathway is managed from the gerontology directorate, part of Medicine Clinical Board, with significant support emergency medicine, therapies and radiology directorates. There are 18 beds at the Acute Stroke Unit at the University Hospital of Wales (ward A6S), including a dedicated thrombolysis bed and 35 Beds at the Stroke Rehabilitation Centre at University Hospital Llandough (with an additional 10 winter beds). The patient pathway aims for timely transfer from acute to rehabilitation care, and the first phase of an early supported discharge team has been established to identify patients suitable for intensive targeted rehabilitation at the earliest possible stage, with plans to develop services for life after stroke. There is a stroke consultant clinical lead and two further stroke consultants supported by sessions from neurology consultants and a stroke specialty registrar as part of the medical team. There is a wider multidisciplinary team including WAST, emergency unit staff, nurses, stroke service co-ordinators, physiotherapists, occupational therapists, clinical psychologists, dietitians, speech and language therapists, nutrition nurses, pharmacists, radiologists, radiographers and support staff. In addition there is a wider team including GPs, community resource teams, the third sector stroke association, and social worker support from both local authorities. Managerial support is given by gerontology and clinical diagnostics and therapeutics, workforce and organisational development with support from the information team, communications team and continuous service improvement. The organisational structure for stroke is in Appendix 1 and 2 Overview of Local Health Need and Challenges for Stroke Services 8

9 The main area of constraint to optimal delivery of the stroke pathway has been the consistent delivery against Bundle 2 of the Stroke Intelligent Targets, which requires the whole pathway to flow efficiently to enable right care, in the right place at the right time. These include issues requiring the team to: Treating stroke as a medical emergency, with 999 WAST assessment and transport to EU Ensure prompt diagnosis of stroke in EU by a senior decisionmaker Ensure timely access to TIA service for urgent and routine patients Need to ensure timely thrombolysis/thrombectomy for those suited to this treatment Need to admit patients to the stroke unit promptly and without delay following diagnosis Need to ensure timely assessments and intensity of rehabilitation by multidisciplinary team Ensure timely repatriation without delays of stroke patients back to other Health Boards Intensive goal driven rehabilitation, for those with rehabilitation potential Appropriate use of pathways of care for those requiring end of life care, or without potential to rehabilitate Timely patient discharge from the Stroke Rehabilitation Centre at University Hospital Llandough, enabling flow from the acute stroke unit UHW, thereby enabling stroke patients to be admitted to SRC from the acute stroke unit in an efficient time scale Efficient and effective management of patients with complex feeding needs Efficient management of the discharge process for those requiring social work assessment and placement with complex care packages, or residential, nursing home placements Review of capacity and demand for early supported discharge service Develop service for life after stroke and those needing specialist care beyond the 6 week early supported discharge period Design robust system to 6 month follow up Ensure primary and secondary prevention of stroke, as well as effective management of atrial fibrillation by primary care clinicians Ensure integrated workforce plan meets patient needs, identifies appropriate roles and training requirements Ensure Cardiff and Vale UHB stroke service leads stroke R&D in Wales. Further challenges may arise due to reconfiguration of stroke services in neighbouring LHBs. However this plan is written assuming no additional flows of patients to Cardiff and Vale UHB. Any subsequent changes would require further enhancements to capacity and necessary resourcing. 9

10 6. DEVELOPMENT OF CARDIFF AND VALE UNIVERSITY HEALTH BOARD LOCAL DELIVERY PLAN FOR STROKE In response to the Together for Health A Stroke Delivery Plan (2012), health boards are required, together with their partners, to produce and publish a detailed local service delivery plan to identify, monitor and evaluate action needed within timescales. These plans need to be updated annually and the health board executive leads for stroke will need to report progress formally to their Boards against milestones in these delivery plans and publish these reports on their websites at least annually. The Cardiff and Vale UHB stroke delivery action plan had been updated to include a revised clinical pathway and actions identified to make improvements to provide good patient outcomes as outlined in the stroke delivery plan, achievement of Welsh Government Tier 1 targets, Welsh Stroke Implementation group priorities, Royal College of Physicians SSNAP audit standards (and shadow bundles) and the Delivery Unit recommendations. The stroke room group along with Executive leads reviewed the stroke delivery plan, and refreshed it, setting out strategic objectives and required actions. This work was informed by the national stroke delivery group and its work programme as well as support and guidance from the national stroke clinical lead. This work was undertaken between November 2014 and January PRIORITIES FOR THE COMING YEAR The Together for Health Stroke Delivery Plan sets out action to improve outcomes in key areas between now and For 2015/16 the following national priorities have been agreed: Management of atrial fibrillation Exploration of a hyper-acute stroke unit model/ enhanced acute stroke unit Scoping of community rehabilitation and Early Supported Discharge services Cardiff and Vale UHB will support the implementation of the national priorities by including actions within the refreshed delivery plan. In addition to these national priorities Cardiff and Vale UHB highlights the following priorities for 2015/16 which reflect the needs of the local population. Stroke Prevention Our priorities for 2015/16 are: To promote stroke risk reduction plans Detecting stroke quickly 10

11 Our priorities for 2015/16 are: To educate and raise awareness of citizens and healthcare profession also in stroke detection Delivering fast, effective care Our priorities for 2015/16 are: Agree and implement Code Stroke including actions required to respond with urgency to facilitate timely conveyance with ASHICE, CT scan, Thrombolysis and admission to acute stroke unit Develop an evidence-based model for a sustainable high quality hyper acute stroke care ( as part of bed capacity) To undertake a review of capital equipment requirement for all areas of the pathway Ensure effective rehabilitation model To identify the bed capacity required to deliver the stroke pathway To strengthen integrated working with Local Authority partners Ensure compliance with All Wales repatriation policy Supporting life after stroke Our priorities for 2015/16 are: Embed delivery plan for Life after stroke and 6/12 follow up model Targeting research Our priorities for 2015/16 are: To develop a research and development delivery plan for stroke Improving information Our priorities for 2015/16 are: To ensure effective monitoring using a suite of performance and service improvement measures to meet requirements of WG and SSNAP monitoring Workforce planning Our priorities for 2015/16 are: Ensure effective workforce planning to deliver integrated stroke pathway To ensure staff have the appropriate knowledge and skills to meet the needs of our service users Service user engagement plan Our priorities for 2015/16 are: 11

12 Develops service user engagement plan 3rd Sector Engagement Undertake EQIA assessment to support the Delivery Plan Leadership and management Our priorities for 2015/16 are: To design and implement an organisational structure which identifies clear lines of accountability and communication for clinical and operational delivery of the Stroke Pathway Engage with other LHBS re national and regional stroke developments including any implications for flow of patients to UHW 8. PERFORMANCE MEASURES/MANAGEMENT The Welsh Government s Delivery Plan for Stroke (2012) contained an outline description of the national metrics that LHBs and other organisations will publish: Outcome indicators which will demonstrate success in delivering positive changes in outcome for the population of Wales. National performance measures which will quantify an organisation s progress with implementing key areas of the delivery plan. Progress with these outcome indicators form the basis of each health board s annual report on stroke. We have already produced two annual reports that highlights our progress against these measures. Our next annual report will be published in October

13 9. ACTION PLAN Preventing Stroke Priority Actions required Lead Due Date Expected Outcomes 1.To promote A. Reduce prevalence of key lifestyle risk factors for hypertension and F. Kinghorn/ 31 March 2016 Stroke risk reduction stroke risk stroke (smoking; obesity; alcohol) Leads within reduction Included in PH plans: LPHT Tobacco: Cardiff and Vale Tobacco Control Action Plan (currently being updated) Obesity: Cardiff and Vale Healthy Weight Framework and overarching action plan Alcohol: Cardiff and Vale Alcohol Action Plan B. Promote and monitor primary and secondary prevention for stroke, including raising awareness of atrial fibrillation, implementing the all Wales anticoagulant AF guidelines Community Directors 31 March 2016 Reduced Number (%) of patients in AF admitted to hospital for stroke who had not been prescribed anticoagulation prior to their stroke C. Decision of UHB prioritisation panel, Re: NOAC prescribing H Shetty 31 March 2016 Number (%) of patients in AF receiving NOAC Detecting Stroke Quickly Priority Actions required Lead Due Date Expected Outcomes A. Lower your risk of stroke campaign Stroke Association T. Williams 30 June 2015 Raised citizen awareness. Launch of campaign in Splott, Cardiff March Ask First, FAST, Stroke Ass/ Outcome measures being Save Time Save Brain PHW developed by PHW 2.To educate and raise awareness of citizens and healthcare profession also in stroke detection B.GP education programme. Schedule CPET training session for GPs on TIA and Stroke & Schedule training on stroke for South Wales cardiac network. Need to confirm dates for 2015 training C. Explore potential use of AV resources e.g. Public TV and PC screens within UHB and GP premises for public awareness messaging re FAST. H. Shetty 31 Dec 2015 Increase in CPET training numbers and cardiac network training numbers C Randall 30 June 2015 UHB and practice screens displaying stroke information 13

14 Delivering fast, effective treatment and care Priority Actions required Lead Due Date Expected Outcomes A. Develop and implement Live data capture system on EU Work Station. Implement stroke button for workstation to enable live tracking of stroke patients. Improve data capture. Use data to inform improvement processes required D. Jones Pilot work completed Dec 14, Review 31 Mar Agree and implement Code Stroke including actions required to respond with urgency to facilitate timely conveyance with ASHICE, CT scan, Thrombolysis and admission to acute stroke unit Live, timed, tracking of stroke and? stroke patients through EU, CT and to admission B Develop plans to ensure capture of revised stroke bundle data A Roderick 28 Feb 2015 Accurate timely capture of stroke bundle data C. Develop escalation procedure where there is potential variance from the Code Stroke pathway. Ensure Code Stroke Action cards include escalation C Randall 14 Feb 2015 Action cards in place and functioning escalation procedure D. Develop and implement standard operating procedures and action cards. Monitor application and modify according to any changes agreed. Develop action card for Primary Care stroke pathway E Ensure affective and safe telestroke service between Cardiff and vale and Cwm Taf F. Patients diagnosed with stroke to be admitted to acute stroke unit in 4 hours. Develop and set Standards for processing times within components of the front end of the acute pathway. Monitor progress and PDSA as required 28 Feb 2015 SOP in place, Action cards in place and functioning T Hughes 31 March 2015 Staff trained, equipment functioning and governance arrangements in place, outcomes monitored S. Ahmad with J. Mower & A. Wood 31 Jan 2015 then weekly review % of stroke patients admitted to acute stroke unit in 4 hours G. Increase % of patients receiving thrombolysis: i. Set Standard for % of patients receiving thrombolysis Increase % of patients who receive thrombolysis up to the Standard of 15% H. Reduce door to needle time for those undergoing thrombolysis i. Set standard for door-to-needle time to reduce to 45 mins Review performance against the standard at weekly meetings and improve relevant components (door to CT & CT to thrombolysis I.Clot retrieval- Implement regional interventional neuroradiology and neurosurgery for appropriately selected stroke patients. S. Ahmad icompleted 15 Jan 2015 ii31 July 2015 S. Ahmad icompleted 15 January 2015 ii30 June 2015 Number (%) of all stroke patients who receive thrombolysis Reduce thrombolysis door to needle time Number of patients undergoing clot retrieval with 14

15 i Executive discussions regarding future neuro-radiology services ii CD&T Clinical Board to recruit replacement(s) ia Casey i31 Mar 2015 neuro-interventional radiology 4.Develop an evidence-based model for a sustainable high quality hyper acute stroke care ( as part of bed capacity) 5.To undertake a review of capital equipment requirement for all areas of the pathway 6.Ensure effective rehabilitation model 7.To identify the bed capacity required to J.SSNAP data: to ensure accurate data entry. review process of data entry facilitate timely, quality assured live data entry K.Mortality data captured via completed NIHSS scores to monitor and benchmark, 30 day mortality Participate in national discussions to determine the most appropriate model for hyper acute services in Wales. i Develop option appraisal. Determine preferred option and secure relevant resources ii Nurse Director to advise re mixed sex acute bay iii Inform WG of plans to develop mixed sex enhanced stroke unit iv Develop plan for an enhanced stroke unit suitable for Cardiff and Vale population to be included in IMTP and business case To undertake a review of capital equipment requirement for all areas of the pathway. Neuroradiology mainly NVA1 (interventional room) requires capital allocation. i Seek Welsh Government funding for Capital required ii Seek support via WHSSC for neuroradiology service as part of a neurosciences service and develop plans A Review different requirements for rehabilitation along the pathway building on scoping work undertaken Undertake workshops Jan/Feb/March 2015 and confirm the Integrated Workforce Plan B. Review Early Supported Discharge and community rehabilitation model, identify gaps and plan to address Undertake analysis of information to enable modelling to create service specification for; Enhanced care unit/hasu ( see 4 above) iim Bourne ii31 Mar 2015 D Jones 28 Feb 2015 Accurate data entered, meet SSNAP data points for monthly reporting H Shetty 28 Feb 2015 Remain at or below SMR of and monthly 1.00 thereafter Establishment of hyper acute i S Ahmed 31 Jan 2015 service C Dodwell/ J Murphy ii R Walker iii F Jenkins iv D Jones i A Harries ii A Casey SThomas/ KTovey S White/ A Morgan S Ahmad/ A Roderick 22 Jan Feb April Jan 2015 Fully commissioned neuro interventional radiology service as part of a neurosciences development, fully staffed and equipped 31 Mar Mar 2015 Integrated workforce plan reflecting patient rehabilitation needs and resource allocation 31 Dec 2015 ESD established, benchmarked, gap analysis completed. Full Business case developed 31 March 2015 Capacity and demand model for the whole pathway 15

16 deliver the stroke pathway 8.To strengthen integrated working with Local Authority partners 9. Ensure compliance with All Wales repatriation policy Acute Stroke SRC Community capacity Remodel the capacity with most recent data, to include required community capacity Work with Local Authority colleagues to improve the discharge process. iagree and implement action to improve the discharge process ii Work with the integrated discharge lead to agree improvements required and timelines for actions. Constraints in discharge process noted and required actions Consistent application of policy. Newly appointed Flow Manager to advise areas for further improvement Quantify current impact. Ensure application of the Policy and monitor adherence i S Brookes/ J Murphy/ S White 31 March 2015 Ensure and facilitate timely discharge. Reduce number of patient who are medically fit who are not discharged on PDD. Reduce DTOC numbers, and reduce mean length of stay ii V Warner 31 March 2015 B Steer 31 May 2015 No lost bed days as a result of delayed out of area repatriation. Supporting living after stroke Priority Actions required Lead Due Date Expected Outcomes 10.Embed delivery plan for Life after stroke and 6/12 follow up model 11. Ensure access to support Design process for 6/12 follow up by rehab team and embed delivery plan for life after stroke (consider whether a 2 year follow up needs scheduling) S White/ A Morgan ( see 17 below) T Williams 30 April 2015 All patients receive 6/12 follow up as part of their stroke care 16

17 Targeting Research Priority Actions required Lead Due Date Expected Outcomes 12.To develop a research and development delivery plan for stroke To participate in NIHR programmes Set up a MDT R&D group H Shetty 30 Sept 2015 Increase research activity beyond current PISTE trial, develop more MDT stroke research. Publish research findings Improving Information Priority Actions required Lead Due Date Expected Outcomes 13. To ensure A Ensure stroke dashboard is comprehensive to include metrics for: A Roderick 28 Feb 2015 Timely, accurate, data for effective i Performance monitoring by WG on a monthly basis to include revised then weekly/ reporting and service monitoring using a suite of stroke bundles ii Collection of SSNAP data and Inputting to SSNAP data base ii Reports for : monthly information monitoring and service improvement performance o Big Room (weekly) Revised Stroke dashboard(s) and service o Stroke delivery group (monthly) Revised Stroke improvement o Board (bimonthly) measures to meet requirements of WG and SSNAP monitoring o o Stroke delivery plan (annually) Annual report Develop plans to ensure capture of revised stroke bundle data ( see 3 B above) Undertake analysis of information to enable modelling to create service specification (see 7 B above) Workforce Planning Priority Actions required Lead Due Date Expected Outcomes 17

18 14. Ensure effective workforce planning to deliver integrated stroke pathway 15.To ensure staff have the appropriate knowledge and skills to meet the needs of our service users A.To undertake a review of the current workforce, undertake a gap analysis and develop an integrated workforce and OD plan to deliver the stroke pathway. i Workshops arranged Jan/Feb and Mar to develop the plan in conjunction with service improvement approach using 1000 lives methodology ii Review of therapies, medical and nursing staff including requirements for HASU, 7 day services for therapists and ESD Team Workforce plan for medical staff to give effective support for the whole medical team supporting the stroke pathway ( EU, medical registrar, neurology, stroke team, radiologists) B Consultant job planning and review of DCC to enable 7 day consultant ward rounds A To undertake a training & development needs analysis. (see 14 a) B Develop training plan to including thrombolysis specific training for acute unit S Thomas/ K Tovey R Evans/JGrey H Shetty/ T Hughes 31 March 2015 Integrated workforce plan, and training plans 30 Sept day consultant ward rounds 30 June 2015 Training plan for thrombolysis pathway to include acute unit and tele stoke Service User Engagement Priority Actions required Lead Due Date Expected Outcomes 16 Develops Develop a patient and public reference group 31 March 2015 Patient and public service user engagement plan i Develop a Co production plan - patient centred care model ( Health Foundation, 2014) A Morgan/ S Harrison reference established group ii Survey views of people annually who have had a stroke with their carers in respect to their experience and outcome of treatment S Harrison Survey report outcome 17. 3rd Sector Agree and finalise service level agreement for services provided by Stroke D Jones 31 March 2015 SLA and KPIs in 18

19 Engagement Association. Review 2015/16 agreement place and monitored 18. Undertake EQIA Ensure EQIA assessment is completed in accordance with the Equality, K Tovey/C 31 May 2015 EQIA agreed and assessment to support the Delivery Diversity and Human rights Policy Randall signed off Management and Leadership Priority Actions required Lead Due Date Expected Outcomes 19.To design and A. Identify Clinical lead for Stroke J Grey 31 Jan 2015 Clinical lead implement an appointed and in organisational place structure which B. Identify Executive lead and Executive champion A Casey 31 Jan 2015 Agreed, appointed identifies clear /F Jenkins and roles lines of communicated accountability and C. Agree constitution of stroke groups Organisational Chart developed S Ahmed 28 Feb 2015 Stroke groups set up communication for members notified clinical and D. Develop a communication plan aligned to the revised Stroke Delivery C Evans 31 March 2015 Comms strategy operational plan developed and in delivery of the place Stroke Pathway 20. Engage with other LHBS re national and regional stroke developments including any implications for E. To develop a business case for stroke to enable delivery of the full stroke pathway. To be considered as part of the UHB prioritisation. To engage with other LHB stroke leads and with national stroke delivery group H Jones 10 Feb 2015 Business case identifying investment to deliver desired outcomes of the stroke pathway F Jenkins/ A Harries 31 March 2015 Effective strategic plans for South Wales 19

20 flow of patients to UHW Supporting National Priorities Priority Actions required Lead Due Date Expected Outcomes 21 Atrial fibrillation See 1B 22 HASU See 4 23 ESD/Community rehab See 6A &B 20

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22 APPENDIX 2 22