Stroke Services Cheshire & Merseyside

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1 PRESENTATION TITLE Stroke Services Cheshire & Merseyside Dr Deborah Lowe Consultant Stroke Physician SCN Clinical Lead for Stroke

2 Why are we here? We all want to deliver high quality stroke care to our patients Most would support services at local Trust, but only if this is deliverable, affordable and sustainable How can we ensure that the majority of patients receive the best quality stroke care? What are we accepting as our core standards? Which services currently fall below that standard? What reconfigurations are needed within Cheshire & Merseyside to provide equitable access whilst not diluting quality of care?

3 Background Cheshire & Mersey - 9 Acute Trusts supported by 12 CCG s Population of approx 2.5 million people All have Acute Stroke Units 34 Stroke Consultants / Associate Specialists working within Stroke 5 Trusts currently provide 24/7 hyper-acute stroke unit (HASU) services with approx 610 strokes per year 3 Trusts have support from other units for 24/7 cover including use of telemedicine 1 Trust doesn t have access 24/7 thrombolysis, despite support from two other large stroke units outside this SCN

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5 Drivetime between trusts (minutes) Aintree Countess of Chester Macclesfield Leighton RLBUHT Southport Whiston Warrington Arrowe Park North Staffs Salford Stepping Hill Wythenshawe Travel times Aintree * Countess of Chester 36 * Macclesfield * Leighton * RLBUHT * Southport * Whiston * Warrington * Arrowe Park * North Staffs * Salford * Stepping Hill * 17 Wythenshawe * Data source: Microsoft Mappoint

6 Cheshire and Merseyside comparisons Cheshire and Merseyside Greater Manchester London Population 2,510,884 2,807,005 8,818,097 Geographical area 1150 sq miles 493 sq miles 700 sq miles % pop over 40 yrs (M/F) 24%/27% 23%/25% 19%/21% Incidence of AF 45,020 (1.8%) (1.4%) (0.9%) Data source : QOF

7 Cheshire and Merseyside demographics Population Prevalence of CVD Prevalence of stroke Prevalence of AF CHADS2>1 anticoagulated Eastern Cheshire 194, % 2.10% 2.1% 81.6% Halton 125, % 2.24% 1.7% 77.2% Knowsley 145, % 2.62% 1.5% 81.3% Liverpool 465, % 2.37% 1.5% 81.7% South Cheshire 175,943 10% 2.07% 1.9% 79.9% South Sefton 159, % 2.52% 1.9% 80.9% Southport and Formby 114, % 2.59% 2.2% 82% St Helens 175, % 2.33% 1.8% 81.3% Vale Royal 102, % 1.98% 1.7% 86.1% Warrington 202, % 1.86% 1.5% 80% West Cheshire 227, % 2.12% 1.9% 78.6% Wirral 319, % 2.53% 2.1% 81% England 53,107, % 2.07% 1.5% 81.3% Data source: Cardiovascular intelligence network

8 Trust catchment populations Trust Catchment Population Aintree 330,000 Countess of Chester 445,000 Macclesfield 450,000 Leighton 280,000 RLBUHT 750,000 Southport 225,000 Whiston 350,000 Warrington 500,000 Arrowe Park 400,000 Data source: Individual trust websites

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16 Who delivers Stroke Care? Medical workforce predominately Geriatricians with specialist training / experience in stroke Mostly Consultant delivered thrombolysis service 3 Trusts use telemedicine out of hours 32 Consultants, 2 Associate Specialists Consultants at most Trusts also part of general medical rota 41 Stroke Nurse Clinicians / Stroke Specialist Nurses within the region

17 How is stroke specialist assessment delivered? Trust In Hours Out of Hours Aintree Face to Face Face to Face Countess of Chester Face to Face Telemedicine Macclesfield N/A N/A Leighton Face to Face Face to Face at North Staffs RLBUHT Face to Face Face to Face (occasionally telemedicine) Southport Face to Face Telemedicine Whiston Face to Face (occ telephone to SpR) Face to Face Warrington Face to Face Face to Face at Whiston Arrowe Park Face to Face Face to Face

18 Thrombolysis assessment? Trust Initial Assessment In Hours Initial Assessment Out of Hours Subsequent Review In Hours Aintree Consultant Consultant Consultant / Stroke Nurse Clinicians Countess of Chester Macclesfield Consultant Consultant via Telemedicine Consultant Subsequent Review Out of Hours Stroke Nurse Clinicians Medical SpR 24/7 thrombolysis at North Staffs for 10% of the population & 7am 7pm M F at Stepping Hill otherwise Leighton Consultant / Specialist Nurse RLBUHT Consultant / Specialist Nurse Southport Consultant / Specialist Nurse Whiston Consultant / SpR / Specialist Nurse Warrington Arrowe Park Stroke Specialist Nurse Consultant with Specialist Nurse ED Consultant / Specialist Nurse Consultant / Specialist Nurse Telestroke / Specialist Nurse Consultant / SpR / Specialist Nurse Consultant Consultant / Specialist Nurse Consultant / Specialist Nurse Consultant Medical SpR Consultant / Specialist Nurse On Call Consultant / Specialist Nurse Consultant ED Consultant Consultant Consultant Specialist Nurse then Consultant Consultant / Medical SpR Consultant / Medical SpR

19 HASU services provided at other trusts Stepping Hill provide a 7am-7pm weekday service for 90% of East Cheshire (Macclesfield) population and North Staffs provide a 24/7 service for 10% (South Sector) of East Cheshire population RLBUHT provide a HASU service for Liverpool Heart and Chest Whiston provide an out of hours service for Warrington (8pm-8am weekdays and all weekend) North Staffs provide out of hours service for Mid Cheshire population Lancs & Cumbria telemedicine network provide out of hours service for Southport

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21 Ward rounds and ring fenced stroke beds Trust Ward rounds 7/7 by a stroke specialist Ring fenced HASU beds Aintree Yes Yes Countess of Chester Yes Yes Macclesfield No No Leighton No No RLBUHT Yes Yes Southport No No Whiston Yes Yes Warrington Yes Yes Arrowe Park Yes Yes

22 Number of beds and nursing workforce Trust Total stroke bed no. (HASU beds/subacute) *rehabilitation Number of stroke specialist nursing staff (band 6-8) wte Nursing to bed ratio for 10 beds Stroke Specialist nursing available 24/7 Aintree 29 (12/17) 7? Yes Countess of Chester 28 (14/14) 1? No Macclesfield 24 (0/24) 1? No Leighton 28 (8/20) 2? No RLBUHT 48 (10/18) *20 8? Yes Southport 28 (4/24) 3.8? No Whiston 39 (8/8) *23 7? Yes Warrington 29 (7/12) *10 1? No Arrowe Park 46 (10/16) *20 9? Yes

23 CT and MRI scanning Trust Do you have rapid access to CT 24/7? Do you have rapid access to MRI in hours? Aintree Yes Yes Countess of Chester Yes Yes Macclesfield No No Leighton Yes Yes RLBUHT Yes Yes Southport Yes Yes Whiston Yes No Warrington Yes Yes Arrowe Park Yes Yes

24 TIA Services: Week days Trust Do you provide TIA clinics every week day? Do you have access to same day CT? Do you have access to same day MRI? Do you have access to same day carotid doppler? Do you have access to same day Echo? Do you have access to same day ECG/Bloods? Do you have access to same day CTA/MRA? Aintree Yes Yes No Yes No Yes Yes Countess of Chester Yes Yes Yes Yes No Yes Yes Macclesfield No* No No No No No No Leighton Yes Yes Yes Yes No Yes Yes RLBUHT Yes Yes Yes Yes Yes Yes Yes Southport Yes Yes No Yes No Yes No Whiston Yes Yes Yes Yes No Yes Yes Warrington Yes Yes Yes Yes Yes Yes Yes Arrowe Park Yes Yes Yes Yes No Yes Yes * Macclesfield Hospital: TIA services provided by Wythenshawe Hospital weekdays only. No TIA service at weekends

25 TIA Services: Weekends Trust Do you provide TIA clinics Saturday and Sunday? Do you have access to same day CT? Do you have access to same day MRI? Do you have access to same day carotid doppler? Do you have access to same day Echo? Do you have access to same day ECG/Bloods? Do you have access to same day CTA/MRA? Aintree Yes No No No No Yes Yes Countess of Chester Yes Yes Yes No No Yes Yes Macclesfield No No No No No No No Leighton No Yes No No No Yes No RLBUHT Yes Yes Yes No No Yes Yes Southport No Yes No No No Yes No Whiston Yes Yes No Yes No Yes No Warrington Yes Yes No Yes Yes Yes No Arrowe Park Yes Yes Yes No No Yes Yes

26 Data collection Trust Do you have a dedicated stroke data clerk? Do you do real time data entry for SSNAP? Who inputs data to SSNAP? Do you have other reporting requirements? Will you be using Capture Stroke? Aintree Yes Not always Combination No Yes Countess of Chester No No Nurse / Data Clerk Macclesfield Yes No Nurse / Data Clerk Leighton No No Nurse / Admin Staff KPIs KPIs / Other KPIs / IPMR / AQ / Trust Report RLBUHT Yes Not always Combination KPIs / IPMR Yes Southport No No Nurse KPIs / IPMR / AQ Yes No No Yes Whiston Yes No Nurse / Data Clerk Warrington Yes No Nurse / Data Clerk Arrowe Park Yes Almost Nurse / Data Clerk AQ KPIs / IPMR / AQ No Yes Yes Already in use

27 ESD service Trust Do you have and ESD service? Is your ESD service stroke specific? Who provides your ESD service? What is the duration of your ESD pathway? Who continues therapy post ESD discharge? Aintree Yes Yes CCG 3 months Community therapy Countess of Chester Macclesfield Leighton Yes Yes Acute trust 6 weeks Community therapy No Not currently but recently in place commissioned RLBUHT Yes Yes Acute trust 6 months Community neurorehab Southport No but Community well developed Neurorehab service Whiston Yes Yes Community trust Depends on needs of patient Community neurorehab Warrington Yes Yes 6 weeks Community therapy Arrowe Park Yes Yes Acute trust 6 12 weeks Community therapy Is ESD a 7 day service? No No No No No Partially

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29 Other quality markers Trust Do you have a neuropsychology service? Do you have a voluntary organisation working with you? Does your inpatient rehab team provide a 7 day service? Aintree Yes (1.5 WTE) Yes Yes Countess of Chester No Yes No Macclesfield No Yes No Leighton No Yes No RLBUHT No Yes Yes Southport Yes (0.4 WTE) Yes No Whiston Yes (0.6 WTE) Yes Yes Warrington No Yes No Arrowe Park Yes (~1 WTE) Yes Yes

30 SINAP vs SSNAP Q SINAP average of 12 indicators Quartile Q SSNAP total key indicator score Aintree 65 4 th 44 D Countess of Chester No data - 44 D Macclesfield nd 49 D Leighton rd 41 D RLBUHT nd 64 C Southport th 58 D Whiston rd 42 D Warrington rd 54 D Arrowe Park rd 71 B National Average Grade

31 North of England- Cheshire and Mersey SCN Performance North of England- Cheshire and Mersey SCN Jul- Sept 13 Oct- Dec 13 Wirral University Teaching Hospital NHS Foundation Trust Royal Liverpool and Broadgreen University Hospitals NHS Trust Warrington and Halton Hospitals NHS Foundation Trust Score SSNAP Score Rank Score SSNAP Score Arrowe Park Hospital D C Royal Liverpool University Hospital D 45 4 D Warrington Hospital D D Rank Southport and Ormskirk Hospital NHS Trust East Cheshire NHS Trust Southport and Formby District General Macclesfield District General Hospital D D D D St Helens and Knowsley Teaching Hospitals NHS Trust Mid Cheshire Hospitals NHS Foundation Trust Whiston Hospital E E Leighton Hospital D E Aintree University Hospitals NHS Foundation Trust Countess of Chester Hospital NHS Foundation Trust University Hospital Aintree Countess of Chester Hospital E 39 7 E X 0 9 E

32 Every minute counts! Time is Brain