Reshaping Stroke Care - Saving Lives, Reducing Disability

Overview

Stroke is a major health issue in Northern Ireland with around 2,800 people being admitted to hospital each year and 36,000 stroke survivors living in our communities.  It is important that every opportunity is taken to secure excellent care for people after a stroke and give them the best possible chance of a good recovery. Opportunities exist across the entire pathway for improving stroke care and much is currently being done to raise awareness of stroke, prevent more strokes, invest in rehabilitation and review the long-term support for those with stroke.

The consultation document is about strengthening and improving stroke care, both in the community and in hospital. The document makes 7 commitments:

Commitment 1: We will identify a regional model for TIA assessment by March 2020 and implement that model by 2022 to deliver a 7 day service of specialist assessment within 24 hours of symptoms.

Commitment 2: By 2022 we will remove the variance in delivering thrombolysis to ensure that patients across NI have timely access to the treatment.

Commitment 3: We will continue to invest in the growth of thrombectomy, increasing hours of operation to Monday – Friday 8am-8pm service by December 2019, and moving to 24/7 service by 2022.

Commitment 4: We will reshape stroke services by 2022 to establish dedicated hyperacute and acute stroke units underpinned by regional service standards to deliver improved outcomes for stroke patients.

Commitment 5: The recently published Stroke Association document ‘Struggling to recover’ makes six recommendations to improve services. Alongside the reshaping of hospital services, we are committed to driving improvement in rehabilitation and long-term support and will use the Stroke Association’s analysis and recommendations as a blueprint to drive that improvement.

Commitment 6:  The HSC will undertake a workforce review to identify the staffing and skill mix required to deliver effective stroke services.

Commitment 7: We will extend the partnership with the charity AANI to enable the Helicopter Emergency Medical Service (HEMS) to provide a secondary response to incidents including strokes by 2022 to improve access to services, particularly from rural areas.

In respect of Commitment 4, Six potential options have been identified for the provision of specialist emergency stroke care in Hyperacute Stroke Unit (HASU) sites; these are:

• Option A: under this option, 5 HASUs would be located at the following sites: Altnagelvin Area Hospital, Antrim Area Hospital, Craigavon Area Hospital, Royal Victoria Hospital and South West Acute Hospital.  Acute Stroke Units (ASUs) would be co-located.

• Option B: under this option 4 HASUs would be located at the following sites: Altnagelvin Area Hospital, Antrim Area Hospital, Craigavon Area Hospital and Royal Victoria Hospital.  Acute stroke units to be co-located, with consideration of a fifth ASU at the Ulster hospital.

• Option C: under this option, 4 HASUs would be located at the following sites: Altnagelvin Area Hospital, Craigavon Area Hospital, Royal Victoria Hospital and South West Acute Hospital, with consideration of a fifth ASU at the Ulster Hospital.

• Option D: under this option, 4 HASUs would be located at the following sites: Altnagelvin Area Hospital, Antrim Area Hospital, Craigavon Area Hospital and Royal Victoria Hospital with services removed from Antrim Area Hospital over time.

• Option E: under this option, 4 HASUs would be located at the following sites: Altnagelvin Area Hospital, Craigavon Area Hospital, Royal Victoria Hospital and South West Acute Hospital, with services removed from the South West Acute Hospital over time.

• Option F: under this option, 3 HASUs would be located at the following sites: Altnagelvin Area Hospital, Craigavon Area Hospital and Royal Victoria Hospital, with additional ASUs located at the Ulster Hospital and Antrim Area Hospital.

The order of options noted above is not a ranking and at this stage the Department has not identified a preferred option.