Welcome to our regular online bulletin bringing you news about the network and the wider world of stroke
Our new Clinical Director Dr Adrian-Parry Jones was appointed as our Hospital Clinical Director in March and shares this thoughts as he starts out in his new role. "Having been part of the Greater Manchester stroke community since I started as a Clinical Research Fellow at Salford in 2003, I have witnessed so much fantastic innovation and improvement all along the stroke pathway that has translated to improved outcomes for our patients.
Since its creation in 2015, the network has been a great success and is now entering a new phase with migration across to an Integrated Stroke Delivery Network (ISDN). I was delighted to be appointed as a Clinical Director and in the first two months I’ve been enjoying meeting people, hearing about how the network can best support teams across Greater Manchester, and getting to grips with the wide range of work ongoing with the ISDN. We are now looking to reinvigorate projects paused due to COVID-19 and to continue to work towards delivering the ambitious and exciting plans for stroke in the NHS Long Term Plan.
I look forward to meeting more of you over the coming months, hearing about your ideas and innovations, and working with you all to deliver the very best stroke care to all of our patients.”
National stroke news NHS England has launched the first ever end to end service specification for stroke. Each of the 20 new ISDNs will be expected to support local systems in implementing the pathway, with a new dashboard using SSNAP and other data also due to be launched.
Our journey over the past 10+ years in developing our stroke services means that we have less of a mountain to climb than other regions, but there is still work to do. The network team have already held an away day to prioritise the work plan that will ensure that we meet all elements of the new document.
We have already started collaborating with the other North of England ISDNs, with regular meetings underway or due to start with the other ISDN Clinical Directors and Managers.
Blood pressure at home We are rolling out a newnational BP@home scheme via ten of our Community Stroke Teams, with nurses leading the way. We are one of 11 national "Trail Blazer" sites, although everywhere else is implementing via primary care.
Early feedback appears to show that patients and carers are very engaged and enthusiastic in managing of their own blood pressure, with teams also reporting a reduction in their own workload. One patient from Eastern Cheshire commented “I feel happy that I can take part in taking my blood pressure and feel positive to be able to do something to help prevent me having another stroke". Community Stroke Nurse Sarah Bolam (pictured) said “the scheme allows me access to more readings giving a more accurate picture of the person’s blood pressure - it feels like a good step forward in secondary prevention”.
Training and education We have some great webinars coming up, with face to face events likely to resume in early 2022. Hyperlinked events are opening for booking:
Pre-hospital pathway In May, our Coordinator Chris Ashton presented virtually at the College of Paramedics National Conference. Chris spoke about the changes made to our pre hospital pathway that ensures all patients taking anticoagulation as a prescribed medicine and with an onset of symptoms >6 hours, receive more timely transportation to our Hyper Acute Stroke Units.
These changes have led to a highly significant reduction in door-to-scan time for suspected stroke patients on anticoagulants 4–48 hours post onset. This has allowed more rapid identification of intra cerebral haemorrhage and subsequent treatment.
The quality improvement project has now been published by BMJ Open and more detail can be found in the paper. We were delighted to hear that the research has been included in the draft proposals of the new Joint Royal Colleges Ambulance Liaison Committee National ambulance guidelines which we hope will change future practice across all ambulance trusts.
Speakeasy At Home This past year has been one of the organisations most challenging but also most successful and rewarding years yet. Through their rapidly re-designed ‘Speakeasy at Home’ online service (which the network helped fund) the charity have increased their reach and levels of provision, with many old and new members becoming part of regular online activities. Referrals are 3-4 times usual levels and the team are connecting with >100 people with aphasia and their carers each week.
One member said “Once lockdown took over I felt like the world just stopped for us. Vital treatments were not taking place and if it wasn’t for your video calls, that were full of wonderful advice from the team, fellow aphasia sufferers and from carers going through the same things I was going through, I doubt we would be in the position we are today".
The team are accepting new referrals and provide the services below following an initial triage by a Speech & Language Therapist. They can be contacted by email or by visiting their website.
Pathway updates Vocational rehabilitation
A lot was done to improve support in 2016-17, with Salford University commissioned to develop and deliver a package of training, whilst also upskilling Job Centre staff and developing a pathway for services. Working jointly with the Greater Manchester Neuro Rehabilitation Network, we have reconvened a group to review whether the training is still fit for purpose and to revisit system wide initiatives that support returning to work to ensure our teams are fully engaged with local programmes.
Seating Access to specialist seating was identified as an area of concern by some of our stroke teams, with similar problems also reported in Cheshire and Merseyside. We have held a number of meetings with staff from both regions to identify core issues and also possible solutions. A detailed scoping exercise revealed:
Lack of training for staff including understanding how to order the correct seating and gain funding
Ordering takes a long time and a lot of effort and patients’ needs can change in the meantime
Care homes are reluctant to or won’t purchase seating
Specialist seating is especially difficult to arrange
Service users are often required to purchase their own seat which is unfair for those on a low income
Non stroke services also struggle with the same issues
Fortunately, we discovered that Oldham is currently piloting a new system and we will be finding out more to see if we can get other localities to implement.
Improving psychological rehabilitation
Our task and finish group which includes patients, the voluntary sector and clinical psychologists has met on several occasions to explore how we can develop a clear pathway that meets the requirements of the new stroke service specification.
The pathway will be based on the matched care model and will ensure that patients and importantly their carers have access to timely, needs led support throughout the patient journey including access to wider mental health services and involvement from the voluntary sector.
We are developing a "model on a page" as we did for community service transformation, supported by a dashboard so that we can scope and measure compliance with key requirements in each borough. We can then develop action plans/business cases to help close gaps and address issues at a local level.
Helping to address health inequalities in local communities During the pandemic, there has been a fall in patients presenting within 4 and 6 hours of stroke symptom onset, meaning fewer people have been accessing potentially life saving treatments. This has been a particularly evident in the Fairfield General catchment which also had lower levels of early presentations pre pandemic.
The F.A.S.T. campaign was re launched during March and April by Public Health England and appears to have increased early presentations at our three Hyper Acute Stroke Units. It is vital that we continue to promote the key messages in our local populations so that any change is sustained. The stroke team at Fairfield, led by Dr Khalil Kawafi and supported by Becky Begum from the Stroke Association, will be supporting a webinar hosted by the British Muslim Heritage Centre (BMHC) on the 7th June. Similar events are planned with the Caribbean and African Health Network and the BHMC are developing recordings in different languages promoting recognition and prevention of stroke.
Improving 6 month reviews These assessments continue to be a focus for the network, with 11/14 of our community teams now inputting data into the same generic collection tool. Anonymised aggregated data shows around 73% of applicable people receive a review, highlighting ongoing problems with reporting on SSNAP, as their data shows only 40% being reviewed.
The additional data collection enables us to better understand the opportunities for improvement, both locally in teams and at a regional level.
At a recent meeting, Carolyn Shimwell, the Lead for the HMR Community Stroke Team, shared her quality improvement project where data was used from their 6 month reviews to drive change and reduce blood pressure as an unmet need. The case study can be viewed here.
Exercise programme launched The organisation has teamed up with the charity A Stroke of Luck, who specialise in exercise-based recovery for stroke survivors, to produce a stroke-specific exercise programme of short videos to help people be more active at home.
There are 12 videos in total, which can be followed at a pace that suits the patient. An introduction video explains how it all works and stroke survivors can assign themselves to a level of difficulty. The first to be made available is Upper Limb with further videos on Strength of Lower Limb, Balance and Coordination, Cardio Endurance and a 15-minute workout which will combine the previous 4 sessions. People are also encouraged to join up to My Stroke Guide for extra support and there is information for carers on how they can help and get involved.
New research centre In May, we were delighted to attend the launch of a new Jefferson Brain Research Centre which is a partnership between the Manchester Centre for Clinical Neurosciences, The University of Manchester and the Manchester Academic Health Science Centre. The centre will focus on a number of areas including stroke (led by Professor Craig Smith) and rehabilitation (led by Professor Audrey Bowen). Evidenced based practice is at the heart of what we do as a network so we hope to be very involved.
Find out more Website: www.gmisdn.org.uk Twitter: @GMISDN YouTube
Phone: 0161 209 2109
National stroke news
Blood pressure at home
Pre-hospital pathway
Access to specialist seating was identified as an area of concern by some of our stroke teams, with similar problems also reported in Cheshire and Merseyside. We have held a number of meetings with staff from both regions to identify core issues and also possible solutions. A detailed scoping exercise revealed:
