Welcome to our regular online bulletin bringing you news about the network and the wider world of stroke and neurorehabilitation
Network team news The network continues to grow and this month we welcome the arrival of two new Facilitators to the team. Anjali George (pictured left) is a nurse who comes to us from Trafford Stroke Unit, with Occupational Therapist Cillian O'Briain (pictured right) also joining from Trafford, but this time from the Inpatient Neuro Rehabilitation Unit.
Our stroke funding from NHS England has been increased for 2022/23 and so we will shortly be advertising for another Facilitator, and we hope to second a clinician from a local team to develop quality improvement skills and capacity in our services. With an expanded project management team and clinical leadership, we are now able to restart some projects and can embark on new areas of work in the coming months.
We are developing clinical leadership in prevention. In a joint appointment with the Greater Manchester and Eastern Cheshire Strategic Clinical Network cardiac programme, we are delighted to announce that Dr Aseem Mishra (pictured left) will be joining us as our CVD Prevention Clinical Lead. Dr Mishra is a GP in South Manchester and academic at The University of Manchester and will bring a wealth of experience as well as a lot of enthusiasm to this important area.
£1 million pound investment to improve community services in South and Central Manchester From Summer 2022, a new model of Community Stroke and Neuro Rehabilitation will be launched across South and Central Manchester. The services help to rehabilitate adult patients who have experienced a stroke or have a neurological condition within a community setting or their home. The enhanced services will ensure that individuals referred have access to the same level of specialist care as currently South Manchester does not offer this for neurorehabilitation pathway patients.
Our Community Clinical Director Tracy Walker, who is also Lead Allied Health Professional for the locality, has helped develop plans and said: “Over the past few years there’s been significant work to improve and standardise the acute stroke and neuro rehabilitation care pathways . This is where all patients, regardless of where they live in Greater Manchester receive the same high standard of care. However, across the city some discharged patients were still experiencing a ‘postcode lottery’ when accessing community stroke and neuro rehabilitation, as the services were working across the city in isolation, all with different models of rehabilitation and resources available. Therefore, this is an exciting time for us here in Manchester. The investment has enabled us to expand upon our workforce capacity, so that we can respond to referrals in timelier manner – removing the ‘patchy provision’ that was in place. No one deserve to miss out on care, so this will make a huge difference." Recruitment is underway for new posts in both the Central and South Manchester teams. The new South Manchester neurorehabilitation team has its first member; Sam is pictured above on the right with Team Lead Cath Roberts.
Training and education Our annual stroke conference will be held on 22nd June at the AJ Bell Stadium in Eccles and is open for registration with limited places so book early to avoid disappointment! This year the event will be live streamed, with recordings hosted on our YouTube channel. We have also launched our poster competition with prizes for winning entries. The deadline for abstracts is the end of April and we hope our local stroke teams as well as the voluntary sector and academic groups will submit entries.
We are thrilled that stroke legend Pippa Tyrrell (pictured above left with 2020 recipient Jo Stevens) will be attending to present her award for outstanding contribution to stroke care. Find out more about the programme and book a place here.
We also have some great webinars coming up, with hyperlinked events open for bookings: Supporting Communication in the Assessment of Mental Capacity Training – 20th April 2022
GMNISDN Annual Neurorehabilitation Conference (AJ Bell Stadium) - 12th October 2022
Parkinson's UK have worked with a number of expert therapists across the UK to develop an online induction programme for all therapists who are new to supporting people with Parkinson’s. The programme will follow in the footsteps of our annual nurse induction, running for 4 weeks from 6 June to 3 July 2022, and will include 4 self-directed webinars each week, plus an optional live Q&A session with the speakers. The course aims to provide:
an overview of each of the 4 stages of Parkinson's
information on a variety of MDT interventions at each stage
additional Parkinson's related information
The draft course programme and details of how to register can be found here. You can find out more about network training including our online packages on our website's training page. We also have a range of content on our YouTube channel with a list (at the the bottom of the training page) of archived webinars you can access to by emailing Lisa Chadwick.
24/7 thrombectomy service goes live at Salford Royal Thrombectomy is a highly effective life saving treatment where clots are extracted via a tiny catheter called a stent from blood vessels in the brain in people with an ischaemic stroke. Only a small proportion of stroke patients are eligible and the procedure can only be performed at the Manchester Clinical Centre for Neurosciences at Salford Royal by a specialist team of Interventional Neuro Radiologists, supported by the stroke team and other disciplines.
Since 2017, we have been working as a region to set up a thrombectomy service for patients treated at our three Hyper Acute Stroke Units at Salford Royal, Stepping and Fairfield General Hospitals. The service was initially only available Monday to Friday during office hours, and this was extended to weekends several years ago. We are absolutely delighted that from March the service is available 24/7 to all residents in Greater Manchester. This has only been achieved after a considerable amount of hard work and the collaboration of staff/departments in the MCCN, as well as the referring HASUs. Few regions in the country have access to 24/7 thrombectomy and in the North West, the Walton Centre in Cheshire and Merseyside launched their extended service in October 2021. Well done to everyone involved!
Pathway updates Stroke prevention Preventing re-strokes is a priority for the network. Atrial Fibrillation (AF) is a major risk factor, with many patients undiagnosed and not receiving the anti coagulation medicine they need to prevent another cardiovascular event. The pandemic has greatly impacted the ability of stroke units to monitor for AF in a timely way as there are significant delays accessing cardiology outpatient services in many Trusts.
An NHS England and Pfizer grant funded project has been developed at Salford Royal Hyper Acute Stroke Unit to ensure patients are monitored on admission and receive extended monitoring if required. The aim is to increase AF detection rates and reduce the time to anti coagulation for patients found to have the condition.
The project uses a technology called SRAclinic® (also known as Apoplex) to help detect AF and inform whether further monitoring using an Electro Cardiogram Patch called ePatch (pictured right) may be needed for patients discharged straight home. We hope to roll out a similar project at Fairfield General, and Trafford and Tameside General Stroke Units have already begun trialing ePatches for their patients following a successful pilot at Salford Royal during 2021.
Service specifications
The current service specifications for stroke units (including Transient Ischaemic Attack) and stroke and neurorehabilitation community services are currently being reviewed and updated in line with national requirements including the new model for stroke. The main changes to the stroke unit specifications are to update key performance indicators (KPIs), include requirements for thrombectomy and explicitly include staffing levels for dietetics, orthoptics and psychology. Benchmarking will be undertaken in May to determine compliance.
Changes to the community specifications include a review of staffing levels and entry criteria for neurorehabilitation services with a comprehensive update of KPIs now complete and data collection currently underway to monitor compliance. We plan to take the revised specifications along with data on current gaps through the appropriate channels in the new Integrated Care System to help improve funding and access to services.
Building links in the neurorehabilitation pathway The network is developing its relationships with voluntary sector organisations who support patients with neurological conditions including BASIC, Headway, Huntington's Disease Association UK, MND Association, MS Society and Parkinson's UK. We are working with these charities to help develop better pathways of care for the different conditions, and all have been invited to join our work focusing on improving longer term support (more later in the bulletin). We hope they will also be able to help us recruit a new Chair to lead the re-establishment of our neurorehabilitation Patient and Carer Group. Our Manager was delighted to meet up recently with Maria Oxtoby (pictured left) who chairs Bolton Neuro Voices, a charity who support people with long term neurological conditions in this part of Greater Manchester. They specialise in offering hydrotherapy and neuro physiotherapy not available on the NHS long term. They run hydrotherapy courses as well as dry exercise sessions at Bolton One Leisure Centre and we look forward to working more closely with the group in future.
In other news, a new branch of the brain injury charity Headway opened at the end of March in Bury which will be based at Ramsbottom cricket club. To find out more contact Jay Lomax.
Working with local Muslim communities During the past year, we have been working with British Muslim Heritage Centre (BMHC) in Trafford on a project that aims to support local Muslim communities in preventing the cardiovascular diseases (CVD) that can lead to strokes and heart attacks.
The project builds on work pioneered by the Centre with Diabetes UKand Greater Manchester and Eastern Cheshire Strategic Clinical Network who developed a diabetes education programme delivered via local Muslim "influencers" including Imams. We plan to replicate this train the trainer model to provide meaningful and culturally appropriate information, training and guidance to local Muslims.
We have developed an education pack on types of CVD, stroke symptoms and the importance of implementing lifestyle changes. Our Facilitator Farheen attended a focus group of female influencers (pictured above) who shared their thoughts on what should be in our pack.
We plan to roll out the information pack via training of male and female influencers in June with support from our new CVD Prevention Lead Dr Mishra. Once trained, they will disseminate this information further in their communities in multiple languages. This will help embed positive changes in Muslim's perceptions and behaviours of their lifestyles.
After listening to the Muslim community, we also identified that we needed to help to raise awareness of the risks of fasting with pre-existing conditions such as CVD. We designed a leaflet for Ramadan supporting a campaign led by the BMHC to re-enforce the Islamic principles of maintaining one’s health whilst fasting, and heeding the advice of health professionals especially when living with a CVD. The leaflet encouraged consumption of healthier food and ingredients in cooking whilst promoting exercise and importance of hydration when opening a fast. The leaflet is being handed out at local Mosques (pictured above) and will appear on social media platforms. We would like to take this opportunity to wish all our Muslim colleagues a healthy and fruitful Ramadan.
Improving longer term support The national stroke programme have published a draft model outlining key elements of a life after stroke pathway. The model states: Life after stroke services coordinate and provide the personalised support that people affected by stroke (including carers and family members in their own right) need to rebuild their lives and live well after stroke, including to minimise their risk of further cardiovascular events. This support commences in the early days after stroke and continues into the long-term for as long as people need it. It aims to optimise all aspects of health and wellbeing, including promoting psychological adjustment, social connection, independence, economic wellbeing, and increasing individuals’ confidence, self-esteem, sense of identity and control over their lives. By design, life after stroke services are accessible and inclusive for all people affected by stroke, including those with communication problems and those with more ‘hidden’ accessibility needs (e.g. cognitive impacts), and embed person-centred perspectives, principles and approaches.
We strongly feel that it shouldn't matter which neurological condition a patient has, longer term support should be available to meet their needs. Therefore, we plan to use the draft model as a basis for stroke service improvement as well as other neurological conditions in the neurorehabilitation pathway. We will also feed in national work on developing optimal care pathways currently at consultion through the Neurological Alliance.
We have formed a steering group consisting of patients and the voluntary sector to start thinking about what key elements should be in place and will consider what gaps we have across the region and how we go about addressing them. We are planning a wider stakeholder workshop in the coming months and will share more in due course as the the work is in the very early stages.
Find out more Websites: www.gmnisdn.org.uk Twitter: @GMNISDN YouTube
Phone: 0161 209 2109
The network continues to grow and this month we welcome the arrival of two new Facilitators to the team. Anjali George (pictured left) is a nurse who comes to us from Trafford Stroke Unit, with Occupational Therapist Cillian O'Briain (pictured right) also joining from Trafford, but this time from the Inpatient
Neuro Rehabilitation Unit.
appointment with the 
From Summer 2022, a new model of Community Stroke and Neuro Rehabilitation will be launched across South and Central Manchester. The services help to rehabilitate adult patients who have experienced a stroke or have a neurological condition within a community setting or their home. The enhanced services will ensure that individuals referred have access to the same level of specialist care as currently South Manchester does not offer this for neurorehabilitation pathway patients.
Manchester. The investment has enabled us to expand upon our workforce capacity, so that we can respond to referrals in timelier manner – removing the ‘patchy provision’ that was in place. No one deserve to miss out on care, so this will make a huge difference." 
Our annual stroke conference will be held on 22nd June at the AJ Bell Stadium in Eccles and is open for registration with limited places so book early to avoid disappointment! This year the event will be live streamed, with recordings hosted on our 
across the UK to develop an online induction programme for all therapists who are new to supporting people with Parkinson’s. The programme will follow in the footsteps of our annual nurse induction, running for 4 weeks from 6 June to 3 July 2022, and will include 4 self-directed webinars each week, plus an optional live Q&A session with the speakers. The course aims to provide:
tiny catheter called a stent from blood vessels in the brain in people with an ischaemic stroke. Only a small proportion of stroke patients are eligible and the procedure can only be performed at the 
We are absolutely delighted that from March the service is available 24/7 to all residents in Greater Manchester. This has only been achieved after a considerable amount of hard work and the collaboration of staff/departments in the MCCN, as well as the referring HASUs. Few regions in the country have access to 24/7 thrombectomy and in the North West, the Walton Centre in Cheshire and Merseyside launched their extended service in October 2021. Well done to everyone involved!
Preventing re-strokes is a priority for the network. Atrial Fibrillation (AF) is a major risk factor, with many patients undiagnosed and not receiving the anti coagulation medicine they need to prevent another cardiovascular event. The pandemic has greatly impacted the ability of stroke units to monitor for AF in a timely way as there are significant delays accessing cardiology outpatient services in many Trusts.
Salford Royal Hyper Acute Stroke Unit to ensure patients are monitored on admission and receive extended monitoring if required. The aim is to increase AF detection rates and reduce the time to anti coagulation for patients found to have the condition.
Our Manager was delighted to meet up recently with Maria Oxtoby (pictured left) who chairs 
and 
campaign led by the BMHC to re-enforce the Islamic principles of maintaining one’s health whilst fasting, and heeding the advice of health professionals especially when living with a CVD. The leaflet encouraged consumption of healthier food and ingredients in cooking whilst promoting exercise and importance of hydration when opening a fast. The leaflet is being handed out at local Mosques (pictured above) and will appear on social media platforms. We would like to take this opportunity to wish all our Muslim colleagues a healthy and fruitful Ramadan.
basis for stroke service improvement as well as other neurological conditions in the neurorehabilitation pathway. We will also feed in national work on developing optimal care pathways currently at consultion through the 
