Across England in recent years, improvements have been made to stroke services to ensure better outcomes for patients through timely access to safe, high quality treatment and rehabilitation – ensuring the best chances of a full recovery. This includes Northamptonshire.
To focus expertise and facilities, diagnosis and treatment is centred upon Northampton General Hospital (NGH). The existing care pathway for all patients with suspected stroke is for them to first be admitted to NGH’s hyper-acute stroke unit.
Following initial diagnosis and treatment, patients are subsequently transferred to the Acute Stroke Unit (ASU) at NGH or KGH, depending on their home address. When they are ready to be discharged, patients are either transferred to community rehabilitation beds at Isebrook Hospital or return home with the support they need put in place.
Working together and with Nene and Corby CCGs, the stroke teams at the two hospitals are now completing systemic changes which began several years ago:
- All hyper-acute and acute stroke services to be based at NGH.
- All acute rehabilitation to be at NGH, rather than split between the two hospitals. KGH will stop receiving acute stroke rehab patients from 25 August 2018.
- KGH to continue providing outpatient follow-up care and treatment for Transient Ischemic Attack (very minor strokes).
- 12 community stroke beds at Isebrook Hospital in Wellingborough, to which NGH will have sole admission rights – with an enhanced community Stroke Team enabling more people to be cared for at home.
There are some important reasons for this change, involving shortfalls in the existing care model:
- The current model delivers variable patient care and outcomes, with some Kettering patients not accessing the most specialist elements of care that are available at NGH.
- There have been difficulties in recruiting the specialist staff needed at KGH, where there is a material shortfall in therapy provision for stroke patients.
- NGH’s acute stroke unit is rated A in the Stroke Sentinel National Audit Programme (the key measure of stroke services), and is one of the top seven stroke units in the country. KGH’s, however, has been rated D as it does not provide the specialist elements of care that are available in a hyper-acute unit.
- Over-long stays in hospital hinder recovery. Stroke patients cared for at KGH stay there on average more than twice as long (25 days) as patients at NGH (11 days). In part, as it is the more clinically complex patients that get repatriated to KGH rather than being discharged straight home from NGH, and in part due to difficulties and delays in discharge to the community. The regional specification is 7 days.
- Some patients with suspected stroke are still inappropriately taken to, or arrive at KGH, and therefore experience delays in accessing the services of the hyper-acute stroke unit at their most critical point of need.
- Public engagement has identified support for a model of care that delivers shorter lengths of hospital stay and expanded community provision.
In recognition of the unsatisfactory pathway and inequitable access to high quality care for stroke patients in the county, and in discussion and agreement with commissioners, KGH has served notice to commissioners that it intends to cease acute inpatient stroke services from September 2018. It will however continue to operate outpatient clinics for stroke and TIA patients as usual.
The new service model will deliver major benefits:
- Equal access to high quality care for all patients, ensuring everyone in Northamptonshire has access to the same high quality standards of care
- Investing in more care in the community where this is safe and effective – with the potential to further reduce hospital lengths of stay
- More sustainable services by working at scale and being more efficient
- NGH will continue to develop specialist expertise, such as therapeutic and psychological input, through additional investment
- A county-wide specialist service better able to recruit staff of the required calibre, with no in-county competition for key personnel
Any stroke patients admitted to KGH before 25 August will continue their acute care at Kettering. Any stroke patient currently receiving outpatient services at KGH will continue to do so, although the outpatient clinic is relocating to Fotheringhay Outpatients Unit in the main block.
The county-wide service will be fully operational from 10 September. From that date, NGH’s stroke team will oversee and monitor ongoing care of patients at KGH via a virtual ward round.
The new county-wide approach to stroke care will ensure that all patients suffering stroke will be taken to a single specialist unit, within the top seven in the country.
This not only helps patients, but will also significantly help in the recruitment and retention of the specialist nursing and therapy staff needed to run the service.
You can be assured the partners involved in these amendments to the stroke pathway – including the doctors involved – feel the changes outlined will be beneficial to the service in