January 2012 - Sandwell & West Birmingham Hospitals

SWBTB (1/12) 286 (a)
OUTLINE BUSINESS CASE FOR CONSULTATION ON THE RECONFIGURATION
OF ACUTE STROKE, TIA AND NEUROLOGY SERVICES
1. INTRODUCTION
Currently we provide acute and inpatient rehabilitation stroke and Transient Ischemic Attack
(TIA) services at both City Hospital and Sandwell General Hospital. There are significant
clinical drivers at a national, regional and local level to consolidate the acute element of these
services in order to provide a critical mass of specialist experience and skills that can deliver
improved health outcomes as measured by reduced mortality rates and increased numbers of
patients returning to independent living following a stroke. In response to these drivers for
change we have established, in partnership with our local commissioners, a project to identify
and develop the options that will provide a configuration of services that delivers these
improved outcomes for our local population.
The purpose of this report is to outline for the Trust Board:
the clinical case for reconfiguration of our acute stroke, Transient Ischemic Attack
(TIA) and inpatient Neurology services,
the short listed options,
the case for formal public consultation on the proposed reconfiguration of these
services, including the draft consultation document,
the initial activity, capacity and financial analysis of the short listed options.
2. STRATEGIC CONTEXT
2.1 What are Acute Stroke and TIA Services?
Hyper-acute stroke services enable patients to have rapid access to the right skills and
equipment and be treated 24/7 on a dedicated stroke unit, staffed by specialist multidisciplinary
teams. Following a stroke, a patient is taken directly to a hyper-acute stroke unit
where they will receive expert care, including immediate assessment, access to a CT scan
and clot-busting drugs (if appropriate) within 30 minutes.
Following this acute care patients then receive inpatient based rehabilitation or are
discharged to their usual place of residence with community rehabilitation as appropriate.
Patients who have suffered a suspected TIA, also known as a ‘mini stroke’, can use an
outpatient assessment service within 24 hours for those deemed to be at high risk of further
TIA or stroke and within seven days for patients at lower risk.
2.2 National and Regional Context
Stroke has a major impact on people’s lives. It is caused by a disturbance of blood supply to
the brain and may be ischemic or haemorrhagic in nature. It starts as an acute medical
emergency, presents complex care needs, may result in long-term disability and can lead to
admission to long-term care.
Each year, 110,000 people in England and Wales have their first stroke, and 30,000 people
go on to have further strokes. It is the single biggest cause of severe disability and the third
most common cause of death in the UK. Over 5% of NHS resources and significant social
care resources are devoted to the immediate and continuing care of people with stroke. In an
average general hospital at any one time there are 25–35 patients with stroke as their primary
diagnosis.
4