January 2012 - Sandwell & West Birmingham Hospitals

SWBTB (1/12) 286 (a)
An initial structured assessment, for example, the Recognition of Stroke In the Emergency
Room (ROSIER) scale, in a high-dependency area, such as, the emergency department or
medical assessment unit, is needed to determine the diagnosis and whether urgent brain
imaging is required.
In 2007 the National Stroke Strategy was published by the Government. It provides a national
quality framework through which local services can, over a ten year period, secure
improvements across the stroke pathway against quality markers. It recommends:
Provision of Hyper-acute stroke services which enable patients to have rapid
access to the right equipment and be treated 24/7 on a dedicated stroke unit,
staffed by specialist teams.
Once the patient is stabilised (within around 72 hours) they will be moved to a
dedicated stroke unit where they receive further care and rehabilitation support.
Since then a number of key national documents have been developed around stroke care
which include:
National Stroke Strategy (DoH, 2007)
National Clinical Guideline for Stroke 3 rd edition-Prepared by the Intercollegiate Stroke
Working Party (July 2008)
Implementing the National Stroke Strategy- Imaging Guide. (DoH , 2008)
NICE guidelines ‘Diagnosis and initial management of acute stroke and transient
ischemic attack’ (2008) and the draft NICE Quality Standard for Stroke (2009).
Royal College of Physicians ‘National Clinical Guideline for Stroke’ (3 rd Edition)
(2008).
Stroke has been a health priority across the West Midlands resulting in several key regional
documents including:
West Midlands Service Specification for the Management of Stroke Thrombolysis and
Acute Care (Hyper-Acute) (2009)
West Midlands Specification of Services for Patients with Transient Ischemic Attack
and Non-Disabling / Minor Stroke (2010).
West Midlands Acute Stroke Steering Group accelerated standards
West Midlands Quality Review Service Quality Standards
The NHS Midlands and East have recently notified Chief Executive Officers of PCT clusters
and acute Trusts of plans to complete a review of acute stroke services, with an interest in
potentially replicating the model being delivered in London. Between 2008 and 2011 a
significant reconfiguration of acute stroke and TIA services took place across London.
Emerging evidence from this reconfiguration is demonstrating compelling improved outcomes
for stroke associated mortality rates, speed and access to appropriate treatments and
specialist care. In addition it is also showing evidence of other improved patient outcomes in
terms of increased levels of independence and reduced levels of disability.
Birmingham PCT Cluster have recently asked the Birmingham and Sandwell Cardiac and
Stroke Network to facilitate a review of the configuration of acute stroke services across
Birmingham which currently are delivered from University Hospitals of Birmingham
Foundation Trust, Heart of England Foundation Trust and our Trust. There are performance
concerns for each acute trust, which has led Birmingham PCT Cluster to consider
configuration options. This process will have clear interdependencies with our proposed
reconfiguration of acute stroke and TIA services. Conversations between the respective PCT
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