January 2012 - Sandwell & West Birmingham Hospitals

SWBTB (1/12) 286 (a)
TIA – high risk
outpatient appointments
TIA – low risk outpatient
appointments
188 71 117
340 164 176
Since the WMQRS findings, our Stoke Action Team has been working to introduce
streamlined processes using LEAN principles with a focus on developing and improving our
Stroke and TIA service; with the aim of ensuring the quality and safety of the service in
response to national guidance and to local concerns. These efforts have produced some
good results with clear improvements in meeting national, regional and local key performance
indicators (KPIs) for the stroke and TIA service (target times). However, we struggle to
consistently meet the required Quality Standards as outlined by the West Midlands Cardiac
and Stroke Network for all patients at all times. There remain continuing concerns about
medium term sustainability, particularly in respect of the Consultant led component of the
service and also the ability to provide timely imaging and diagnostic investigations. In view of
this the Trust Management Board agreed in January 2011 to initiate a project to develop
options that would ensure a configuration of acute stroke and TIA services that meet quality
standards in a sustained way and allow the service to continually improve.
As with previous reconfigurations and in line with national guidance this project has been
established with our local commissioners with Sandwell PCT (as our host commissioner)
being the lead organisation for the planning phase of the project.
In the longer term and in line with our strategic objectives, our acute stroke and TIA services
would transfer along with other acute in-patient care to the Midland Metropolitan Hospital
when this opens. This is subject to the approval of the Outline Business Case for the new
hospital which is currently being considered by the Department of Health.
3. THE CLINICAL CASE FOR CHANGE
Following the Trust Management Board decision to initiate a review of the configuration of
stroke services a Project Steering Group was established to develop a Clinical Case for
Change. This is a separate document that was agreed by the Trust’s Clinical Service
Reconfiguration Programme Board in June 2011. The key points are summarised below.
National Guidance has defined the key bundles of care that are necessary for optimum stroke
care. Achieving the goals will ensure the best outcomes for our population and would likely
lead to a reduction in mortality and morbidity of stroke. Delivering the care bundles represents
a significant organisational and service challenge particularly when duplicated across two
hospital settings. The clinical case for change review has identified the following key drivers
for change.
3.1 New and increasing National standards particularly in relation to Specialist
Consultant cover and wider staffing requirements.
The National Stroke Strategy (DoH, 2007) recommends that all front-line staff should be
competent in identifying people with suspected stroke. It also recommends that
commissioners ensure that care pathways and protocols are in place so that all people with
suspected acute stroke are transferred immediately by ambulance to a hospital with access
to a 24-hour, 7-day a week (24/7) hyper-acute stroke service that can provide a stroke triage
system, expert clinical assessment, timely imaging and intravenous thrombolysis.
Currently our services fall short of the recommendations as, although there is a service being
delivered across the Trust, this service is not consistent in its approach on both acute sites
over the 24hour/seven day period. We currently have 8 specialist consultants (5 stroke
7