January 2012 - Sandwell & West Birmingham Hospitals

SWBTB (1/12) 286 (a)
physicians and 3 Neurologists) and whilst they work as one team they are not able to provide
24/7 cover for the two acute sites. The service is therefore also reliant at both sites on nonspecialist
but trained Consultants in Acute Medicine, Emergency Medicine and General
Physicians to deliver thrombolysis, assessment and treatment. Specialist registrars who are
designated ‘on call’ for general medicine to support the service. Although safe this is unlikely
to deliver the required commitment to achieve the accelerated access to thrombolysis that will
be required in the longer term. In addition developing further specialist skills in stroke care will
be difficult whilst this range of doctors deliver specialist stroke care and whilst there is not a
sufficient critical mass of stroke patients on each site.
3.2 The need to ensure that the actions which have been taken to improve
quality and safety are sustainable in the medium term.
Clinical leadership and supervision- A key aspect of the actions to be implemented by the
Stroke Action Team is to strengthen the clinical leadership within the service. This is in line
with national recommendations and review findings including, ‘the overall root cause of poor
performance is often weak managerial or clinical leadership which can leave problems
unidentified or unresolved’ (Healthcare Commission, 2007). A Clinical lead for Stroke and TIA
has been appointed and there is currently a dedicated Consultant Stroke Clinician working at
City Hospital. However a key part of ensuring improvements are implemented and remain
sustainable will be continuing and extending robust clinical leadership and supervision. This
will be particularly challenging with acute services being delivered on two sites with the
requirement for a stroke specialist to be present on both sites.
The two acute stroke wards and related TIA services are part of one Service within the Trust
and there is a need to ensure access to services and quality of care is equitable across the
Trust. Cross site clinical policies and monitoring arrangements have been introduced but it is
challenging to integrate staff into one team whilst individuals primarily work on one site or
another. Cross site working and rotation can be introduced but raises issues of continuity of
care and services. Currently there are duplications of functions and there is insufficient
critical mass at either site to deliver an excellent service.
The National Stroke Strategy (DoH,2007) proposes a model of hyper-acute stroke units
Hyper-acute stroke services enable patients to have rapid access to the right equipment and
be treated 24/7 on a dedicated stroke unit, staffed by specialist teams. This means following
a stroke, a patient is taken directly to a hyper-acute stroke unit where they will receive expert
care, including access to a CT scan and clot-busting drugs (if appropriate) within 30 minutes.
The consolidation of acute care on to one site would facilitate improvements more rapidly e.g.
extended consultant cover for Stroke ward rather than trying to achieve this on two sites. It
will also more robustly ensure the improvements will be sustained in the medium term
particularly in relation to clinical leadership and presence. In addition such consolidation will
ensure integration of staff from the two sites into one team working to the same clinical
policies, competences and processes ahead of the opening of the new Acute Hospital.
Reconfiguration on to one site would allow 24/7 cover from our team of 8 specialist
consultants (5 stroke physicians and 3 Neurologists) and ensure continuity of service and
capacity for development of real time leadership. This would also facilitate data collection and
audit of stroke metrics.
Consolidation of acute stroke and TIA services on one site would have a similar impact on
nursing and other clinical staff in terms of developing and consolidating stroke specific
competencies, skills and experience.
3.3 Meeting Key Performance Indicators
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