Findings from West Yorkshire and Harrogate Stroke Services initial conversations

Health professionals across West Yorkshire and Harrogate invited people to share their views in February and March 2017 on how stroke services across the area could be further improved. This is to ensure services are ‘fit for the future,’ whilst making the most of the latest technology, such as mechanical clot retrieval thrombectomy, staff skills and maximising a person’s opportunity of a good recovery.

The engagement work, led by Healthwatch, was all about the sustainability of quality stroke services and reducing the incidence of stroke happening in the first place, wherever possible.

Over 1500 people gave their views via an online survey, outreach sessions with voluntary and community groups, and interviews with people in GP practices, rehabilitation units, stroke wards, and libraries. Stroke consultants also took part in sessions so that people could hear first-hand about the care and support available from health professionals.

In 2015/16 there were approximately 3,600 stroke admissions to West Yorkshire and Harrogate hospitals, with the majority of strokes occurring in the 65+ age group and over half being 75 years+.

The numbers of people having a stroke is expected to increase in the future and the demand for services is growing. Stroke is a life changing event and evidence shows the care people receive in the first few hours can make a difference to how well they recover.

Further improving hyper acute stroke and acute stroke services (hyper-acute refers to the first few hours and days after the stroke occurs) and making sure all stroke care services are ‘fit for the future’, whilst achieving the quality standards, and maintaining great outcomes that are sustainable has been highlighted as a priority in the draft West Yorkshire and Harrogate Sustainability and Transformation Plan (STP).

This outlines how we want to improve people’s health and wellbeing, for example by reducing incidence of stroke, premature mortality and further improving care and quality, such as increasing the proportion of people scanned within 12 hours.

There is strong evidence that outcomes following stroke are better if people are treated in specialised centres, even if this increases travelling time following the event, and this is likely to be the case in West Yorkshire and Harrogate. Ongoing rehabilitation should, however, be provided at locations closer to where people live and they should be transferred to these as soon as possible after initial treatment.

Most people with a suspected stroke arrive at hospital by ambulance. Ambulance staff provide assessment and treatment as they convey people to the right hospital for their medical needs.

Findings from the engagement highlighted some concern that a decision had already been made to reduce the number of hyper acute stroke units (HASUs). It’s important to note that no decision at this stage of our review process has been made to reduce the number of units across West Yorkshire and Harrogate.

Many people said that they would travel further if it meant they were able to receive the best treatment and to be treated by specialists; however, they wanted their rehabilitation to be available closer to home. Although some people were worried that if they had to travel further the extra journey time could negatively affect their health, and would make it more difficult for their family to visit them.

Those who had experienced a stroke described the excellent levels of care that they received in hospital, from being seen quickly, to accessing the most appropriate treatments and being kept informed throughout.

They talked about staff being willing to help, whilst recognising that some were extremely busy. It was also felt that there should not be a difference in care during the week and at the weekend.

Many described how stroke can be a life changing event which can be difficult for the patient and their families to deal with. It was felt that there was a need to ensure that the patient and their family are provided with the appropriate levels of emotional support and advice.

The valuable role of voluntary and community organisations specialising in stroke support, particularly on hospital wards, was recognised in the report.

Comments also included the need to raise awareness of the signs and symptoms of a stroke, and what to do if you think someone is having a stroke.

It was felt that more support should be provided for carers, so they know what to expect and how to support the person they are caring for. For many people this is the first time they have had to care for their loved one.

The need to educate people on how to lead a healthier lifestyle was outlined as important. This included raising awareness of the signs and symptoms of a stroke, for example the F.A.S.T. campaign.

Rob Webster, STP Lead and Chief Executive of South West Yorkshire Partnership NHS Foundation Trust said, ‘This work shows the benefits of a Sustainability and Transformation Partnership that engages people in the development of its plans. By listening to people in our communities and working across the whole system, we can look at improving all aspects of stroke care – from prevention to emergency treatments and through to rehabilitation’.

Dr Andy Withers, Chair of the West Yorkshire and Harrogate Clinical Forum said, ‘I’d like to thank Healthwatch for undertaking this important piece of engagement work for the area and everyone who took the time to give us their views. We will be looking at the findings in more detail over the coming months and will be talking to doctors, nurses, and community care specialists for their views in terms of what this means for health and social care and most importantly the person. We will be talking more to people who have had a stroke, their families and carers so we understand fully their needs now and in the future.

It’s important to note that no decision has been made to close any of the units across the area and we are committed to ensuring we provide the best care possible for people living in West Yorkshire and Harrogate’.

Stacey Hunter, Director of Operations at Airedale Hospital and Lead for Stroke on behalf of West Yorkshire Acute Association of Trusts, said: ‘Depending on where you live, some people have better experiences and access to specialist services than others. The engagement findings suggest further work is needed to reduce differences in the services people receive, so that no matter where people live and what time of day they are admitted to hospital, they are able to receive high quality stroke services. We need to maximise the opportunities to further improve quality of life for people whilst also reducing a person’s chance of living with a disability afterwards. We recognise that ongoing care should be provided at locations closer to where people live, and people should be transferred to these as soon as possible after initial treatments. Further work will take place to design and develop any proposals, which would be subject to formal consultation if appropriate’.

The engagement findings suggest further work is needed to reduce differences in the services people receive, so that no matter where people live and what time of day they are admitted to hospital, they are able to receive high quality stroke services. We need to maximise the opportunities to further improve quality of life for people whilst also reducing a person’s chance of living with a disability afterwards. We recognise that ongoing care should be provided at locations closer to where people live, and people should be transferred to these as soon as possible after initial treatments.

Rory Deighton, from Healthwatch said, ‘I want to thank everyone who got involved in this important piece of work. The engagement findings provide a good foundation block for health and social care professionals to build upon in terms of further conversations with the public, communities and importantly staff’.

You can read the full report and supporting information at http://bit.ly/2sjcLfa

Consultation will follow early in 2018, if appropriate.

Ends

Further information

  • You can read a copy of the West Yorkshire and Harrogate STP at www.wakefieldccg.nhs.uk/stp
  • It’s important to note that Bradford and Airedale have previously carried out engagement work on their local stroke services and this is reflected in the approach we have taken across the area, which is highlighted in the engagement report.
  • West Yorkshire and Harrogate has five hyper-acute stroke units (HASU), based in:
  • Please refer media enquiries to West Yorkshire and Harrogate STP – 01924 317659 or email Westyorkshire.stp@nhs.net You can also contact Karen.coleman2@wakefieldccg.nhs.uk Mobile 07811766006.

-Bradford Teaching Hospitals NHS Foundation Trust – Bradford Royal Infirmary

-Calderdale and Huddersfield NHS Foundation Trust – Calderdale Royal Hospital

-Harrogate and District NHS Foundation Trust

-Leeds Teaching Hospitals NHS Trust – Leeds General Infirmary; and

-Mid Yorkshire Hospitals NHS Trusts – Pinderfields Hospital.