Greater Manchester Stroke Operational Delivery Network Centralising stroke

Greater Manchester Stroke Operational Delivery Network Centralising stroke services in Greater Manchester - lessons learnt Sarah Rickard, Network Manager @GMStroke. ODN www. gmsodn. org. uk

2010 2011 2014 2015 2016 Greater Manchester Stroke Operational Delivery Network 2017 Partial centralisation of acute care in GM, full centralisation in London Internal review of pathway concludes further change is needed NIHR research demonstrates superiority of full centralisation PAT rationalises stroke services to one site Work to improve community services commences GM implements full centralisation ODN established Macclesfield stroke unit closes Annual review of acute pathway shows improvement GM achieves ‘A’ acute care for all residents

GM stroke providers Greater Manchester Stroke Operational Delivery Network 3 Hyper Acute Stroke Units 6 District Stroke Centres 16 community rehabilitation teams

Pathway strokes Greater Manchester Stroke Operational Delivery Network 5000 4500 4000 3500 3000 2500 2000 1500 1000 500 0 SSNAP HASU SSNAP DSC SSNAP GM Y 14/15 Y 15/16 Y 16/17

Acute pathway performance Greater Manchester Stroke Operational Delivery Network PAT reorganisation GM full centralisation 2014 CCG Eastern Cheshire Bolton Bury Central Manchester Heywood, Middleton & Rochdale North Manchester Oldham Salford South Manchester Stockport Tameside & Glossop Trafford Wigan Borough 2015 2016 2017 Dec 16 -Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jul Aug-Nov 17 D D C C B B B A A D D X D B B A A A D C C B A A A A D D D C B B A A A C C C B A A A A D C C D D D C C B D C D D D C C C D C C B B B D D C A A B C C C B B A A A B B B B B A A A B B B A A A A A

Review at 2 years Greater Manchester Stroke Operational Delivery Network • Significant decrease in stroke assessments and admissions at District Stroke Centres • 9% increase in proportion of strokes <4 hours time of onset at HASUs • 94% of stroke patients admitted to a stroke ward • Significant reduction in stroke mimics assessed in A&E and admitted to HASU stroke wards in Year 2 • Significant increase of directly admitted stroke patients at DSCs treated on non-stroke wards in Year 2

Key learning Greater Manchester Stroke Operational Delivery Network • Realistically model changes in patient flow and consider future developments e. g. IAT, ICH pathways • Minimise number of stroke units (and community teams) to future proof quality of care and improve efficiency • Redesign community services at the same time • Measure impacts across whole patient journey

Key learning Greater Manchester Stroke Operational Delivery Network • Collaboratively agree SOPs to support pathway • Agree at CEO level robust processes to ensure timely repatriation of strokes and mimics • Ensure sufficient support to manage increased patient flow at HASUs • Improve recognition of stroke to reduce burden of false positives at HASUs • Ensure ASUs still able to treat direct admissions appropriately • Consider pathway exclusions (e. g. time of onset cut off) and referral pathways (carotid artery etc)

Critical success factors Greater Manchester Stroke Operational Delivery Network • Decision to centralise based on robust evidence • Collaborative approach built relationships and trust over time • Include patient voice • Effective use of data to demonstrate impacts • Network support for change management

Who are we? Greater Manchester Stroke Operational Delivery Network • Established in July 2015; pump primed by SCN and now provider funded (~£ 200 k/annum) • Only Stroke ODN in the country • Non-statutory body constituted from all public sector stroke provider organisations across Greater Manchester, including NWAS • Providers, in partnership with the Host, are collectively responsible for delivery of the functions of the network

Greater Manchester Stroke Operational Delivery Network

Meet the team Sarah Rickard Manager Chris Ashton Co-ordinator Supported by Administrator Lisa Chadwick; shared with Neuro Rehab ODN Greater Manchester Stroke Operational Delivery Network Dr Jane Molloy Hospital Clinical Lead Tracy Walker Community Clinical Lead

Continuous improvement Stroke unit capacity Greater Manchester Stroke Operational Delivery Network Patient information Mortality Community services Service developments TIA services Measuring performance Regional IAT service Sector Forums Audit Patient flow Rehabilitation Life after stroke Vocational rehabilitation Driving Use of assessments Training & Education Competency frameworks Training programme Annual conference Induction training Online training Teaching at universities Secondary prevention Sa. LT Cardiology services Shared clinical SOPs ICH pathway

Greater Manchester Stroke Operational Delivery Network sarah. rickard@srft. nhs. uk www. gmsodn. org. uk @GMStroke. ODN