by Admin 4

NI Stroke Consultation: Call for Dept. of Health to Assess for Population Health and Rural Needs as Next phase of Work

Dept.of Health NI have stated in Hospital Reconfiguration Update Nov 2019 that 19,000 responses were submitted to NI ‘Reshaping Stroke Care’ Centralisation proposals and 4,500 responses received on proposed centralisation of NI Reshaping Breast Assessment Services.

The Department’s plans to proceed after these two consultations differ radically with a plan to carry out a Population Health Needs Assessment for BREAST ASSESSMENT but NOT FOR STROKE SERVICES.

The two statements on (1) Stroke and (2) Breast Assessment services appear below.
(1) Statement on ‘Reshaping Stroke Care’ services:

“A consultation on improving stroke services to improve outcomes launched in March 2019. The consultation document set out seven commitments to improve stroke care across the stroke pathway, alongside six potential options for the establishment of a hyperacute stroke network in Northern Ireland.
19,000 consultation responses were received. The Department is currently analysing consultation responses to inform the development of a preferred model for stroke care.”
Dept. of Health NI (DoH) 2019 Hospital Reconfiguration Update

(2) Statement on ‘Reshaping Breast Assessment Services’ :
“A consultation on proposals to improve breast assessment services ran from 25 March to 30 August 2019.
Over 4,500 responses have been received. The Department is currently analysing all responses. This will help to inform the next phase of work to review breast cancer treatment services which is commencing with a Population Needs Assessment. Further details will be announced in the weeks ahead.
Dept. of Health NI (DoH) 2019 Hospital Reconfiguration Update

Official statistics, as presented by NISRA must determine where Specialist acute Hospitals are located in NI.

POPULATION HEALTH NEEDS ASSESSMENT VITAL FOR BOTH STROKE SERVICES AND BREAST CANCER SERVICES.

The Department’s plan to carry out a “Population Health Needs Assessment” for Breast Cancer services as a next phase of work is a good proposal, but where is the plan to carry out a Population Health Needs Assessment for specialist emergency, inpatient, outpatient and rehabilitation treatment for Stroke Services covering the complete stroke pathway – across NI? THERE HAS NEVER BEEN ONE.

A failure to carry out accurate Population Needs Assessments for health services is a recurring theme in the Southern Trust area – NO NEEDS ASSESSMENT WAS UNDERTAKEN as part of the SOUTHERN TRUST STROKE CONSULTATION in 2014.

Despite this, the 2016 Full Bengoa Expert Panel Report used the controversial proposed removal of Specialist Acute Stroke services, and its specialist Acute Stroke staff, from Daisy Hill acute Hospital in Newry as the prime local Case Study for Centralising Stroke Services in NI.

The full Bengoa Report inappropriately promoted (quote below) the choice of Craigavon Hospital for a Specialist Stroke Unit, singled out ahead of all other NI hospitals, and WITH NO NEEDS ASSESSMENT.

This was proposed to make sure that Craigavon could have a 24/7 specialist Stroke Centre leaving Daisy Hill Newry without its existing life saving combined specialist Acute Rehabilitation Stroke Unit and its valuable specialist stroke staff.

“In 2014…, a decision was taken to create a single specialist stroke inpatient unit within the Southern Health and Social Care Trust, at Craigavon Area Hospital. The Trust is proposing to provide a consistent and specialist service 24/7 in one centre rather than spreading the specialist team of staff across four sites. Daisy Hill Hospital will continue to provide ongoing rehabilitation and support through community stroke teams working to a regionally agreed care model.”
Bengoa Expert Panel 2016 (Full Report) (pg 72/ 73).

WHY ASSESS NEED?

Population Needs Assessments are widely recognised as a statutory requirement for health commissioning across the UK to ensure fairness and to reduce inequalities. A Needs Assessment is absolutely vital to ensure that immediate access to stroke services is available for all NI stroke patients – not just those attending hospitals confirmed in all six options in the urban areas of in and around Belfast namely the Royal, Craigavon and Altnagelvin.

POPULATION NEEDS ASSESSMENT DATA MUST USE OFFICIAL NISRA STATISTICS

This Needs Assessment must be undertaken using accurate NISRA Local Government Districts Demographics – not by using (1) imaginary theoretical demand of 600 stroke patients to certain hospitals or (2) Integrated Care Partnerships (which vary across local government districts).

Neither is an accurate statistical representation of the POPULATION health needs of an area.

New investment in acute specialist hospital services, hospital beds and specialist medical staff is due in the Newry & Mourne area, in Daisy Hill Acute Hospital, including in the Emergency Department.

DEPT. OF HEALTH N.I. ARE FAILING TO ADDRESS THE HEALTH NEEDS OF NEWRY & MOURNE POPULATION

(1) Newry & Mourne LGD is consistently the HIGHEST POPULATION IN THE SOUTHERN TRUST OPERATIONAL AREA

(2) Newry & Mourne LGD is consistently the 4TH HIGHEST POPULATION IN NI -SINCE c1972

Newry and Mourne locality has always been the largest population of the 5 localities (LGDs) in the Southern Trust and must have investment for a Specialist Acute Hospital.

The DOH, PHA, HSCB and Commissioners need to take action to assess Population Health Needs and provide services for Newry & Mourne former LGD , (which includes South Armagh) both as:

(1) Newry & Mourne has been the consistently largest local government district that remains in the operational area of the Southern Trust since its inception in 2007. NISRA demographics confirm this.

Latest official population stats for the 5 LGDs in the operational area of the Southern Trust

(1)Newry & Mourne ( 105,693*); (2) Craigavon ( 101,489*); (3)Armagh(62,976*) (4) Dungannon (62,666*) and (5) Banbridge (50,717*) [ [2018* NISRA]. This has been consistently ignored by the Southern Trust since they came into operation in 2007.

(2) Newry &Mourne LGD has always been the 4th highest LGD population in NI since 1972 (for nearly 50 years) after only Belfast, Lisburn (Greater Belfast ) and Derry.

(3) NISRA demographics confirm the Newry & Mourne population is projected to be the 3rd HIGHEST LGD POPULATION IN THE WHOLE OF NI BY 2023 with 110,090 population after only (1st)Belfast (289,130) and (2nd) Lisburn (Greater Belfast): 133,106. Derry is projected to be the 4th highest population in NI with 110,028 (NISRA).

These demographics were not considered in the ‘Reshaping Stroke Care’ Consultation or by the Southern Trust. A population Health Needs Assessment using accurate statistics will show the DoH the population health needs within Newry & Mourne, including needs for specialist stroke services.

A Population Health Needs Assessment (at local Government District Level) using accurate NISRA demographics will show quite clearly the continued need for specialist Stroke staff in Daisy Hill acute Hospital combined Stroke Unit, in order to provide time crucial emergency, acute and rehabilitation stroke care for the Newry & Mourne population and further afield within the same time frame as in urban areas in NI.

Centralisation of stroke services to one area in Craigavon will not provide safe stroke care in Newry & Mourne and will cost lives.

Act FAST Stroke - HyperAcute Stroke Unit for Newry 2019

PHASE OF WORK REQUESTED:

CALL FOR THE DOH, PHA, HSCB and COMMISSIONERS TO:

1. Conduct a Full Population Health Needs Assessment at individual Local Government District level (not at Trust level) using official NISRA Statistics – not Administrative stats such as Integrated Care Partnerships or theoretical modelled hospital demand.
2. Carry out Full Rural Impact Assessment (Rural Needs Act 2016)
3. Carry out an Environmental Impact Assessment to assess the Carbon Footprint implications of Centralisation
Then
4. Rewrite the Stroke Consultation and Stroke Options following these assessments, based on population needs, along with the Consultation Responses.

WHY THE STROKE OPTIONS NEED TO BE RE-WRITTEN

Under “Change or Withdrawal of services” – ALL 8 existing specialist Acute Stroke Units (including Daisy Hill, Newry combined specialist Acute Stroke Rehabilitation Unit) , NOT JUST 6 STROKE UNITS are entitled to be included in an NI wide consultation questionnaire options for upgrading to Hyperacute stroke units and retained as Acute Stroke Units.

The finally selected options must ensure immediate access to Emergency and inpatient specialist stroke Care in a fair and regionally balanced way across NI

>>>>>BACKGROUND

Dept. of Health NI latest Update to NI 2019 ‘Reshaping Stroke Care’ Consultation can be seen at the following link:
https://www.health-ni.gov.uk/hrn-newsletter-edition1

For Bengoa Report: Systems not Structures: Changing Health & Social Care (FULL REPORT) (link Below) See pages 72/73
https://www.health-ni.gov.uk/topics/health-policy/systems-not-structures-changing-health-and-social-care

You can follow the Daisy Hill Acute Hospital campaign also by visiting and liking our Facebook page where you will find current information at https://www.facebook.com/daisyhillforlife/ – Thank you.

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© Daisy Hill for Life on Facebook and http://www.savedaisyhillhospital.com, 2015 – 2021. We welcome sharing of this info and the use of excerpts and links, provided that full and clear credit is given to http://www.savedaisyhillhospital.com and Daisy Hill for Life with appropriate and specific direction to the original content. Thank-you!

08.20.19

by Admin 4

Another Call to Action for the Specialist Stroke Unit in Newry: Write for your rights!

NI Reshaping Stroke Care Consultation 2019 -Write for Right to Life at Daisy Hill Specialist Stroke Unit Newry

Suggested Answers to the RSC Consultation NOW AVAILABLE – including the Extra 5 Equality, Human Rights & Rural impact Questions

As the 2019 Stroke Consultation Deadline is Fri 30th August, Daisy Hill’s campaign for Hyperacute Stroke Unit status continues, with a renewed call for action for the people of Newry & Mourne, South Armagh, South Down and surrounding areas.

Based on demographics Daisy Hill Acute Hospital, Newry should be confirmed as a location for a Hyperacute and Acute Stroke Unit – so Suggested Answers to Reshaping Stroke Care are now ready to Download for sending back to the Department.

If you want to help but haven’t submitted any Response to the Consultation, OR if you have already signed a Support Our Stroke Services Questionnaire and need to answer the Equality Questions, both documents are available below.

1. For those YET TO REPLY to Re-shaping Stroke Care 2019 Consultation

ALL Questions Suggested Answers Version 1 (Complete Questionnaire) is available to download and save as a new filename from this Link: All Qs Answers Reshaping Stroke Care questionnaire

OR

2. For Those who have Responded to the first Questions but not the EQUALITY\ RURAL IMPACT QUESTIONS in Reshaping Stroke Care 2019

5 EQUALITY Q’s ONLY Questionnaire is available to download and save as a new Filename from this link: 5 Equality Qs answers Reshaping Stroke Care Questionnaire

These Suggested answers are already typed onto the RSC Questionnaire in Word Format for easy access for you to download and read.

The Answers are only intended to be a Guide for your own Answers – but if you agree with these and find it useful and time-saving– you can use all or part of the content. You can type changes directly onto the Questionnaire, (adding or delete as you wish!) It is recommended that you do make some changes so they are not all identical. Please remember to add your name/address/email address too.

After Downloading, please remember to ‘Save As’ and Give the document a new filename – perhaps adding your Initials or Surname. For e.g. RSC_Questionaire_All_JSmith_2019

The Original RSC blank Questionnaire is available from the Department of Health NI website : https://www.health-ni.gov.uk/reshaping-stroke-care . Click on ‘Reshaping Stroke Questionnaire’(Word doc) and save.

DIFFERENT WAYS TO RESPOND

(1) EMAIL: Email your Questionnaire \answers to the Department of Health at: StrokeConsultation@health-ni.gov.uk

(2) ONLINE: You can copy and paste some or all the Reshaping Stroke Care ‘suggested answers’ plus add your own comments onto the online questionnaire at:

https://consultations.nidirect.gov.uk/doh-healthcare-policy-group/reshaping-stroke-care-saving-lives-reducing-disabi/consultation/intro/

(3) BY POST (using First Class Stamp) post (before 4.30pm Wednesday 28th August 2019 at the latest) to:

Reshaping Stroke Care, Hospital Services Reform, Department of Health, Annexe 3, Castle Buildings, Stormont Estate, Belfast BT4 3SQ

If you know people that would like to respond to the Consultation, that do not have a computer or do not wish to respond online, forms are available from the Department of Health.

To get a form posted to you: Phone (028) 9076 5643 and ask for a RESHAPING STROKE CARE Consultation Questionnaire. It is advisable to do this as soon as possible as All Responses must be received by the DOH before the Deadline of Friday 30th August 2019 @5pm.

All the Consultation Documents (including the Questionnaire Form are available online at https://www.health-ni.gov.uk/reshaping-stroke-care

IMPORTANT INFORMATION

THIS ACTION IS TO FURTHER SUPPLEMENT THE EXCELLENT WORK ALREADY DONE BY SUPPORT OUR STROKE SERVICES COMMITTEE

As you know, another Campaign Group, Support Our Stroke Services Committee organised Community Outreach events over the summer in Shops, Shopping Centres and local places to encourage people to sign Questions from the Online Questionnaire. These Questionnaires supported the community goal to ensure that Daisy Hill Acute Hospital both retains its acute specialist Stroke Unit and is elevated to a Specialist Centre with Hyperacute Stroke Unit.

Many thousands signed these Consultation Questions up to the Alternative Option Question, but answering the remaining Equality & Human Rights Questions is an absolutely vital part of this whole process.

The flawed Department of Health Consultation Questionnaire prevented access to the Equality Questions previously, as these Questions could only be reached once you had selected one of the Options and every one of them excludes Daisy Hill Hospital.

Now with the Extended deadline – we have the opportunity to supplement the ‘Support Our Stroke Services’ Committee facilitated Questionnaires by submitting the rest of the 5 Equality Questions to support the need for a Hyperacute Stroke Unit in Daisy Hill, Newry.

People power through Consultations -Based on demographics Daisy Hill Acute Hospital, Newry should be confirmed as a location for a Hyperacute and Acute Stroke Unit

The united community of Newry and Mourne and South Armagh will work together to ENHANCE stroke services in Daisy Hill Acute Hospital

The people from Newry & Mourne, South Armagh, South Down and surrounding areas, still stand together to challenge the flawed Consultation document which deliberately excluded Daisy Hill’s specialist combined Acute Stroke Rehabilitation Unit from the proposed Options in Reshaping Stroke Care, but every-one of us need to continue to put the case in writing.

STILL NEED CONVINCING?

Time is Brain - Urban and Rural -None of the Options in the NI Stroke Consultattion are best for all of NI. Every minute matters during a stroke says London Stroke Strategy.

The DoH states that the proposals will have MINOR IMPACT in NI. This is not the case in Newry & Mourne, Down and South Armagh area where there will be MAJOR IMPACT on the lives of stroke patients.

There will be removal of scanning, administration of the crucially time dependant clot-busting drug Alteplase and removal of direct access into a specialist acute stroke rehabilitation unit from Daisy Hill acute Hospital as if it never existed.

This includes losing existing direct access to the Royal for Thrombectomy from Daisy Hill Hospital.

Your life could depend on it.

We must challenge the Department of Health by answering this Consultation – The more the better to get the message through loud and clear. We can do it with YOUR help.

WE CAN DO THIS TOGETHER !

Thank you.

Daisy-Hill-still-needs-you!-call-to-action-for-the-specialist-stroke-unit-in-Newry

For background information on the 2019 NI stroke Consultation document – please see the following post:

https://savedaisyhillhospital.com/2019/05/05/ni-stroke-consultation-2019-overview/

07.30.19

by Admin 4

Clinical evidence proves the importance of ‘Golden Hour’ in Emergency Stroke care

The effectiveness of stroke treament within the ‘Golden Hour’ is well documented in clinical research and in the stroke treatment community. (Hussain, M.S.(2018); Fassbender, K.et al (2013); Saver, J.(2006,2010)

Clinical evidence proves the importance of the ‘GOLDEN HOUR’ in Emergency Stroke care, but ‘Golden Hour’ is not recognised by Department of Health (DoH).

It is well known that STROKE is a 999 EMERGENCY where every second counts for the patient receiving acute stroke care and the critically time dependant clot-busting drug Alteplase used in Thrombolysis.

The options given in the 2019 Stroke consultation show clearly that the Department of Health NI are IGNORING the fact that every stroke patient, no matter where they live, needs to be seen and treated as an Acute Stroke Care 999 Emergency ideally within the ‘Golden Hour’. This means making pre hospital travel times as SHORT AS POSSIBLE, so that the patient can ideally be treated within the ‘Golden Hour ‘from onset of stroke to needle time.
Rather than make pre-hospital travel times SHORTER, the DoH are proposing to make pre hospital travel times LONGER for patients living in Newry Mourne & Down and other areas in NI.

Stroke patients who presently are scanned in Daisy Hill (and if eligible) given Thrombolysis are already immediately transferred to the Royal for Thrombectomy if suitable.

If 2019 Reshaping Stroke Care proposals go ahead, dying stroke patients WILL BE DENIED IMMEDIATE TREATMENT and have to be transferred to Craigavon, 45 minutes away (to see if they are even suitable for Thrombolysis, never mind Thrombectomy) and will have much worse outcomes due to the delay in transfer and will be denied the best chance for survival.

TIME DELAY IN GETTING 999 EMERGENCY CARE IS NOT ACCEPTABLE

It is not acceptable that people from the Rural Areas of NI who will already have travelled long distances to access existing specialist Stroke Units, (using up precious minutes of the ‘Golden Hour’ already) will have to travel even FURTHER, losing vital brain cells and causing untold brain damage on the journey. It also means that patients who suffer a stroke when in hospital or ED will be denied access to the existing specialist Acute Stroke/Rehab Unit in Newry and denied immediate treatment.

WHY IS THE FIRST HOUR TERMED ‘GOLDEN’?

The Golden Hour in stroke is well supported by Clinical Evidence

The effectiveness of treatment in the GOLDEN HOUR is well documented in the emergency medicine and stroke treatment community, even if our DoH refuse to recognise the term ‘Golden Hour’ in the recent FAQ/ Frequently asked Questions supplement to the consultation document (see FAQ5).

It is well known that patients receiving treatment within the first 60 minutes of symptom onset, (termed the Golden Hour,) have the greatest opportunity to benefit from restoration of blood flow therapy with respect to disability and living independently. This time-frame is when the volume of salvageable brain and the patient’s capacity to benefit from clot-busting therapy are greatest.
The reason the first hour of stroke is called ‘golden’ is because stroke patients have a much greater chance of SURVIVING and avoiding long-term brain damage if they arrive at the hospital and receive treatment with a clot-busting drug called TPA (Altepalse) within that first hour from onset of stroke:

“Therapeutic benefit is maximal in the first minutes after symptom onset and declines rapidly during the next 4.5 hours.” (Saver MD)

DoH DO NOT RECOGNISE THE TERM ‘GOLDEN HOUR.’

The DoH try to justify selectively making Stroke patients travel further for immediate Emergency Stroke Care during the ‘Golden Hour’ from onset of stroke in Newry Mourne & Down by stating that: “the Golden Hour is not a recognised term in Stroke Care. In our healthcare system we work to the National Clinical Guidelines for stroke, which is the definitive source of how stroke care should be delivered in the UK.”

It is the DoH’s opinion that: “The most important factor in stroke care is not the time to hospital. It is the time to expert assessment, brain scanning and treatment that is critical.” (See FAQ 5:Taken from Questions and Answers Supplement to 2019 Stroke Consultation).

CLINICAL EVIDENCE SUPPORTING IMPORTANCE OF ‘GOLDEN HOUR’

At the International Stroke Conference 2018 in Los Angeles M. Shazam Hussain, MD, Director of Cleveland Clinic Cerebrovascular Center presented significant findings that the “golden hour” is proving to live up to its name, even for patients with one of the most serious forms of ischemic stroke.

According to this study, 52 percent of individuals suffering an ischemic stroke had better long-term outcomes if they received Thrombolysis medication (Alteplase) within 60 minutes of symptom onset. This compares to only 27 percent of patients showing good long-term outcomes – with respect to disability and living independently — if administered Alteplase beyond the golden hour.

A summary of The Lancet article (2013): ‘Streamlining of pre-hospital stroke management: the golden hour’ reinforces the importance of the narrow time-frame or ‘Golden Hour’:

“Thrombolysis with Alteplase administered within a narrow therapeutic window provides an effective therapy for acute ischaemic stroke. However, mainly because of prehospital delay, patients often arrive too late for treatment, and no more than 1–8% of patients with stroke obtain this treatment.
We recommend that ALL LINKS in the PREHOSPITAL STROKE RESCUE CHAIN must be optimised so that in the future more than a small minority of patients can profit from time-sensitive acute stroke therapy.”
The Lancet article (2013)

Therefore pre-hospital travel time for the Newry Mourne and Down population should also be shortened, not lengthened, in receiving 999 Emergency Stroke Care to save lives with better outcomes.

Just as in the Western Trust (with a total population of 301,448*) there is need for TWO Specialist Acute Stroke Units - so too, the Southern Trust (with a larger population of 380,312*) is also entitled to TWO Specialist Stroke Units (HASUs and Acute Stroke Units), at Daisy Hill Hospital, Newry and Craigavon Hospital. This would ensure that everyone in the Southern Trust has immediate access to CT scanning and life saving thrombolysis, followed by direct access into a stroke unit.

DAISY HILL, NEWRY IS THE RIGHT PLACE FOR A HYPERACUTE STROKE UNIT – A VITAL OMISSION FROM THE 6 PROPOSED 2019 STROKE CONSULTATION OPTIONS

Newry Mourne and Down – with a population of 180,000 is the third largest Local Government District population in NI. Daisy Hill Acute Hospital, Newry City with its STRATEGIC LOCATION – is the right place, entitled to have a hyperacute stroke unit co-located with an acute stroke unit.

This option will give a fair and equitable chance of survival with better outcomes for dying stroke patients in this LGD, like the population attending the Royal, Altnagelvin and Craigavon.

‘TIME LOST IS BRAIN LOST.’

The Emergency Stroke Care “Golden Hour” is already a very narrow time-frame. Additional delay in pre-hospital travel times which the DoH are selectively imposing on the Rural Catchment population of Newry Mourne and Down will cost lives, not save saves and cannot be condoned.

The population is entitled to fair and equitable treatment, so this proposal to withdraw emergency and specialist acute stroke care from the combined Specialist Acute Stroke/Rehab Unit, which has existed since pre-2003 in Daisy Hill Acute Hospital, Newry, must be challenged!

You can follow the Daisy Hill Acute Hospital campaign also by visiting and liking our Facebook page at https://www.facebook.com/daisyhillforlife/ – Thank you.

07.20.19

by Admin 4

Largest rural population in NI: Newry, Mourne and Down Local Gov. District must have immediate access to life saving 999 Emergency Stroke Care

Withdrawal of immediate access to life saving 999 Emergency Stroke Care, including direct admission into the existing specialist Acute Stroke Unit from Newry, Mourne & Down Locality is not fair and equitable treatment. Under the Rural Needs Act (NI) 2016 due regard must be given by Public Authorities to the needs of rural populations to fairly access key public services. This includes immediate, not delayed access to hospital stroke care. The largest rural population is in Northern Ireland is in Newry, Mourne & Down Local Government District which includes South Armagh.

Under the Rural Needs Act (NI) 2016 due regard must be given by Public Authorities to the needs of rural populations to fairly access key public services. This includes immediate, not delayed access to hospital stroke care.

The largest rural population is in Northern Ireland is in Newry, Mourne & Down Local Government District which includes South Armagh.

Since 2018, the Rural Needs Act 2016 (NI), which aims to deliver fairer and more equitable treatment in Rural areas, must be adhered to by all Public bodies in NI. Because of this, the Dept. of Health filled in a Rural Needs Assessment Form to accompany the 2019 NI Stroke Consultation.

Definition of Rural in Rural Needs Assessment Form

On this form, the definition of “Rural” which according to the DOH “is better able to distinguish between those who will be MOST IMPACTED by additional travel times caused by proposed changes to services is:
“Populations outside of a 30 minute drive time of Derry/Londonderry or Belfast”

Using the above definition confirms that the 5 Urban hospitals in the Stroke Consultation 2019 are:
Altnagelvin, Royal Victoria, Craigavon, Antrim and Ulster hospitals,
while there are only three Rural Acute hospitals:–
Daisy Hill, Newry, Causeway Hospital, Coleraine and South West Hospital, Enniskillen.

The DoH’s reply to Question 2B in the Rural Needs Assessment states:

“The key impact that differently affects rural dwellers is likely to relate to travel times to hospital etc.” They continue:
“ALL OF THE OPTIONS outlined in the consultation document INCLUDE the provision of hospital care” at “Altnagelvin, Craigavon and Royal Victoria Hospital” (all URBAN Sites.) “Therefore people living in the catchment areas for these three sites WILL NOT experience any increase in respect of travel times. Under the potential options, people living in the catchment areas for Causeway Hospital and Daisy Hill Hospital, WOULD experience an INCREASE in journey times if taken to hospital after a suspected stroke.”

INCREASE IN JOURNEY TIMES AFTER A SUSPECTED STROKE FOR RURAL CATCHMENT AREAS

From research by Werner Hacke, MD It is known that the drug “Alteplase” used in Thrombolysis, is nearly twice as effective when administered WITHIN the first 1.5 hours after stroke as it is when administered 1.5 to 3 hours after stroke.

Yet, The DoH have admitted, above, that there WILL BE AN INCREASE IN JOURNEY TIMES for people living in the Rural Catchment areas of Causeway and Daisy Hill hospitals, and that people living in the Urban catchment areas of Altnagelvin, Craigavon, and Royal Victoria hospitals WILL NOT experience any increase in respect of travel times.

They have decided also to WITHDRAW COMPLETELY the existing stroke units in the Rural Locations of Daisy Hill Acute Hospital, Newry and Causeway Hospital, Coleraine. This proposal means dying stroke patients from these Rural localities will have to TRAVEL FURTHER for the CRITICALLY TIME DEPENDENT, LIFE-SAVING drug Alteplase used in Thrombolysis, and direct access from ED into the existing combined Specialist Acute/Rehabilitation Stroke Units in Daisy Hill, Newry, and Causeway Hospital, Coleraine, essential to save lives.

Daisy Hill Hospital Emergency Department is vital for stroke and life threatening emergencies

The 3 Urban Hospitals Altnagelvin, Craigavon, and Royal Victoria will never experience an increase in travel times because they feature in all 6 Options in the 2019 Stroke Questionnaire to be upgraded to Hyperacute stroke units with co-located Acute Stroke Units.

RURAL HOSPITALS OF DAISY HILL AND CAUSEWAY OMITTED FROM ALL SIX OPTIONS

However the two Rural hospitals of Daisy Hill and Causeway have been omitted altogether from all six options, confirming they will be shut down as if they never existed as part of the network providing 999 Emergency Stroke care to the population of NI.

THERE ARE NO RURAL HOSPITALS INCLUDED IN ALL 6 OPTIONS FOR HYPERACUTE AND ACUTE STROKE UNITS.

The DOH forget that Rurality is a factor in allocating Health and Social Care Funding which means that there is extra money to provide services in Rural areas which should be taken into account in deciding where stroke Units will be provided.

*********RURAL NEEDS ACT (2016)*************

To have Three Hyperacute stroke units for Urban Areas of NI in all 6 Options and NO Option for a Hyperacute Stroke Unit for the Catchment population for the LARGEST RURAL POPULATION in NI namely Newry, Mourne & Down (which includes S.Armagh) Local Government District is NOT FAIR AND EQUITABLE TREATMENT in revising policies, strategies and plans, and designing and delivering public services such as Acute Stroke Care under the 2016 Rural Needs Act.

The Rural Needs Act NI 2016, (which is not a devolved matter) is there to PROTECT the Rural Population from this unfair treatment and “can relate to the ability to access key public services such as health, the ability to access suitable employment opportunities, and the ability to enjoy a healthy lifestyle”.

NEWRY MOURNE & DOWN LOCALITY SHOULD ALREADY HAVE A MAJOR ACUTE HOSPITAL

There is no doubt that Newry Mourne and Down LGD with the largest Rural population in NI with 179,000 people, SHOULD ALREADY have a major acute hospital, in Newry as proposed by Secretary of State Peter Hain in 2005.

This Stroke consultation shows that the Department of Health are not even prepared to give dying stroke patients from the largest rural Population in NI, the basic essential need of immediate access to Emergency Stroke Care.

The Rural catchment population for Daisy Hill Acute Hospital, Newry, is not being treated fairly and equitability in the same way as the catchment population of the Urban Stroke Units in Altnagelvin, Craigavon and Royal Victoria Hospitals who will have immediate access, as they should, to life saving stroke care, in Hyperacute and Acute Stroke Units without having to travel further than at present.

This deliberate plan to exclude the Rural populations need for IMMEDIATE, not delayed, access to life saving Emergency Stroke Care, including CT scanning and Thrombolysis, followed by direct access into a specialist Hyperacute Stroke Unit /Acute Stroke Unit will COST LIVES, not save lives of Stroke patients and should not be condoned.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
BACKGROUND INFO
Link to Rural Needs Act 2016
https://www.legislation.gov.uk/…/19/pdfs/nia_20160019_en.pdf

“RURAL NEEDS ACT (NORTHERN IRELAND) 2016
Duty of public authorities to have due regard to rural needs
1.(1) A public authority must have due regard to rural needs when— (a) developing, adopting, implementing or revising policies, strategies and plans, and (b) designing and delivering public services.
6. In this Act— “the Department” means the Department of Agriculture and Rural Development; “rural needs” means the social and economic needs of persons in rural areas.”
‘PUBLIC AUTHORITIES’ include:
A Northern Ireland department
A district council
A Health and Social Care Trust
Invest Northern Ireland
The Regional Agency for Public Health and Social Well-Being
The Regional Health and Social Care Board

06.11.19

by Admin 4

Urgent Message to HSCNI: Retain Emergency Stroke Services in Newry Now

Urgent Message to the HSCNI: Retain Emergency Stroke Services in Newry Now (Re: NI stroke Consultation 2019) As Trusted Clinicians confirmed scanning and thrombolysis would remain in Daisy Hill Hospital, Newry city.

There is plenty of Clinical evidence in support of the combined Acute Stroke/Rehabilitation Unit at Daisy Hill Acute Hospital, Newry. Multiple official quotes show that Clinicians, Directors, Chief Executive and the Health Minister in 2014, spoke in favour of keeping all emergency Stroke Services, especially scanning and Thrombolysis (Alteplase – clot busting drugs treatment) in Daisy Hill Hospital.

This evidence from the Southern Trust Stroke Consultation in 2014 is relevant today as Stroke Services in the Southern Trust was used as a local case study in the Bengoa Expert Panel report (2016, p72). This Bengoa Report continues to inform Health Policy in 2019.

The 2014 Consultation questionnaire itself and clinician’s statements made it very clear that emergency services for stroke – Scanning and Thrombolysis would always be in Daisy Hill Hospital. This was reiterated by more official statements in press, minutes and meetings in 2014/15.

Now fast forward to 2019, the people of Newry & Mourne discover that in the latest NI wide Stroke Consultation, the Emergency services for stroke (Scanning and Thrombolysis), that Trusted clinicians had assured them would remain, are proposed for removal from Newry too.
Secondly Daisy Hill Hospital, Newry is completely excluded from the Stroke consultation Options and Questionnaire.

We will not accept this – and we ask the Permanent Secretary to deliver on his promised statement:

“to do better, for the public we serve”
(Source: Department of Health Blog 05.04.2019)

>This urgent message to the HSC Northern Ireland, is to ask them to publicly explain their actions for the proposed Change or Withdrawal of Services from Daisy Hill, Newry – one of the designated acute hospitals in Northern Ireland with 24/7 emergency services.

We urgently request the Health Social Care Northern Ireland (HSCNI) to take action to Retain Emergency Stroke Services in Newry Now.

We need to appeal for Emergency Care for the dying and vulnerable in our society.

CLINICAL EVIDENCE QUOTE EXAMPLES – supporting Emergency Stroke Care at Daisy Hill Hospital, Newry

Example 1:

“The Southern Local Commissioning Group supported the proposal to retain thrombolysis on both Craigavon and Daisy Hill Hospital sites, given the need to ensure that for those patients who are suitable for this procedure, they receive it within the optimum time.”
(Source: Appendix 1, Southern Local Commissioning Group, March 2015)

Example 2:

“We are proposing that patients who have had a stroke will continue to go to their nearest Emergency department, at Daisy Hill or Craigavon, where they will receive the appropriate specialist assessment. Stroke Thrombolysis, the clot busting drug, can be provided at both sites to the patients who are suitable. This is the same immediate and urgent access to emergency care that patients experience at present.”
(Source: Southern Trust Chief Executive, M. McAlinden, at a meeting with the Newry & Mourne Council representatives, in the presence of senior medical staff and Directors, ‘Chief Executive meets with Newry and Mourne Council Representatives’ Southern Trust Website 21/10/2014)

BACKGROUND
The 2014 decision by the Southern Trust to create a single specialist stroke inpatient unit in Craigavon was widely contested by the people and the Council of the largest locality in the southern Trust – Newry & Mourne. The high performing stroke unit, on Level 6, Daisy Hill Hospital, Newry was the only existing Specialist Acute Stroke Rehabilitation Unit in the Southern Trust.

Newry and Mourne population Rally for enhanced Stroke services at Daisy Hill Acute Hospital in 2015 — 2015 Rally to Save Stroke Services at Daisy Hill Hospital, Newry was attended by over 10,000.

This appeal for Emergency Care for the dying and vulnerable in our society continues in 2020, so we urgently request the HSCNI to take action to Retain Emergency Stroke Services in Newry Now.

Please share widely if you agree. You can follow the Daisy Hill Acute Hospital campaign also by visiting and liking our Facebook page at https://www.facebook.com/daisyhillforlife/ – Thank you.

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05.29.19

by Admin 4

NI Stroke Consultation 2019: ‘TIME IS BRAIN’ – URBAN and RURAL

Stroke is a crucially time dependant 999 Emergency Service for ALL the POPULATION of Northern Ireland – no matter where they live – URBAN or RURAL. The location of stroke units is vitally important so that immediate access is available for ALL.

HSCNI Reshaping Stroke Care proposals 2019 do not reflect the URGENCY of the complete stroke pathway – especially from ONSET OF STROKE TO ARRIVAL IN HOSPITAL for ALL the population of Northern Ireland.

> Every delay in time in treating stroke patients will cost lives – not save lives.

The Royal College of Physicians states the best outcome for patients is achieved when the time from onset of Stroke to treatment is as SHORT as possible:

“So the more we can do both to reduce the time taken from the start of symptoms to arrival in hospital, and from arrival in hospital to treatment, the less disability people will suffer.”
[Royal College of Physicians SSNAP Report 2016.]

Newry Mourne and Down (which includes South Armagh) is the 3rd highest population in Northern Ireland with a population of 179,000 (105,000 living in a rural area).

Why does this local government district and other rural areas in Northern Ireland have to COMPROMISE YET AGAIN for life saving 999 EMERGENCY services, while all 6 proposed options in the Consultation include: Belfast, Derry and Craigavon.

Belfast, Derry and Craigavon areas do not even need to answer the consultation document, because in this Department of Health Stroke Consultation, Reshaping Stroke Care 2019’, they are guaranteed a Hyperacute Stroke Unit co located with Acute Stroke Unit on their doorstep.

CONCLUSION
Nothing justifies the removal of Stroke services from the long established combined specialist Acute Stroke/ Rehabilitation Unit in Daisy Hill Hospital, Newry City (the only one of its kind in the Southern Trust).

OPTIONS
Daisy Hill Hospital’s Specialist Stroke Unit in Newry must feature in the proposed 2019 NI Stroke Consultation Options.

It must be retained and enhanced to a Hyperacute Stroke Unit co-located with an Acute Stroke Unit as part of the LONG TERM future plan for Stroke Services in NI- so the dedicated staff can continue to save lives and reduce disability if the DoH NI wants to save lives with better outcomes.

For more info on this topic – see https://savedaisyhillhospital.com/2019/05/05/ni-stroke-consultation-2019-overview/ and
https://savedaisyhillhospital.com/2019/05/05/ni-consultation-document-does-not-fully-follow-the-research-evidence-referred-to/

You can follow the Daisy Hill Acute Hospital campaign also by visiting and liking our Facebook page at https://www.facebook.com/daisyhillforlife/ – Thank you.

05.28.19

by Admin 4

Why did the NI Stroke consultation doc leave out vital facts about local stroke units in London?

Why did the NI stroke consultation doc leave out vital facts about the remaining 22 local stroke units in London? Is Northern Ireland getting the full picture? 22 local stroke units remain in London as well as 8 Hyperacute units

IS N.IRELAND GETTING THE FULL PICTURE?

Like the Bengoa Report in 2016, ‘Reshaping Stroke Care’ 2019 uses the London Stroke Model as good practice to follow here, but by mentioning only the 8 Hyper Acute Stroke Units and ignoring the rest of the local stroke services network in London –are they giving the people of N. Ireland the full picture about the Complete Stroke Pathway?

Dying Stroke patients in Northern Ireland are entitled to better.

The NI Consultation document, like the Bengoa Expert Panel Report before it, imply that all the 30 Stroke Units in London were centralised to only 8 hyper acute stroke units. The facts are, as the info-graphic shows-:

AFTER reconfiguration of stroke services: A network of 30 STROKE UNITS REMAIN In London: 8 HYPERACUTE STROKE UNITS + 22 STROKE UNITS which provide both specialist treatment and acute rehabilitation.

None of the 30 mentioned SUs in London were closed.

It was never intended that ‘Hyper Acute’ Stroke Units in London should work in isolation from the other 22 existing local stroke units included in the Sentinel Audit.

According to the London Stroke Model HYPER ACUTE STROKE UNITS (HASUs) are only for the FIRST 72 HOURS of STROKE CARE – that is why a network of dedicated Local Stroke Units as well as the 8 Hyper Acute stroke units were needed in London.

LONDON DEALT WITH THE COMPLETE STROKE PATHWAY

The 2010 London Stroke Model dealt with the complete stroke pathway including from 999 call to Hyperacute (HASU) and Stroke Unit (SU) care – where patients receive most of their care.

The London Consultation confirms the IMPORTANCE of the REMAINING 22 STROKE UNITS in London. (Known as non-routinely admitting Stroke Units in the Royal College of Physicians Sentinel SSNAP AUDIT.)

> Final Summary

Like London, the people of Northern Ireland and their dying stroke patients need this Consultation to consider the best care for all stages of the Complete Stroke Pathway. As the people of London were told:

“You will stay in the hyper-acute stroke unit for the first 72 hours, or until you are stable.
You will then be transferred to a dedicated local stroke unit in the same hospital or closer to your home where you will receive continued specialist treatment and intensive rehabilitation. CARE IN A LOCAL STROKE UNIT WILL SIGNIFICANTLY IMPROVE YOUR CHANCES OF RECOVERING FROM A STROKE.”
London Stroke Consultation

The people of all parts of Northern Ireland are entitled to the same care.

> This NI Stroke Consultation needs to be CHALLENGED to ensure that all local Stroke Units in all areas of Northern Ireland are included.

HyperAcute Stroke Unit for Daisy Hill -Newry and Mourne/South Armagh Area Hospital Reshaping Stroke Care Consultation 2019 — Image by cor gaasbeek from Pixabay

BACKGROUND INFO:

LIST OF EXISTING STROKE UNITS IN LONDON
(Source: Royal College of Physicians Sentinel SSNAP AUDIT).

There are still 30 STROKE UNITS IN LONDON: 8 of these are called Hyperacute Stroke Units There are also 22 stroke units. (8 HASUs and 22 SUs).

8 HASUs in London :

Queens Hospital Romford HASU / Royal London Hospital HASU / Charing Cross Hospital HASU / Kings College Hospital HASU / Princess Royal University Hospital HASU / Northwick Park Hospital HASU / St George’s Hospital HASU / University College Hospital HASU /

22 Stroke Units in London: 8 of these are attached to Hyperacute Stroke Units.

[Queens Hospital Romford SU] / Newham General Hospital /Whipps Cross University Hospital / [Royal London Hospital SU] /Chelsea & Westminster Hospital /West Middlesex University Hospital /Croydon University Hospital / St. Helier Hospital / St Thomas Hospital / Hillingdon Hospital / Homerton University Hospital / [Charing Cross Hospital SU], Nine South Ward /[Princess Royal University Hospital SU] / [Kings College Hospital SU]/Kingston Hospital /University Hospital Lewisham /[Northwick Park Hospital SU] /North Middlesex University Hospital SU / Barnett General Hospital /Royal Free Hospital / [St George’s Hospital SU] / [University College Hospital SU] /

You can follow the Daisy Hill Acute Hospital campaign also by visiting and liking our Facebook page at https://www.facebook.com/daisyhillforlife/ – Thank you.

05.05.19

by Admin 4

NI STROKE CONSULTATION DOESN’T FULLY FOLLOW THE RESEARCH IT REFERS TO

The NI Stroke Consultation 2019* has stated various research to justify the choices that have been made, determining which hospitals will keep or lose their acute stroke units in Northern Ireland – but the very supporting research referred to, does not fully back up these configurations. Two Topic examples are given below.

books-408220_1920Image by Jens P. Raak PIXABAY

[TOPIC 1]:

RECONFIGURATION OF STROKE SERVICES IN LONDON

Bengoa and the NI Department of Health Reshaping Stroke Services 2019 have referred to the London Stroke (Model) as a good example to follow in Northern Ireland.

The main NI Stroke Consultation Document (like the Bengoa Report 2016**), implies that in London after Reconfiguration, the number of stroke units were REDUCED from 30 acute stroke units to 8 Hyperacute stroke units (HASUs) (see pg p25)

THIS IS NOT WHAT HAPPENED.

FACT: FOLLOWING RECONFIGURATION IN LONDON, 30 STROKE UNITS REMAINED and 8 OF THESE ARE HYPERACUTE STROKE UNITS (HASUs).

The fact is – that AS WELL as these 8 HASUs (Hyperacute SUs) – 22 stroke units ALSO remained and to this day provide continued specialist treatment and intensive rehabilitation. (8 of these are attached to these HASUs) Confirmation of this can be seen in the latest Royal College of Physicians Sentinel Audit. (see Background Information Source 3*** ).

LOCAL STROKE UNITS ARE CRUCIAL IN THE STROKE PATHWAY

HyperAcute Stroke Unit for Daisy Hill -Newry and Mourne/South Armagh Area Hospital Reshaping Stroke Care Consultation 2019

The 2010 London Stroke Model dealt with the complete stroke pathway including from 999 call to Hyperacute (HASU) and Stroke Unit (SU) care – where patients receive most of their care.

The London Stroke Consultation document advised the public:

“You will stay in the hyper-acute stroke unit for the first 72 hours, or until you are stable. You will then be transferred to a dedicated local stroke unit in the same hospital or closer to your home where you will receive continued specialist treatment and intensive rehabilitation. CARE IN A LOCAL STROKE UNIT WILL SIGNIFICANTLY IMPROVE YOUR CHANCES OF RECOVERING FROM A STROKE.”

This quote above from the London Consultation confirms the IMPORTANCE OF THE REMAINING 22 STROKE UNITS in London which provide both specialist treatment (some including thrombolysis) and intensive rehabilitation. They are known as non-routinely admitting stroke units in the Royal College of Physicians Sentinel SSNAP AUDIT.

[TOPIC 2]

UNIVERSITY OF EXETER

UNIVERSITY OF EXETER ADVISES THAT EFFICIENT TRANSFERS TO LOCAL STROKE UNITS WILL BE NEEDED.

As stated in the Research documents which were commissioned for the NI Stroke Consultation 2019, the research concentrated only on proposed Hyperacute stroke units and the Thrombectomy Unit in the Royal Victoria, Belfast with the understanding that EXISTING ACUTE STROKE UNITS WOULD CONTINUE TO EXIST.

The University of Exeter Research**** (p31) states:

“We assume that patients are taken to their closest stroke unit first”.

>This information is vitally important as statements in the research do not support the closing of existing Stroke units in Daisy Hill in Newry or Causeway in Coleraine.

In fact the research actually supports the important role of transfers to local stroke units. The research paper (University of Exeter p38)states:

“NI only focuses on the Hyper Acute Stroke Unit phase of stroke care and does not extend to organisation of ongoing step-down care in local stroke units, or after discharge home. We have also not modelled bed use in a reconfigured system; though IT IS LIKELY THAT EFFICIENT TRANSFERS BACK TO LOCAL STROKE UNITS WILL BE REQUIRED to prevent overload in the thrombectomy centre (and possibly the other local HASUs).

Consultant Doctor examining notes

IN CONCLUSION

The NI Reshaping Stroke Care consultation document does not fully follow the research evidence referred to and the Questionnaire provided has biased Options which completely excludes existing Acute stroke units in Daisy Hill Hospital, Newry City and Causeway Hospital, Coleraine.

If this goes ahead unchallenged – Newry Mourne and Down Council – the 3rd highest Local Government District in NI with a population of 179,000 people (with 105,300 residents in rural areas) will be left with no immediate access to a designated specialist stroke unit (either Hyperacute or Acute Stroke Unit) vital for saving lives.

Stroke patients will be denied immediate access to this 999 crucially time dependant Emergency stroke service including timely access to the existing Daisy Hill, Newry City, specialist Acute Stroke /Rehabilitation Unit as a ward of first admission – a key recommendation of the Royal College of Physicians.

Daisy Hill Acute Hospital specialist stroke unit has been in existence since pre 2002 and already has saved thousands of lives, thanks to its entire specialist frontline staff.

It is up to us and our representatives to keep it there.

We have a right to continue to challenge, at every opportunity, these vital healthcare decisions.

ACTION NEEDED

Both of these issues must be rectified with immediate effect.

Please write to all your representatives, and to the Department of Health to sort this out before an unjust decision on the entire future of stroke units is made in Northern Ireland.

Background Information Sources

*Department of Health NI (2019) Reshaping Stroke Care – Saving Lives, Reducing Disability. Consultation 2019 – see p25 for partial London Centralisation quote.
**Department of Health NI (2016) Systems, Not Structures – Changing Health and Social Care – Expert Panel Report (Bengoa Report) Page 72 for partial London Centralisation quote.
***Royal College of Physicians Sentinel Audit RCP SSNAP Audit 2018 – List of Hyper-acute Stroke Units and Stroke units in London

There are still 30 STROKE UNITS IN LONDON: 8 of these are called Hyperacute Stroke Units (HASUs and SUs).

8 HASUs in London :

Queens Hospital Romford HASU / Royal London Hospital HASU / Charing Cross Hospital HASU / Kings College Hospital HASU / Princess Royal University Hospital HASU / Northwick Park Hospital HASU / St George’s Hospital HASU / University College Hospital HASU /

22 Stroke Units in London: 8 of these are attached to Hyperacute Stroke Units.

[Queens Hospital Romford SU] / Newham General Hospital /Whipps Cross University Hospital /
[Royal London Hospital SU] /Chelsea & Westminster Hospital /West Middlesex University Hospital /
Croydon University Hospital / St. Helier Hospital / St Thomas Hospital / Hillingdon Hospital /
Homerton University Hospital / [Charing Cross Hospital SU], Nine South Ward /[Princess Royal University Hospital SU] / [Kings College Hospital SU]/Kingston Hospital /University Hospital Lewisham /[Northwick Park Hospital SU] /North Middlesex University Hospital SU / Barnett General Hospital /
Royal Free Hospital / [St George’s Hospital SU] / [University College Hospital SU] /

****University of Exeter stroke modelling. Dr. Michael Allen, PhD et al. ‘Northern Ireland hyper-acute stroke care modelling: Maximising sustainability of services and clinical benefit from thrombolysis and thrombectomy.’ (p31, p38)
Link: https://www.health-ni.gov.uk/…/he…/rscs-stroke-modelling.pdf

You can follow the Daisy Hill Acute Hospital campaign also by visiting and liking our Facebook page at https://www.facebook.com/daisyhillforlife/ – Thank you.

© Daisy Hill for Life on Facebook and http://www.savedaisyhillhospital.com, 2015 – 2021. We welcome sharing of excerpts & links, provided that full and clear credit is given to http://www.savedaisyhillhospital.com and Daisy Hill for Life with appropriate and specific direction to the original content. Thank-you!

05.05.19

by Admin 4

NI Stroke Consultation 2019 – Overview

The NI Stroke Services Consultation, Reshaping Stroke Care 2019 aims to create Hyperacute stroke units attached to acute stroke units, while cutting existing stroke units “to as few as sites as possible” to consolidate staff.

This is a consultation like no other, where the Department of Health is inviting people all over Northern Ireland to decide which stroke units will be kept or closed.

If all acute stroke units in Northern Ireland had an equal chance – this would be fair consultation – but they do not.

Some entire Councils have been omitted completely. (E.g. Newry, Mourne & Down locality, and its population of 179,000 people).

A Clear vision for Daisy Hill Acute Hospital - Newry _Daisy Hill for Life

SIX OPTIONS WHICH EXCLUDE ENTIRE POPULATIONS

There are Six Options in the Questionnaire of preferred hospital sites to choose for Hyperacute/Acute Stroke Units in Northern Ireland.

In this NI Stroke Consultation the existing acute stroke units in Daisy Hill, Newry and Causeway in Coleraine are excluded and do not even get a chance to be selected, because they do not appear anywhere in the Six Options.

These excluded populations are not even given the Option to voice their discontent with being left out – as the Options Question does not have a neutral or ‘Disagree’ or ‘None of the above’ Option.

At the other end of the spectrum, appearing six times, in each available Option are the stroke units in Altnagelvin, Craigavon and Royal Victoria Hospitals. Their continuation has been pre-determined and recruitment for their foretold Hyperacute stroke Units may have already started.

Redress the unbalanced NI Stroke Consultation 2019 - additional Options needed to include the Excluded populations.

WE PRE PAY FOR EMERGENCY SERVICES INCLUDING STROKE & HEART

Hospital services are paid for with public money –general taxation, national insurance contributions and rates (including business rates).

All adults in Northern Ireland prepay for their life saving emergency care and hospitals, but this consultation downgrades Stroke from a time dependant Emergency service (which includes immediate vital CT scanning to confirm if patients are eligible for Thrombectomy and for Thrombolysis.

The NI Stroke Consultation 2019 has stated various research to justify the choices that have been made, determining which hospitals will keep or lose their acute stroke units in Northern Ireland – but the very supporting research referred to, does not fully back up these configurations.

These research Topics are looked at in more detail in the next article: https://savedaisyhillhospital.com/2019/05/05/ni-consultation-document-does-not-fully-follow-the-research-evidence-referred-to/

We have a right to continue to challenge, at every opportunity, these vital healthcare decisions

You can follow the Daisy Hill Acute Hospital campaign also by visiting and liking our Facebook page at https://www.facebook.com/daisyhillforlife/ – Thank you.

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Enter your email address to subscribe to this blog and receive notifications of new posts by email.

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© Daisy Hill for Life on Facebook and http://www.savedaisyhillhospital.com, 2015 – 2023. We welcome sharing of excerpts & links, provided that full and clear credit is given to http://www.savedaisyhillhospital.com and Daisy Hill for Life with appropriate and specific direction to the original content. Thank-you!

04.29.19

by Admin 4

STROKE CONSULTATION (NI) 2019: Questionnaire Bias and Stroke Options that don’t fully reflect Research given

Intro and Recap

The NI Stroke Services Consultation 2019 aims to create Hyperacute stroke units attached to acute stroke units, while cutting existing stroke units “to as few as sites as possible” to consolidate staff.

This is a consultation like no other, where the Department of Health is inviting people all over Northern Ireland to decide which stroke units will be kept or closed. If all acute stroke units in Northern Ireland had an equal chance – this would be fair consultation – but they do not.

Some entire Councils have been omitted completely. (E.g. Newry, Mourne & Down locality, and its population of 179,000 people).

A Clear vision for Daisy Hill Acute Hospital - Newry _Daisy Hill for Life

There are Six Options in the Questionnaire of preferred hospital sites to choose for Hyperacute/Acute Stroke Units in Northern Ireland.

Redress the unbalanced NI Stroke Consultation 2019 - additional Options needed to include the Excluded populations.

WE PRE PAY FOR EMERGENCY SERVICES INCLUDING STROKE & HEART

Hospital services are paid for with public money –general taxation, national insurance contributions and rates (including business rates).

It divides our society into the have (emergency stroke care) or have not.

NI CONSULTATION DOCUMENT DOES NOT FULLY FOLLOW THE RESEARCH EVIDENCE REFERRED TO

books-408220_1920Image by Jens P. Raak PIXABAY

[TOPIC 1]:

RECONFIGURATION OF STROKE SERVICES IN LONDON

Bengoa and the NI Department of Health Reshaping Stroke Services 2019 have referred to the London Stroke (Model) as a good example to follow in Northern Ireland.

THIS IS NOT WHAT HAPPENED.

FACT: FOLLOWING RECONFIGURATION IN LONDON, 30 STROKE UNITS REMAINED and 8 OF THESE ARE HYPERACUTE STROKE UNITS (HASUs).

The fact is – that AS WELL as these 8 HASUs (Hyperacute SUs)- 22 stroke units ALSO remained and to this day provide continued specialist treatment and intensive rehabilitation. (8 of these are attached to the HASUs) Confirmation of this can be seen in the latest Royal College of Physicians Sentinel Audit. (see Background Information Source 3*** ).

LOCAL STROKE UNITS ARE CRUCIAL IN THE STROKE PATHWAY

HyperAcute Stroke Unit for Daisy Hill -Newry and Mourne/South Armagh Area Hospital Reshaping Stroke Care Consultation 2019

The 2010 London Stroke Model dealt with the complete stroke pathway including from 999 call to Hyperacute (HASU) and Stroke Unit (SU) care – where patients receive most of their care.

The London Stroke Consultation document advised the public:

“You will stay in the hyper-acute stroke unit for the first 72 hours, or until you are stable. You will then be transferred to a dedicated local stroke unit in the same hospital or closer to your home where you will receive continued specialist treatment and intensive rehabilitation. CARE IN A LOCAL STROKE UNIT WILL SIGNIFICANTLY IMPROVE YOUR CHANCES OF RECOVERING FROM A STROKE.”

[TOPIC 2]

UNIVERSITY OF EXETER

UNIVERSITY OF EXETER ADVISES THAT EFFICIENT TRANSFERS TO LOCAL STROKE UNITS WILL BE NEEDED.

The University of Exeter Research**** (p31) states:

“We assume that patients are taken to their closest stroke unit first”.

>This information is vitally important as statements in the research do not support the closing of existing Stroke units in Daisy Hill in Newry or Causeway in Coleraine.

In fact the research actually supports the important role of transfers to local stroke units. The research paper (University of Exeter p38)states:

“NI only focuses on the Hyper Acute Stroke Unit phase of stroke care and does not extend to organisation of ongoing step-down care in local stroke units, or after discharge home. We have also not modelled bed use in a reconfigured system; though IT IS LIKELY THAT EFFICIENT TRANSFERS BACK TO LOCAL STROKE UNITS WILL BE REQUIRED to prevent overload in the thrombectomy centre (and possibly the other local HASUs).

Consultant Doctor examining notes

IN CONCLUSION

Daisy Hill Acute Hospital specialist stroke unit has been in existence since pre 2002 and already has saved thousands of lives, thanks to its entire specialist frontline staff.

It is up to us and our representatives to keep it there.

We have a right to continue to challenge, at every opportunity, these vital healthcare decisions.

ACTION NEEDED

Both of these issues must be rectified with immediate effect.

Please write to all your representatives, and to the Department of Health to sort this out before an unjust decision on the entire future of stroke units is made in Northern Ireland.

Background Information Sources

*Department of Health NI (2019) Reshaping Stroke Care – Saving Lives, Reducing Disability. Consultation 2019 – see p25 for partial London Centralisation quote.
**Department of Health NI (2016) Systems, Not Structures – Changing Health and Social Care – Expert Panel Report (Bengoa Report) Page 72 for partial London Centralisation quote.
***Royal College of Physicians Sentinel Audit RCP SSNAP Audit 2018 – List of Hyper-acute Stroke Units and Stroke units in London

There are still 30 STROKE UNITS IN LONDON: 8 of these are called Hyperacute Stroke Units (HASUs and SUs).

8 HASUs in London :

22 Stroke Units in London: 8 of these are attached to Hyperacute Stroke Units.

****University of Exeter stroke modelling. Dr. Michael Allen, PhD et al. ‘Northern Ireland hyper-acute stroke care modelling: Maximising sustainability of services and clinical benefit from thrombolysis and thrombectomy.’ (p31, p38)
Link: https://www.health-ni.gov.uk/…/he…/rscs-stroke-modelling.pdf

You can follow the Daisy Hill Acute Hospital campaign also by visiting and liking our Facebook page at https://www.facebook.com/daisyhillforlife/ – Thank you.

© Daisy Hill for Life on Facebook and http://www.savedaisyhillhospital.com, 2015 – 2019. We welcome sharing of excerpts & links, provided that full and clear credit is given to http://www.savedaisyhillhospital.com and Daisy Hill for Life with appropriate and specific direction to the original content. Thank-you!

POPULATION HEALTH NEEDS ASSESSMENT VITAL FOR BOTH STROKE SERVICES AND BREAST CANCER SERVICES.

WHY ASSESS NEED?

POPULATION NEEDS ASSESSMENT DATA MUST USE OFFICIAL NISRA STATISTICS

DEPT. OF HEALTH N.I. ARE FAILING TO ADDRESS THE HEALTH NEEDS OF NEWRY & MOURNE POPULATION

Latest official population stats for the 5 LGDs in the operational area of the Southern Trust

PHASE OF WORK REQUESTED:

CALL FOR THE DOH, PHA, HSCB and COMMISSIONERS TO:

WHY THE STROKE OPTIONS NEED TO BE RE-WRITTEN

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DIFFERENT WAYS TO RESPOND

IMPORTANT INFORMATION

THIS ACTION IS TO FURTHER SUPPLEMENT THE EXCELLENT WORK ALREADY DONE BY SUPPORT OUR STROKE SERVICES COMMITTEE

STILL NEED CONVINCING?

WE CAN DO THIS TOGETHER !

WHY IS THE FIRST HOUR TERMED ‘GOLDEN’?

CLINICAL EVIDENCE SUPPORTING IMPORTANCE OF ‘GOLDEN HOUR’

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LONDON DEALT WITH THE COMPLETE STROKE PATHWAY

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[TOPIC 1]:

LOCAL STROKE UNITS ARE CRUCIAL IN THE STROKE PATHWAY

[TOPIC 2]

SIX OPTIONS WHICH EXCLUDE ENTIRE POPULATIONS

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NI CONSULTATION DOCUMENT DOES NOT FULLY FOLLOW THE RESEARCH EVIDENCE REFERRED TO

[TOPIC 1]:

LOCAL STROKE UNITS ARE CRUCIAL IN THE STROKE PATHWAY

[TOPIC 2]

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