Tag Archives: London Stroke Model

06.11.19
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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.

Act FAST Stroke - HyperAcute Stroke Unit for Newry 2019

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.

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

© Daisy Hill for Life on Facebook and http://www.savedaisyhillhospital.com, 2015 – 2021.

05.29.19
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NI Stroke Consultation 2019: ‘TIME IS BRAIN’ – URBAN and RURAL

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.

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
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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.

Act FAST Stroke - HyperAcute Stroke Unit for Newry 2019
Image by VSRao from Pixabay

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] /

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.

© 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!

05.05.19
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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.

Support Daisy Hill Acute Hospital in the Reshaping stroke services Department of Health NI 2017 consultation. stroke services. Newry and Mourne is the right place for a hyperacute stroke unit.

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] /

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

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.

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

© 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

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.

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.

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

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 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.”

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.

Support Daisy Hill Acute Hospital in the Reshaping stroke services Department of Health NI 2017 consultation. stroke services. Newry and Mourne is the right place for a hyperacute stroke unit.

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] /

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!

01.08.17
by

Bengoa Report uses the London Stroke Model – does it give N.Ireland the full picture?

The Bengoa Report uses the London Stroke Model as an example of international good practice, but by only mentioning the 8 Hyper acute stroke units and ignoring the rest of the local stroke services network in London – is N.Ireland getting the full picture?

The diagram shows there are 31 Stroke Units in London including 8 ‘Hyper acute’ stroke units (HASUs) following reconfiguration of stroke services.

The diagram shows there are 31 Stroke Units in London including 8 ‘Hyper acute’ stroke units (HASUs) following reconfiguration of stroke services.

The International Level Case Study in the Bengoa Panel Report (pg 72) would seem to imply that all the 30 stroke units in London were centralised to only 8 hyper acute stroke units.  As the diagram shows- there is a network of 31 Stroke Units remaining in London including 8 ‘Hyper acute’ stroke units (HASUs) following reconfiguration of stroke services.

It was never intended that ‘Hyper Acute’ Stroke Units in London should work in isolation from the other 23 existing dedicated local stroke units providing stroke services. The Sentinel Stroke National Audit Programme for 2016 shows there is a total of 628 stroke beds in all 31 stroke units in London.

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.

Confirmation the Southern Trust have proposed the creation of a’ hyper-acute’ stroke unit can be seen in the following extract from a 27th October 2014 press statement:

“The Trust’s proposals are:

  1. The modernisation of in-patient acute and rehabilitation Stroke Services, which are currently provided at Lurgan, Loane House (South Tyrone Hospital) Daisy Hill and Craigavon Area Hospitals. The Trust is proposing the development of a ‘hyper-acute’ stroke unit at Craigavon Area Hospital…..”*.

The Southern Trust’s proposal to have only one ‘Hyper Acute’ Stroke Unit in Craigavon locality with no network of dedicated local stroke units in Newry or Dungannon is in COMPLETE CONTRAST to the London Stroke Model.

If the London Stroke Model is followed correctly by the Southern Trust for safe stroke care –TWO ‘hyper acute’ stroke units – one in Newry City’s Daisy Hill Acute Hospital, and one in Craigavon Hospital – attached to the already existing stroke units are needed. Only this proposal would give ALL THE POPULATION of the Southern Trust the same EQUALITY OF ACCESS to a network of stroke services (both ‘hyper acute’ and dedicated local acute rehabilitation stroke services) as there exists in London.

The criteria evolving from this Bengoa Report is the subject being addressed by the Department of Health in a series of public meetings around Northern Ireland before the current health Consultation on the criteria closes on 20th January 2017.  The meeting in Newry will take place on Monday 16th January in the Newry Conferencing and Banqueting Centre, 39-41 The Mall Newry from 7 -9 pm.

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