UPDATED STROKE DELIVERY

Transcription

1 UPDATED STROKE DELIVERY PLAN MARCH 2015 FINAL AUTHOR: L RICHARDSON REVISION DATE: MARCH 2016

2 1. INTRODUCTION The first Cwm Taf Stroke Delivery Plan was published in 2013 in response to the Welsh Government s Together for Health Stroke Delivery Plan (2012). It was updated for 2014/16 and this is a further update for 2015/16. This updated Cwm Taf Stroke Delivery Plan notes the successful progress made with implementation to date, and sets out our priorities for action in the year 2015/ BACKGROUND AND CONTEXT Together for Health Stroke Delivery Plan was published by Welsh Government in December 2012 and provides a framework for action by Local Health Boards and NHS Trusts working together with their partners. It sets out the Welsh Government s expectations of the NHS in Wales to tackle stroke in people of all ages, wherever they live in Wales and whatever their circumstances. The Plan is designed to enable the NHS to meet the needs of people at risk of a stroke or affected by a stroke. It sets out: The population outcomes we expect. The outcomes from treatment and support to return to health and independence we expect. How success will be measured and the level of performance we expect. Themes for action by the NHS, together with its partners. What do we want to achieve in Wales? The Delivery Plan sets out action to improve outcomes in the following key areas between now and 2016: 1. Preventing stroke - People live a healthy lifestyle, make healthy choices and minimise risk of stroke. 2. Detecting stroke quickly - Stroke is detected quickly where it does occur or recur. 3. Delivering fast, effective care - People receive fast, effective treatment and care so they have the best chance of living a long and healthy life. 4. Supporting life after stroke - People are placed at the centre of stroke care with their individual needs identified and met so they feel well supported and informed, able to manage the effects of stroke. 5. Improving Information - patients and carers have timely access to information about their condition, treatment, care and support available; and stroke services manage information effectively to monitor performance and inform service change. 6. Targeting research - foster a strong culture of research to support ongoing improvements in patient outcomes. 2

3 3. CWM TAF HEALTH BOARD - PROFILE Population Profile Cwm Taf Health Board provides services to the 289,400 residents of Merthyr Tydfil & Rhondda Cynon Taff. Almost 81% of the population live in Rhondda Cynon Taf Local Authority and the remaining 19% in the boundaries of Merthyr Tydfil. The Health Board s catchment population increases to 330,000 when including patient flow from the Upper Rhymney Valley, South Powys, North Cardiff and the Western Vale. The circulatory disease (including stroke) European age-standardised mortality rate for Cwm Taf Health Board is higher than the Wales average. The rate for Merthyr Tydfil is higher than that for Rhondda Cynon Taff but both are among the highest in Wales. Around 3% of the adult population of Merthyr Tydfil and Rhondda Cynon Taff report ever having had a stroke. The areas with the lowest prevalences are below 2%. About 500 people a year have a stroke in Cwm Taf, and in light of the ageing population, and without any further population and individual action to address risk factors, this number is set to rise significantly annually. Health risk behaviour indicators in Cwm Taf are generally worse than, or at best, similar to the Wales average. The high prevalence of these risk factors in the Cwm Taf area, according to the Welsh Health Survey 2011, are highlighted below. They have obvious implications for the high prevalence of these common conditions relevant to vascular surgery. Smoking - The proportion of the population aged 16 and over who smoke, although improving, remains higher at 26% than the Welsh average of 23%. In Cwm Taf as a whole over one in four people smoke, contributing to around 630 deaths per year. Substance misuse: alcohol 45% of the Cwm Taf population drinks more alcohol than recommended limits. Nearly three out of ten people binge drink at least one day a week. Hospital admission rates due to alcohol are higher in Cwm Taf than for Wales as a whole. Fruit and vegetable consumption - Overall, a minority of less than a third of people eat the recommended amount of fruit and vegetables in Cwm Taf. Overweight and obesity - around 63% of adults in Cwm Taf are either overweight or obese, with 26% classed as obese. Improving diet and physical activity are essential to reducing the high proportions of people who are overweight or obese. In terms of clinical risk factors, Cwm Taf also compares unfavourably to the rest of Wales : Hypertension (high blood pressure) this is one of the most significant risk factors for stroke. Within Cwm Taf, the percentage of adults who report being treated for high blood pressure, at 28%, is significantly higher than the average for Wales. 3

4 Atrial fibrillation (irregular pulse) is being increasingly recognised as a key risk factor for stroke and improving access to AF screening and management will be a key feature in the future; High LDL Cholesterol can be a risk factor for cardiovascular disease, particularly when combined with other clinical and lifestyle risk factors. Although high cholesterol is sometimes genetic or linked to other clinical conditions, it can usually be modified through diet and healthy lifestyle choices, and/or through medication, usually a statin; Diabetes - can lead to many different health problems, including stroke, because large amounts of glucose can damage the blood vessels, nerves and other organs. There is a higher prevalence of diabetes in the Cwm Taf areas compared to the Wales average. Organisational Overview Stroke prevention services are provided within primary care, and acute and rehabilitation stroke services are provided by Cwm Taf University Health Board. We work in close partnership with the Stroke Association who support stroke survivors and carers, and with Rhondda Cynon Taff and Merthyr Tydfil local authorities who provide support for those with stroke related disability. A major programme of service redesign has been underway with our stroke services in Cwm Taf: acute stroke services which are currently provided at the Royal Glamorgan Hospital in Llantrisant, and at Prince Charles Hospital in Merthyr Tydfil are to be centralised at Prince Charles; stroke rehabilitation beds have now been centralised at Ysbyty Cwm Rhondda. This has built upon the significant improvements to stroke services made over recent years including the appointment and development of specialist stroke staff, provision of 24/7 thrombolysis services and improved treatment rates, provision of TIA assessment clinics and the development of an Early Supported Discharge service. All these developments have helped to improve the UHB s performance against the stroke Intelligent Targets and Royal College of Physicians national audits, thereby leading to improved patient outcomes. 4. PROGRESS MADE AGAINST THE STROKE DELIVERY PLAN 2014/15 Our key achievements against the local Stroke Delivery Plan during 2014/15 have been: Preventing stroke Inverse Care Law as part of the Inverse Care Law programme, a structured approach to cardiovascular disease risk identification and management is being piloted in practices serving our most deprived communities (January March 2015) which will be evaluated with a view to rolling out across Cwm Taf in a phased approach from April The Smoke Free Cwm Taf programme continues with its aim to reduce smoking prevalence to 16% by Training continues to be provided to frontline health and community workers to help the motivate smokers to quit, and to refer them to smoking cessation services. 4

5 Community Pharmacies and the Stroke Association have run a national Lower Your Risk of Stroke campaign which has included awareness raising events in the Cwm Taf area. Detecting stroke quickly The FAST campaign has been promoted locally by the Stroke Association and stroke teams at local public events, such as the Big Bite in Pontypridd, and Merthyr Tydfil s Global Village; Handover times of stroke patients from paramedics to A&E have remained at a sustained time of under 10 minutes on both sites during 2014/15. Delivering fast, effective treatment and care Our performance against the Royal College of Physicians Sentinel Stroke National Audit Programme (SSNAP) has improved from a level E to a level D on both sites. Cwm Taf participated in a pilot of Unscheduled Care performance measures for stroke from time of 999 call to admission to acute stroke unit. Stroke Thrombolysis rates for 2014/15 to date are 8% at PCH and 11% at RGH. Prompt access to CT scanning has improved with the phased introduction of a radiographer shift system providing 24/7 CT head cover on both sites. The redesign of stroke services has progressed, with stroke rehabilitation now centralised on one site, and plans in place to centralise hyper-acute stroke services at Prince Charles Hospital. This redesign is driven by continuous improvement to meet clinical and quality standards. In November 2014 a Multidisciplinary, Stroke Early Supported Discharge (ESD) service was established using ICF funding as proof of concept. This team is already demonstrating good outcomes in terms of clinical outcomes, responsiveness of service, reducing length of stay and patient/carer satisfaction. Supporting life after stroke A Living Well with Stroke programme is being offered to stroke survivors and carers to help them adapt to life after their stroke and to promote self management. The Community Stroke CNS s are now undertaking 6 weekly and 6 monthly reviews of stroke patients and recording these on SSNAP. The Stroke Association have continued to provide support to stroke survivors in the area and are reviewing their service model in conjunction with service users and the stroke team. Improving Information A Stroke Patient Passport has been piloted and launched, providing stroke survivors with accessible and tailored information at each stage of their stroke pathway the acute stage, rehabilitation stage and through to living with stroke. The Passport won a Mediwales Innovation Award in

6 A stroke webpage - provides information on stroke, prevention, symptoms, the FAST campaign, local stroke services, our Delivery Plan and links to key documents and associated organisations. Feedback from stroke patients and carers is obtained and regularly analysed through patient questionnaires issued on discharge. Performance information is analysed and reported on a monthly basis. Targeting Research & Development The UHB is participating in 3 research trials (RESTART, FOCUS, and CACTUS) and has signed up to others to commence in the coming year. The in-house Stroke Awareness programmes have continued to be delivered and evaluate well. A competency matrix has been developed identifying the competency requirements for delivering stroke care, against which staff training and development needs can be identified. This will be particularly helpful in supporting the implementation of the proposed new service model. An electronic staff training record has been developed enabling monitoring of staff training activity. 5. SUMMARY OF THE UPDATED PLAN PRIORITIES for 2015/16 The updated Cwm Taf Local Stroke Delivery Plan includes refreshed actions against each of the 2016 milestones within the Welsh Government s Stroke Plan. Preventing stroke The priorities for are: To continue to work with partners to implement key actions in the priority areas of: o Smoking o Obesity o Physical activity o Alcohol To evaluate the cardiovascular risk stratification pilot and roll it out across Cwm Taf, as part of the Inverse Care Law programme. To promote active management of the key cardiovascular risk factors in primary care, particularly hypertension, high cholesterol, Atrial Fibrillation and diabetes. 6

7 Detecting stroke quickly The priorities for are: To continue to raise public awareness through press articles and participation at public events of the signs and symptoms of potential stroke and the need to treat it as a medical emergency. To continue to work with the Welsh Ambulance Service and A&E staff in ensuring efficient and effective communication over / handover of suspected stroke patients. To raise awareness of TIA as a warning sign of potential stroke, and ensure timely referral and assessment services are in place. Delivering fast, effective treatment and care The priorities for are: To reduce door to needle time for stroke thrombolysis working towards the target of 30 minutes. To increase the thrombolysis rate to ensure as many eligible patients as possible benefit from the treatment. To meet the target for stroke patients admitted to the acute stroke ward within 4 hours. To provide improved stroke specialist medical, nursing and therapy services across the week and weekends. To implement and evaluate the redesign of stroke services by centralising hyper-acute stroke services at PCH. Supporting life after stroke The priorities for are: To maintain and evaluate the stroke Early Supported Discharge service To explore options for developing a community stroke team to provide episodes of treatment to stroke patients living within the community, and to work with partner agencies, regarding the provision of services for moderate to higher dependency stroke patients being discharged from hospital and living within the community. To develop a strategy for improving access to and co-ordination of Life After Stroke services. Supporting the Stroke Association with their transitional redesign of local services, to align with the Life after Stroke model. Secondary prevention of stroke and TIA, through advice and referral to support services. Improving Information The priorities for are: To embed the Stroke Patient Passport into practice. 7

8 To increase participation in patient surveys to inform service improvements, to be summarised in an annual Patient Experience report. To improve the efficiency and timeliness of data entry onto the SSNAP database and other audits, enabling effective performance monitoring and reporting. Targeting Research & Development The priorities for are: To maximise opportunities for involvement in other stroke related research. To address the training and development needs of stroke staff to deliver the new stroke model. To develop new approaches to Environmental Enrichment in the acute and rehabilitation setting. 6. PERFORMANCE MEASURES / MANAGEMENT The Welsh Government s Delivery Plan for Stroke (2012) contained an outline description of the national metrics that LHBs and other organisations will publish: Outcome indicators which will demonstrate success in delivering positive changes in outcome for the population of Wales. National performance measures which will quantify an organisation s progress with implementing key areas of the delivery plan. Progress with these outcome indicators form the basis of each LHB s annual report on stroke. They are calculated on behalf of the NHS annually at both a national and LHB population level. LHBs produced their first annual report in September 2013 and report annually thereafter. In place of the quarterly progress reports originally required by LHBs, Welsh Government has now stated its expectation that stroke services are discussed at least four times a year at Board. During 2014/15, acute stroke performance was discussed as part of the Performance Dashboard Report at every Cwm Taf UHB Board meeting. In addition, the updated Stroke Delivery Plan was discussed at and endorsed by Board in May 2014, and the 2014 Stroke Annual Report was discussed at and endorsed by Board in January

9 Reducing smoking prevalence Increasing physical activity Halting the rise in obesity Reducing alcohol consumption ACTION PLAN Preventing stroke 1. People are aware 1.1 Implement key actions Increased take up of Poor referral rates to Figures reported Cwm of and are supported within the Smoke Free Cwm training and services Stop Smoking Wales annually via Welsh Public in minimising their Taf Strategic Action including: Health Survey, Health risk of stroke through Provision and promotion of Reduction of 1 2% Multiple usually in September Team healthy lifestyle smoking cessation services every year in adults actions/interventions choices, in particular: Rollout of Brief Intervention who smoke from being delivered by a training programme to a current baseline range of partners. range of health board, local authority and community The parameters staff Smoke Free Homes 1.2 Implement the Healthy Weight Healthy Valleys Strategy, including implementation of the actions identified in the Cwm Taf Obesity Pathway, LAPA and leisure plans Engagement of targeted communities with Smoke Free Homes pilot project Increase in the % of adults who are physically active from current baseline Prevent any further increase in the % of adults who are obese from the current baseline identified in the stroke delivery plan as performance measures are, in fact, population indicators which are pertinent to more than just stroke risk reduction. These are only likely to change over a medium-long period As above time Figures reported annually via Welsh Health Survey Taf Cwm Taf Public Health Team / APB 9

10 Preventing stroke 1.3 Implementation of the alcohol component of the local Substance Misuse Action Plan including roll out of national Brief Intervention training programme to a range of health board, local authority and community staff Reduction of 1% yearly in the % of adults who report drinking above recommended guidelines, from current baseline 2. People identified at risk of stroke have their clinical risk factors actively managed within primary care Provision of an extended alcohol brief intervention scheme via primary care for adults who consume at unsafe levels 2.1 Risk factors through the Inverse Care Law Programme, evaluate and roll out the cardiovascular risk stratification system. A minimum of 100 additional staff trained in Brief intervention each year. Increased referral to extended Brief Intervention Scheme Prevention of primary and secondary stroke Lack of GP or patient engagement Report on annual basis Cwm Taf Public Health Team / APB Q1 - Evaluate pilot Q2 to 4 roll out to practices across Cwm Taf ST 2.2 AF - participate in national Atrial Fibrillation programme to screen for AF, assess and manage risk factors Effective identification and management of AF patients thereby reducing their risk of stroke Lack of engagement In line with national programme Provide an update in Q2 JR / RID 10

11 Detecting stroke quickly 3. Raise awareness 3.1 Public raise public Improved public Public non Report activity Q1 Stroke of the signs and awareness throughout the year awareness resulting responsive and Q3 Association symptoms of potential through regular press articles in reduced delays in (RE) stroke and the need and promotion at public events contacting health to treat it as a services following MGE medical emergency onset of symptoms. 3.2 Primary Care contractors attend a GP CPD event and other appropriate groups to raise awareness amongst GPs, optometrists and other primary care contractors of stroke risk factors, signs and symptoms and the appropriate referral pathways to secondary care stroke/tia services 3.3 A&E arrange twice yearly awareness sessions for A&E staff on the acute stroke pathway, including preparedness to receive suspected stroke patients ASHICE d by ambulance clinicians 3.4 CT ensure 24/7 access to CT scanning and aim to scan all stroke patients within 4 hours regardless of their potential for thrombolysis, and Increase in and Improved timeliness of referrals to stroke service and TIA clinic Maintaining A&E handover times for stroke patients of < 10 minutes. Consistently prompt access to CT scanning, meeting the 12 hour target Primary contractors responsive Care non By end of Q3 High staff turnover Q2 (new August intake) and Q4 Availability of CT trained radiographers 24/7 and reliance on one CT scanner at PCH Monthly reporting RID / JR RID / JW CK 11

12 Detecting stroke quickly achieve the 12 hour target for all. 4. Ensure patients with suspected TIA are identified, referred and assessed in a timely way 4.1 TIA monitor access to TIA clinics Timely access to TIA assessment and treatment Reliant on acute physicians on weekends Establish baseline by end Q1 Audit again in Q4 RID/JW Delivering fast, effective treatment and care 5. Improve access to and effectiveness of stroke thrombolysis Reduced average door to needle times Continuous review and improvement. RID / JW 6. Improve timeliness and equity of access to acute stroke care, in accordance with RCP guidelines and 5.1 Door to Needle pathway streamline the stroke thrombolysis pathway to achieve a door to needle time of under 30 minutes. 5.2 Thrombolysis effectiveness review patient outcomes for those who are thrombolysed, and reasons for not thrombolysing 6.1 access to stroke unit protect the ring-fenced stroke beds and streamline the pathway to enable admission within the new target of 4 Increased thrombolysis rates Improved patient outcomes Reassurance that thrombolysis is achieving the desired outcomes and is being offered appropriately Stroke patients receive care in line with clinical guidelines / care bundles Failure to engage A&E and CT Consultants continued commitment to rota Home connection issues Consultants time for audit and review Stroke bed availability Achieve the 50% target by September 2015 Review twice yearly, in Q1 and Q3 Continuous review and improvement. Achieve 95% target by September 2015 RID / JW RH / NC 12

13 Delivering fast, effective treatment and care care indicators hours Achievement of new 6.2 stroke specialists ensure improved stroke specialist medical, nursing and therapy cover to enable care to be provided in accordance with clinical guidelines 6.3 weekend services explore ways to improve services at weekends such as use of acute physicians and support workers care bundle 3 Improved outcomes for patients Lack of cover for single handed specialists / funding Continuous review and improvement. Achieve 95% compliance with new bundle 3 by Sept 2015 Funding By end Q1 undertake review of current weekend services develop action in place to implement in Q2 and 3. RID/RH/Therapy leads RID/RH/Therapy leads 7. Provide access to carotid surgery in line with clinical guidelines 8. Ensure stroke patients who require palliative care receive this in accordance with the Last Days of Life ICP 7.1 Review outcomes of VSQIP audits and ensure prompt referrals to vascular surgeons 8.1 Audit compliance with the Last Days of Life ICP for stroke palliative care patients Continued compliance with clinical guidelines sustained or improved performance in Audit Compliance with ICP Families satisfaction with care received Vascular Surgeon availability Q1 identify any actions required Q2 undertake audit and identify improvement actions RID MB / RID / JW 9. Implement and evaluate service implement the final element of stroke service Centralised hyperacute stroke service. Patient flow and capacity implications April 2015 NC and Stroke Redesign 13

14 Delivering fast, effective treatment and care redesign proposals redesign ie the centralisation Improved Project Team of hyper-acute/acute services compliance with at PCH clinical quality standards 9.2 monitor and evaluate Clarity around Access to Ongoing monitoring NC / MB the impact of stroke services outcomes achieved information from April and formal redesign and any issues to evaluation end address September 2015 Supporting life after stroke 10. Develop 10.1 Evaluate the impact of Clarity around Sustained funding May 2015 KH/JI /DD community based the Early Supported Discharge effectiveness of the rehabilitation services Service ESD service and any issues to address explore options for developing a community stroke team Reduced length of acute stay Improved outcomes patient Funding and staffing availability December Develop Life After Stroke services 11.1 Develop and implement a Strategy for improving access to and co-ordination of Life After Stroke services Patients and carers feel adequately supported post stroke. Increased % of patients reviewed 6 Resource availability Q1 and 2 develop a strategy for improving Life after Stroke services Q4 Implement across Cwm Taf KH 14

15 Supporting life after stroke weeks, 6 months and annually 12. Support the provision of Stroke Association services 12.1 SA service model support the Stroke Association in their phased implementation of their new service model. Enhanced Stroke Association support for stroke survivors and carers in Cwm Taf. Engaging survivors stroke Delivering desired model within resource envelope Q1 and 2 engage with stroke survivors / service users over proposed new model Q3 and 4 phased implementation of new model RE / MGE 13. Secondary prevention of stroke and TIA, through advice and referral to support services: Provide training opportunities/raise awareness among stroke services staff to ensure appropriate referral to: Smoking cessation Smoking Brief Intervention Community weight management NERS Brief intervention advice for reduction in alcohol consumption. EPP programme Enhanced support to stroke survivors to reduce future risk/improve lifestyle Staff capacity to provide and be released for training Patients willingness to engage Review annually in Q2 ST 15

16 Improving information 14. Improve stroke information provision to patients and carers Patients and carers well informed Appropriateness of KH/JI/RH 15. Encourage feedback from patients and carers to inform service improvements 16. Use stroke performance data for quality assurance and to inform service improvements 14.1 Stroke Passport - ensure all patients are provided with a Stroke Passport giving appropriate information about their condition, treatment plan, secondary prevention and support available, at relevant points along their pathway Patient & Carer Education continue to deliver the Stroke Patient & Carer Education Programme 15.1 Patient Survey Increasing participation in patient surveys to inform service improvements, to be summarised in an annual Patient Experience report 16.1 SSNAP Performance Management improve the efficiency and timeliness of SSNAP data entry and use the results to inform and improve service planning and delivery 16.2 RCP Audits participate in the RCP clinical, organisational and community audits and take action to improve future performance Patients have and use their Stroke Patient Passport Patients and carers well informed and empowered Patient services centred Quality assurance, achievement of standards and targets information, communication methods and timing Patient and carer engagement Response rates Resource availability Data collection and entry Q4 - Review Passport and how well it is embedded in practice Deliver quarterly Review annually Q4 Quarterly Q4 annual Patient Experience Report Monthly reporting In accordance with RCP SSNAP audit timeframes MF JI/RH JI RID/JW RID / JW 16

17 Targeting research and development 17. Foster a strong 17.1 Research - Maximise Participation in Time and funding Review twice yearly RID / JW culture of research to opportunities for involvement in increased number of in Q2 and Q4 support ongoing stroke related research research projects improvements in patient outcomes 18. Continue to Skilled and Ability to release staff JI/KH develop the stroke care skills of the workforce competent workforce Increase the % of for training 18.1 In-house training continue to deliver the Agored accredited in-house training programme, All Wales Train the Trainer programme and Dysphagia training, and promote the online STARS awareness programme Development of Environmental Enrichment in the acute and rehab stroke units, including use of Stroke Association volunteers stroke staff who have completed the training Skilled competent staff and Improved outcomes for patients Ability to release staff for training Q1 establish baseline for stroke ward staff who have completed the training Q3 provide update By March 2016 Review in Q1 and Q3 KH 17

18 QUARTERLY PLAN QUARTER 1 APRIL to JUNE 2015 REPORT PROGRESS AT STROKE DELIVERY GROUP 21 st JULY 2015 Ref Action Lead 2.1 Prevention - Evaluate cardiovascular risk stratification Sara Thomas tool and prepare for roll out across Cwm Taf 3.1 Raise Awareness - Raise public awareness of signs and symptoms of stroke - report quarterly activity Ross Evans for Stroke Association Marie Evans for CTUHB 3.4 CT Ensure prompt access to CT scanning quarterly Chris Kalinka update 4.1 TIA establish baseline re access to TIA clinics 5.1 Door to Needle Pathway review door to needle times for Q1 and progress towards achieving 50% < 30 mins target by Sept Thrombolysis effectiveness - review patient outcomes for thrombolysed patients and reasons for not thrombolysing 6.1 Access to stroke unit - review access to stroke unit times for Q1 and progress towards achieving 95% < 4 hrs target by Sept Stroke Specialists - review compliance with bundle 3 and progress towards achieving 95% compliance by Set Weekend services undertake review of current weekend services and develop action plan to implement in Q2 and Carotid Surgery review VSQIP audit results and identify any actions required to improve performance 9.2 Monitor stroke redesign update on monitoring to date of impact of stroke services redesign Dr Richard Dewar / Rosemarie Hazzard / Therapy leads Dr Richard Dewar / Rosemarie Hazzard / Therapy leads Dr Richard Dewar Neil Cooper / Mark Bowers 10.1 ESD evaluate the impact of the ESD service Kathryn Head 12.1 Stroke Association - update report on engagement with service users over new model 14.2 Patient & Carer Education - update on Patient and Carer Education Programme for the year 18.1 In-house training establish baseline for staff who have completed in-house stroke training 18.2 Enriched Environment review and update on progress with developing an Enriched Environment for stroke patients Ross Evans Dr Malin Falck Janet Ivey Kathryn Head 18

19 QUARTER 2 JULY to SEPTEMBER 2015 REPORT PROGRESS AT STROKE DELIVERY GROUP 17 th NOVEMBER 2015 Ref Action Lead 1 Prevention update on outcomes of the Welsh Health Sara Thomas survey 2.2 AF update on progress with AF screening and monitoring 3.3 A&E awareness update on A&E stroke awareness raising 3.4 CT Ensure prompt access to CT scanning quarterly update 5.1 Door to Needle Pathway review door to needle times performance against 50% < 30 mins target 6.1 Access to stroke unit - review access to stroke unit times performance against 95% < 4 hrs target 6.2 Stroke Specialists - review compliance with bundle 3 95% target 8.1 Last Days of Life ICP undertake audit of compliance for stroke patients 9.2 Evaluate stroke redesign present formal evaluation of impact of stroke services redesign 12.1 Stroke Association - update report implementation of new model 13.1 Secondary prevention update on access to stroke prevention schemes Prof Jonathan Richards and Dr Richard Dewar Chris Kalinka Dr Richard Dewar / Rosemarie Hazzard / Therapy leads Neil Cooper / Mark Bowers Ross Evans Sara Thomas 17.1 Research review participation in research activity NB prepare Stroke Annual Report by 30 th September

20 QUARTER 3 OCTOBER to DECEMBER 2015 REPORT PROGRESS AT STROKE DELIVERY GROUP JANUARY 2016 Ref Action Lead 2.1 Prevention - Update on roll out across Cwm Taf of Sara Thomas cardiovascular risk reduction tool 3.1 Raise Awareness - Raise public awareness of signs and symptoms of stroke - report quarterly activity 3.4 CT Ensure prompt access to CT scanning quarterly update 5.1 Door to Needle Pathway review door to needle times performance against 50% < 30 mins target 5.2 Thrombolysis effectiveness - review patient outcomes for thrombolysed patients and reasons for not thrombolysing 6.1 Access to stroke unit - review access to stroke unit times against 95% < 4 hrs target 6.2 Stroke Specialists - review compliance with bundle 3 95% target 6.3 Weekend services update on implementation of plan to improve access to weekend services 10.2 Community stroke services explore options for developing a community stroke team 11.1 Life After Stroke services- update on development of Strategy for Life After Stroke services 12.1 Stroke Association - update on implementation of new model 18.1 In-house training provide update on in-house stroke training 18.2 Enriched Environment review and update on progress with developing an Enriched Environment for stroke patients Ross Evans for Stroke Association Marie Evans for CTUHB Chris Kalinka Dr Richard Dewar / Rosemarie Hazzard / Therapy leads Dr Richard Dewar / Rosemarie Hazzard / Therapy leads Kathryn Head/ Janet Ivey / Debbie Davies Kathryn Head Ross Evans Janet Ivey Kathryn Head 20

21 QUARTER 4 JANUARY to MARCH 2016 REPORT PROGRESS AT STROKE DELIVERY GROUP MARCH 2016 Ref Action Lead 3.2 Primary Care Awareness update on awareness RID / JR raising with primary care via GP CPD events etc 3.3 A&E awareness update on A&E stroke awareness raising 3.4 CT Ensure prompt access to CT scanning quarterly Chris Kalinka update 4.1 TIA update the audit re access to TIA clinics 5.1 Door to Needle Pathway review door to needle times performance against 50% < 30 mins target 6.1 Access to stroke unit - review access to stroke unit times against 95% < 4 hrs target 6.2 Stroke Specialists - review compliance with bundle 3 95% target Dr Richard Dewar / Rosemarie Hazzard / Therapy leads 11.1 Life After Stroke update on implementation of Kathryn Head Strategy for Life After Stroke 12.1 Stroke Association - update report implementation of new model Ross Evans 14.1 Stroke Patient Passport review the Passport and how well it has been embedded into practice 14.2 Patient & Carer Education - update on Patient and Carer Education Programme Kathryn Head Dr Malin Falck 15.1 Patient Survey present annual patient experience report Janet Ivey 17.1 Research review participation in research activity NB prepare refreshed Stroke Delivery Plan by 31 st March