STROKE MANAGED CLINICAL NETWORK

Transcription

1 NHS GRAMPIAN STROKE MANAGED CLINICAL NETWORK ANNUAL REPORT 1 October 20 to 31 December 2007

2 CONTENTS 1. Forward 2. Highlights this Year 3. Turning Strategy into Action 4. Education and Training 5. Public Involvement 6. Measuring how we are doing 7. Investments 8. Plans for the Coming year Enquiries Website 2

3 1. FORWARD Grampian Stroke Managed Clinical Network (MCN) continues to meaningfully involve patients, carers, staff and partners in promoting improvements for the prevention and treatment of stroke. Better Health, Better Care states that.where appropriate we will also strengthen the traditional model of Managed Clinical Networks so that they provide effective clinical leadership for action to plan and deliver national services against stretching targets. We feel that the Grampian Stroke MCN is well placed to take this on and to help NHS Grampian to deliver the targets which the Scottish Government have set. The past year has enabled us to deliver or make significant progress on the improvements we hoped for last year and this report also highlights what is new this year. The Network continues to work well together to tackle issues and ensure that patients get the best possible service wherever they live in Grampian, however, there is still much more to do. We would again wish to take this opportunity to thank all staff across the MCN for their hard work and goodwill in the last year, as without this we would not have made such considerable progress. The website at keeps everyone up to date with our work. We wish to continue to encourage further discussion and involvement in the way services develop in Grampian. Should you wish to be more involved or simply to make contact with the Stroke MCN we would be delighted to hear from you. Dr Steve Hamilton MCN Lead Clinician Dr James Black Lead GP Stroke MCN Thérèse Jackson Consultant Occupational Therapist In Stroke Mr Sandy Reid MCN Manager The Stroke Managed Clinical Network brings together professionals from NHS Grampian with patients, carers, the independent sector and local authorities to work in a co-ordinated way across geographical, organisational and professional boundaries. The MCN aims to ensure equitable provision of high quality clinically effective care for stroke patients throughout Grampian. 3

4 2. HIGHLIGHTS THIS YEAR This has been another very successful year for the Stroke Managed Clinical Network in Grampian. Highlights have included:- Further progress in meeting QIS Standards for Acute in-patient care Allocation of 123, (non-recurring) for Equipment, Training and Travel Agreement for the development of a North Aberdeenshire Stroke Service with North Aberdeenshire CHP Participation in NHS Grampian Change and Innovation Plan Implementation of the Moray Stroke Action Plan Establishment of GP Stroke Fellowship Invitation to participate in a number of Protected Learning Time opportunities with GPs Poster Presentations and attendance at Stroke National and International Conferences Neurovascular Clinic Electronic Referral and added guidance Establishment of the Scottish North Stroke Research Network Development of MCN Objectives and Quality Assurance Framework Improved links within the MCN via regular Newsletters, rotating Project Board venues and second Annual Networking Seminar Collaboration with Scottish Centre for Telehealth 3. TURNING STRATEGY INTO ACTION The CHD and Stroke Strategy for Scotland was produced in 2004 and made recommendations for several service developments, which were supported with extra funding. Since then other national policy has influenced the direction of service developments and this report highlights the activity undertaken by the Grampian, Stroke Managed Clinical Network (MCN) to implement those strategies. Stroke Neuro-Vascular Clinic The Neurovascular Clinic was set up some years ago to identify patients suspected by their GPs as having suffered from a Transient Ischaemic Attack. The clinic has however become a convenient place to refer patients with vague and bizarre neurological symptoms including light-headedness and dizzy turns. At present only about 50% of referrals in a recent audit were considered to have a vascular problem. 4

5 Recent evidence has made it clear that all patients with a suspected TIA, who are considered fit enough for investigation and treatment, should be assessed as soon as possible following the event. There is a window of 14 days between the event and carotid surgery, which provides the best outcome in relation to the prevention of subsequent stroke. It is therefore imperative that GPs refer urgently stating suspected TIA to the Neurovascular Clinic, and to help triage these patients GPs are being asked to include the ABCD score which is a proven way of identifying those patients with TIAs most likely to go on to develop a stroke. A age >60 1 <60 0 B BP >140/90 1 <140/90 0 C Clinical Limb weakness 2 Loss of speech 1 Any other neurological loss 0 D Duration >60mins mins 1 <10mins 0 Scores of 5/6 identify those patients with TIA at highest risk of developing a stroke. We are now therefore recommending that GPs, when presented with a patient who has symptoms suggestive of TIA, carry out an ABCD score and refer electronically to the neurovascular mailbox where consultants will daily triage and arrange rapid investigation. This system went live on Monday 30 th October 20. Mean Waiting Time for ARI Neurovascular Clinic (Date Referral Received to First Appointment Offered) Number of Days Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- 07 Feb- 07 Mar- 07 Apr- 07 May- 07 Jun- 07 Jul- 07 Aug- 07 Sep- 07 Month Referral Received 5

6 Clinical Neuropsychology Service 35% (or more) of people who have suffered a stroke will have cognitive problems. 50% will experience depression. The Stroke MCN funded Neuropsychology services to people with stroke which has seen the following improvements:- Clinical Faster access to clinical neuropsychology assessment and treatment Increase in therapy time Increase in family work Wider range of problems addressed Dedicated service for mood and adjustment problems Consultancy Stronger links with Stroke Services More liaison with hospital and community staff Advice to Professionals Research Joint research with Aberdeen University Developing links with Aberdeen University Psychology Department Participation in Grampian Research Committee for Stroke Supervision First ever placement for a trainee Clinical Psychologist in Stroke Education Contribution to stroke education programme Training of carers and other professions on an individual basis MSc in Clinical Neuropsychology by Dr Jackie Hamilton near completion The development of a specific Neuropsychology for Stroke Service has resulted in increased referrals but at the same time significantly reduced waiting times. Contacts Between 05/ referrals of contact for people with stroke have increased by 15% to 24% Six times as many stroke rehabilitation in-patients were seen in 20 compared to 2005 Waiting Times Waiting times for non-urgent acute referrals have reduced from 8 months to 2 months Rehabilitation waiting times have reduced from 1 year to 6 weeks 6

7 Moray Stroke Plan Extensive work has been undertaken at Dr Gray s Hospital involving discussions with management and clinicians with the aim to identify a suitable area for eight dedicated stroke beds. At the end of 20, a detailed Moray Stroke Action Plan was agreed and the focus for the year ahead was to ensure it s implementation. Dr Louise Millar, Consultant General Physician, has responsibility for stroke locally and has led progress in Moray along with the Moray MCN sub group, chaired by Thérèse Jackson. Various elements of the action plan have been progressed in the last year. Particular highlights being a series of Stroke Awareness Events held with significant user and carer input. Meetings continue between Dr Gray s Management and Stroke MCN representatives to ensure that the outcomes for patients and carers are the same in Moray as they are in the rest of Grampian. North Aberdeenshire Stroke Rehabilitation Service (Fraserburgh Hospital) Members of the MCN have met regularly with Aberdeenshire CHP to develop a Stroke Rehabilitation Service for North Aberdeenshire, as part of the redesign of services. The Unit will deliver a stroke rehabilitation service which is equitable to that delivered on the stroke rehabilitation wards, 6 & 12 at Woodend Hospital. Patients living north of river Don e.g. Ellon patients could be transferred to this Unit in order to assist patient throughput at ARI and Woodend. The Lead Clinician, the Consultant OT & Stroke and the Stroke Training Coordinator will have input to develop services and support training. There will be daily GP and weekly Consultant physician input to the Service. A local Lead has been identified to oversee the above. It is anticipated that the new Service would open in April Stroke Rehabilitation Wards 6 & 12, Woodend Hospital Ward beds Patients are of school leaving age up to 65 years Average length of stay was 82 days (as at September 2007) Ward 6 16 beds Patients are over 65 years of age Average length of stay was 172 days (as of September 2007) 7

8 Stroke Rehabilitation Wards 6 & 12, Woodend Hospital (cont.) Both wards continue to work closely and in particular for preparation for co-location on the ground floor in Westview (Woodend) in Flexible Therapy Stroke Team The Flexible Therapy Stroke team provides enhanced input to patients on Wards 6 and 12 at Woodend Hospital, and seeks to facilitate effective discharge and transition into the community Each discipline also provides services which are specific to the areas of service need in their professional remit. The team also provides stroke specific education and support across NHS Grampian. The team comprises of a Dietitian, Occupational Therapist, Physiotherapist and a Speech and language therapist. The team have been auditing their clinical activity this year and a report is due in May 08. Other clinical activity includes the initial development of a multi disciplinary tone management pathway, & development of patient appointment cards. Training activity has continued to be busy with the team delivering introductory and advanced course across Grampian. Advanced Study Day in Stroke Care: An advanced study day on `Communication difficulties after stroke - Living with st Aphasia` took place on Wednesday the 21 November The day offered 18 delegates (AHPs, N/S, Social Care Managers / Workers) the opportunity to have direct interaction with people with Aphasia and to hear various presentations about Living with Aphasia, Disability and Work and Health Conditions and the work of the CHSS Volunteer Stroke Service. The response to this study day was very encouraging and positively rated by both course delegates and our trainers (people with Aphasia). This seems a good way of involving ex-service users in training purposes and we hope to repeat this successful study day format in the future. Acute Stroke Unit Ward 11, Aberdeen Royal Infirmary The Acute Stroke Unit is based in ward 11 in Aberdeen Royal Infirmary. It has 20 beds for the assessment and management of stroke patients in the early phase of their illness, with dedicated nursing, therapy and medical staff. Patients commence their rehabilitation in this unit and continue until discharge home or transfer to either one of the stroke rehabilitation units (wards 6 and 12 Woodend Hospital) or to a more general rehabilitation area e.g. Community Hospital, Maple or Links Unit. Patient progress is monitored via a weekly multidisciplinary meeting. Patients are referred to the unit via a Stroke Pager usually held by one of the Consultant medical staff. As well as for admission, the pager is a route for Stroke advice for GPs, A&E and other hospital areas both in Grampian and Orkney/Shetland. 8

9 FAST Campaign F = Facial weakness. Can the person smile? Have their mouth or eye drooped? A = Arm weakness. Can the person raise both arms? S = Speech Problems. Can the person speak clearly and understand what you say? T = Test all three symptoms These photographs show staff in Aberdeen Royal Infirmary supporting the FAST Campaign in October The Campaign explains that a stroke is a Medical Emergency and that it is imperative people can recognise a stroke when it is happening and take prompt action. 9

10 Mobile Stroke Team, ARI The Mobile Stroke Team (MST) provides a specialist stroke service, to assess, treat and support people with a stroke who are not admitted to the acute stroke unit at ARI. The team is multidisciplinary, comprising a dietitian, nurse, occupational therapist, physiotherapist and speech and language therapist. The team have been involved in several clinical developments this year as well as delivering a specialist stroke service to patients. Activity has included development of a patient information leaflet, MST notes review, early supported discharge team audit of need (alongside the acute stroke unit and stroke rehabilitation wards) and data collation for production of an annual report due in Feb Research and Development The MCN will continue to support the work of the National Initiative and the people working actively locally in this area. This included support from the MCN for separate Events considering research and best practice, which will be held in November 20. Dr Mary-Joan MacLeod was appointed as Local Lead for the Scottish Stroke Research Network in November Acute Stroke Sub Group Chair, Dr Mary Joan MacLeod This Sub Group undertook work to fast track referrals to the Neurovascular Clinic. One of the aims for the future is to look at the surgical side of acute stroke. The group has been also looking at the patient discharge letter to meet QIS Standards and monitoring the QIS Standards in the Acute Hospital setting. The Acute Stroke Unit produced a poster for A&E to help them identify potential thrombolysis patients. Information was also given to Acute stroke referral procedure. Medical Assessment Unit (AMAU) on suspected Moray Sub Group The Moray sub group has been meeting every 6 weeks and comprises a multidisciplinary group of clinicians who have an active interest in developing stroke services across Moray. The group initially developed some work as a result of the discharge pathway which was developed by the discharge sub group and have produced the `Now you are going home leaflet` which is available for use across Grampian. Copies are available 10

11 Moray Sub Group (cont.) from Christine Gray, Stroke MCN secretary. This leaflet was developed to provide a consistent patient discharge information leaflet on stroke across the region as it was felt that there were too many variations on the same theme in use. Staff are encouraged to use this for all patients who are going home from stroke services. The group have also been driving the development of services across Moray which includes acute services in Dr Grays in Elgin, and community hospitals and teams. The Stroke MCN is working closely with clinicians to ensure that an equitable service is delivered to patients wherever they receive stroke services. Secondary Prevention Sub Group Chair, Dr David Williams The Sub Group has produced an agreed Protocol, which requires annual review. The group met in 2007 as a result of the publication of new data on the secondary prevention of stroke and has agreed a revised set of guidelines which were approved by the Stroke Project Board on 29 March The Group will continue to meet annually and more frequently should further evidence become available. Nursing and AHP Forum Chair, Ms Elaine Horne A new Nursing and AHP Forum was established in Autumn The remit of the Forum is, To discuss issues relating to stroke practice in Grampian in order to inform the Managed Clinical Network in a multidisciplinary context. Elaine Horne has been nominated as Chairperson of the Forum. 11

12 4. EDUCATION AND TRAINING Education Sub Group Chair, Thérèse Jackson Membership of this group includes patient and service users, members of the public and healthcare professionals from the acute sector, CHP`s, social services, and Higher education institutes, all with and interest in stroke education. The sub group considers and advises on stroke education needs and implementation across Grampian, and meets every two months. Some of the discussions/topics to date include:- Carer issues and research. Collaboration with HEIs i.e. the Robert Gordon University in delivering a range of stroke related training for differing needs. The delivery Framework for Adult rehabilitation in Scotland implications for Stroke services Stroke Training in Grampian study day suggestions and CHSS course direction. National learning activity several group members are contributing to the development of a national on line learning resource called the STARS Project (Stroke Training and Awareness Resources ) The project aims to deliver a web based learning resource for the Core Competencies for Stroke. It is funded by NHS Education for Scotland. The project is led by CHSS and facilitated by the University of Edinburgh. The aim is for Edinburgh University to host the project on its website. The project aims to be completed by mid A series of road shows is being planned to raise aware of this resource across Scotland. The group continues to develop its role and remit and new members are welcome GP Fellowship in Stroke Medicine In September 2007 the Stroke MCN launched a GP Fellowship in Stroke Medicine sponsored by Sanofi Aventis. This will be used to provide education on various aspects of stroke medicine. Early feedback from these sessions has been very positive. Stroke Training Co-ordinator employed by Chest, Heart and Stroke Scotland (CHSS) Stroke Training Programmes Members of the multidisciplinary stroke team should undertake a continuing programme of specialist training and education. (SIGN 64, 2002) Stroke training programmes have been running throughout Grampian since September The training programmes are aimed at health professionals, social service staff and informal carers working with stroke. The aim of each programme is to build on knowledge and skills and increase confidence when working with stroke. The training programmes have been held across Grampian between 1 st October th 20 and 30 September 2007, programmes have been completed, resulting in 348 people receiving training. A breakdown of these training programmes is shown below. 12

13 Title Length st Number completed (1 Oct 30 th Sep 07) Introductory Course in 3 days 5 Stroke Care (part 1) Intermediate Course in 3 days 5 Stroke Care (part 2) Advanced Course in 1 day 1 (Post-stroke, What s Out Stroke Care Social Service Staff Study 1 day 3 Day Social Service Staff and 1 day 1 Care Home Staff Joint Study Day Care Home Staff Study Day 1 day 5 There?) Stroke Awareness 2 hours 1 (Volunteers) Session Student Nurse Session 2 hours 1 An Introductory Course in Stroke Care (part 1) was held in the Shetland Isles in May 2007 at the request of the local Stroke Liaison Nurse. This was very successful and an Intermediate Course in Stroke Care (part 2) has been requested for Two discipline specific training programmes have also been organised throughout the year. Harrison Associates have provided a training programme for occupational therapists and Harcourt Assessment also provided a training programme for occupational therapists. Both these programmes were funded by the Grampian Stroke Managed Clinical Network. Assistance has also been given with support and organisation of the Best Practice in Stroke Conference on 23 rd November 20. The training programmes have proven very beneficial this year and as a result 17 training programmes are planned for Details of these are available from: Lynsey Duncan Stroke Training Co-ordinator Stroke Office Westholme, Woodend Hospital Aberdeen Tel: (5) lynseyduncan@nhs.net Training can be arranged to meet the needs of individual areas. Please see contact details above. The MCN has also participated in several CHP Protected Learning Time events and attended various other meetings to discuss it s role and raise overall capacity within Grampian for Stroke Care. Invitations for these events/meetings are always welcome. 13

14 5. PUBLIC INVOLVEMENT Meaningful public involvement is very high priority for the MCN. Public Involvement Sub Group Chair, Margaret Somerville The Stroke Public Involvement Sub Group continues to meet every three months. Chaired by Margaret Somerville, Deputy Director of Advice & Support, Chest, Heart and Stroke Scotland (CHSS), the membership includes six members of the public who have had experience of stroke, two of whom live in Moray and two members who are carers of someone who has experienced a stroke. The remit of the group is to act as Advisory Group to the Stroke MCN on any relevant issues, contributing to steering the agenda and strategy for Grampian. The member of the Group who represents patients nationally by attending meetings of the National Advisory Committee for Stroke (NACS) MCN Sub Group in Edinburgh has been a key player in the Aphasia in Scotland Project. The aim of this project is to look at service provision for people with aphasia in Scotland. The final report is due imminently. Activities this year included: Three members attended a Get-together meeting and Training Session for patient and public representatives organised by the Corporate Communications Team of NHS Grampian. It was generally felt to be a very useful day. One member has joined the Woodend Development Group whose remit includes redesign/relocation of services provided on the Woodend site. Protocol development: a service user friendly version of the Discharge Protocol has been developed. Consultation regarding a similar document for the Goal Setting Process is in progress. Patient/Carer Leaflet development: comments on the Now You are Going Home Leaflet were incorporated in the final document sent to print. Work is ongoing with the Stroke Drivers leaflet. Quality Assurance Framework (QAF): Standard 2 of the QAF was examined in detail and suggested amendments accepted by the QA subgroup. The role of the Group has been further acknowledged in Section 7.8 the quality of information flow to the public about stroke services will be informed and monitored by the MCN Public Involvement Group 14

15 6. MEASURING HOW WE ARE DOING The ultimate aim of MCNs is to improve patient care in terms of quality, access and appropriateness. During the past year, the MCN completed a Quality Assurance Framework and submitted this for approval to NHS Grampian. Copies are available from the MCN office. To achieve this, the clinical governance agenda and quality issues will be set by quality assurance programmes agreed with local clinicians, patients and Quality Improvement Scotland (QIS). This will ensure that high standards of care can be demonstrated. This puts quality assurance firmly at the centre of all managed clinical network activity. A Stroke Quality Assurance Framework has been developed and approved by NHS Grampian. This includes:- a document scoping the outline of the MCN and the services it will provide a set of standards for the services provided by the network, ratified by NHS QIS agreed arrangements by which performance against the standards will be reviewed and monitored Performance review of existing stroke services across Grampian on a regular basis Stroke Protocols/Stroke Proformas It was agreed that all Stroke Protocols be submitted to the MCN Project Board. The next stage would be for them to be placed on the Stroke website. Stroke Quality Assurance Sub Group Chair, Dr Stephen Lynch The Stroke Quality Assurance Sub Group has been meeting approximately every 3 months. From October 20, work of the group has included:- 1. Reviewing the work of the other stroke subgroups where any items of relevance to do with quality assurance have arisen 2. Looking at the QIS unmet Standards in the Acute Hospital setting and working through addressing these issues. 3. Reviewing and agreeing the local Quality Assurance standards for the MCN 4. Review of QOF stroke indicators for Stroke from primary care Future activity: We aim to continue to review the QIS standards and our local QA standards to identify any unmet standards, and organise an action plan to meet unmet standards as they arise. Future review of QOF Stroke standards and results when they become available in April 2008 We hope to plan and organise an educational workshop for General Practitioners on the work of the MCN and stroke related issues in early

16 QIS Aberdeen Royal Infirmary and Woodend only Dr Grays Hospital, Elgin, figures not available QIS Standards Period Period Period Period Period Period 1/12/5-31/5/6 1/6/6-30/9/6 1/10/6-31/12/6 1/01/07-31/3/7 1/4/7-30/6/7 1/7/7-30/9/7 % % % % % % % of patients diagnosed with stroke are admitted to Acute Stroke Unit within 24 hours of admission to hospital Admitted to ASU at any time during admission Admitted to ASU within 24 hours of admission Patients admitted to ASU at any time or seen by Mo bile Stroke Team % o f new patients are seen within 14 days of referral to Neurovascular Clinic Seen within 14 days of receipt of referral * (Desirable) 80% of new patients are seen within 7 days of referral to Neurovascular Clinic Seen within 7 days of receipt of referral % of patients have CT/MRI imaging performed within 48 hours of admission Scanned at any time during admission Scanned within 48 hours of admission Aspirin treatment is initiated within 48 hours for all patients unless contraindicated Started on aspirin at any time during admission Started on aspirin within 48 hours of admission All patients have an initial swallow screen test performed unless contraindicated Swallow screen performed at any time during admission Swallow screen performed on day of admission ** (* Manually calculated by logging date referral received at ASU - this was picked up recently as some referrals taking up to 5 days to be sent from GP Referrals Section to ASU for booking. New electronic referral system commenced 1st November, electronic referral protocol was sent to GP's June 20. However prompt attention to referrals by Stroke Consultant is major factor in this increase.) (**Date swallow screen performed was not recorded until 1/8/6 onwards which accounts for difference in figures) 16

17 Period Period Period Period Period 1/12/5-31/5/6 1/6/6-30/9/6 1/10/6-31/12/6 1/1/07-31/3/7 1/4/7-30/6/7 % % % % % Carotid Intervention Audit (Data collected from 1 Jan 2007) Number of patients audited 17 Mean Number of days Event to Assessment 8.5 Mean Number of days Assessment to Referral 6 to Vascular Surgeon Mean Number of days Assessment to Date 12 Seen by Vascular Surgeon For Quality Assurance Framework: % undergoing Carotid intervention within 4 weeks of assessment % undergoing Carotid intervention within 2 weeks of assessment Stroke Register Co-ordinator Grampian Stroke Audit The Grampian Stroke Audit was set up in September 2000 under the name of Grampian Stroke Register to capture details of patients suffering a stroke within Grampian and primarily to identify where they were being treated. The role has diversified over the years and the Stroke Audit now supports the work of the Stroke MCN, the 4 Chest, Heart and Stroke nurses across Grampian and also has an active role in the provision of research support to various ongoing research projects an example being the Study of Visual Impairments run by Aberdeen University. There are now 5000 patients held on the database and ongoing developments allow our local stroke service to be monitored closely against QIS Standards for Stroke Care in Scotland. If you would like to know more about the audit then please contact: Elaine Horne Stroke Audit Coordinator Acute Stroke Unit Ward 11 Aberdeen Royal Infirmary elaine.horne@nhs.net Tel (5)59505 Stroke MCN Newsletters The Stroke MCN were regularly producing Newsletters: Issue 5 November 20 Issue 6 April 2007 Issue 7 July 2007 Issue 8 October 2007 Back copies are available on the Stroke MCN Website. Positive reports from staff had been received regarding the Newsletters which kept staff informed of what was currently happening within the MCN. Newsletters were also circulated to all participants in the Stroke Training Courses run by the Stroke Training Co-ordinator. 17

18 7. INVESTMENTS What Funding has there been to support MCNs? The CHD/Stroke Strategy in Scotland has been supported by an annual funding allocation of 15m from the Scottish Executive. This funding which has been made available since 2003/04 has facilitated the establishment of MCN Networks, the development of Stroke and Heart Disease databases and has provided funding to implement a number of local developments. A proportion of the funding is continuing to be top-sliced for various national initiatives ( 1.5m). NHS Grampian receives just over 9% of the total funding available for distribution which means that we receive 1.2m per year, to be shared equally between CHD and Stroke. A significant amount of slippage has been generated over a number of years and detailed plans on the use of this funding have been agreed with relevant MCN Project Boards. The Stroke monies includes repayment of slippage in the 2003/04 and 2004/05 allocations that was used to support certain CHD developments during these years. The funding plans for financial years 2005/ through to 2009/10 are detailed in the table below. Allocations specifically approved in 2007/08 are as detailed below Stroke Non-Recurring Funding 1. Equipment 85, Training 37, Further non-recurring monies will be available for distribution in 2008/09. 18

19 STROKE STRATEGY FUNDING FOR NHS GRAMPIAN / to 2009/ / 20/ / / /10 FUNDING '000 '000 '000 '000 '000 Stroke Stroke MCN Stroke Database Gait Trainer Expansion Neurovascular Clinic Early Stroke Rehab SpR Training Neuropsychology services Stroke Flexible Therapy Team Mobile Doppler Beds Stroke AHP Consultant Stroke Vascular Prevention CHSS Nurse Dr Grays Training Courses Clinic Nurse Mobil e Stroke Nurse Cardiovascular Risk Nurse (NOF) CHSS Stroke Training Co-ordinator IT Equipment - New Neuropsychology Strok e Travel Fellowship Strok e Minor Refurbishment and Equipment Strok e Equipment Total Stroke Expenditure

20 8. PLANS FOR THE COMING YEAR Stroke MCN Objectives 2007/08 Supports corporate objective(s): Meet Financial Targets, Redistribution of resource in line with Health Plan and ensure best value through continuous improvement Shift the balance of care from hospital to community Develop effective joint working with partners Improving Health, Reduce Health Inequalities Ensure the public is involved, engaged and consulted in healthy living and on service delivery and planning Learning and Growth Ensure right numbers of staff with right skills, in right place The Grampian MCN can help with all these objectives and is building them into its prioritised workplan which will be available in full on the MCN website. We expect to deliver the following new improvements: The top priorities for the Stroke MCN in Grampian in the coming year are to support the establishment of the Stroke Rehabilitation Service in North Aberdeenshire and to implement the Moray Stroke Plan in full. The Stroke MCN will undertake regular performance reviews across the various components of the Stroke Network in Grampian. The outcome of these reviews will be formally submitted to NHS Grampian as part of its governance arrangements. Improved Grampian-wide pathways for patients with suspected stroke and TIA to ensure that they receive appropriate assessment and treatment. This will provide guidance for local GPs, NHS 24, ambulance services and those working in A&E departments. It is likely to involve quite a lot of change in consultant work patterns and therefore will take time to introduce. It is hoped that the introduction of these changes will help the service to meet NHS QIS standards for the waiting times to access a neurovascular clinic, the time taken for a stroke patient to access a stroke unit bed and the time to be given aspirin if appropriate. We will continue to seek to reduce waiting times for carotid endarterectomy intervention. We will contribute to prevention of stroke and TIA in the community through working with GP practices and in particular promotion of the FAST Campaign. We are involved with several primary care initiatives to improve primary prevention. We will review each area of our work and develop improved links with the Community Health Partnerships and the Acute Sector.. We want to make more use of the information we already collect in the NHS by feeding it back to staff so they can benchmark themselves and learn from others. We expect to build on our successful staff training and pilot new learning methods for taking forward the national guidance on Core Competencies for all staff. We want to strengthen our involvement with patients and carers and our links with Chest, Heart and Stroke Scotland and the Stroke Association. 20

21 ENQUIRIES Headquarters: CHD & Stroke MCN Office, Westholme, Woodend Hospital Site, Ed ay Road Aberdeen, AB15 6LS, Telephone: (01224) Dr Steve Hamilton, Lead Clinician, Stroke MCN (1 session) Ms Thérèse Jackson, Consultant Occupational Therapist in Stroke Dr Jim Black, Lead GP, Stroke MCN (1 sessi on) Mr Sandy Reid Network Manager (1½ days pe r week) sandy.reid2@nhs.net Ms Lynsey Duncan, Stroke Training Co-ordinator lynsey.duncan@nhs.net Mrs Christine Gray (2½ days per week), Secretary Christine.Gray@arh.grampian.scot.nhs.uk PROJECT ORGANISATION T he MCN for Stroke in Grampian has: S teering Group and Sub Groups Chairperson: Project Board Dr Steve Hamilton, Steve.Hamilton@arh.grampian.scot.n hs.uk Acute Services Sub Group Dr Mary-Joan MacLeod, mary.macleod@arh.gramppian.scot.nhs.uk Moray Sub Group Ms Thérèse Jackson, T.Jackson@arh.grampian.scot.nhs.u k Secondary Prevention Sub Group Dr David Williams, davidwilliams4@nhs.net Education Sub Group Ms Thérèse Jackson. T.Jackson@arh.grampian.scot. nhs.uk Public Involvement Sub Group Ms Margaret Somerville, margaret.somerville@chss.org.uk Quality Assurance Sub Group Dr Stephen Lynch, stephen.lynch@calsayseat.grampian.scot.nh s.uk Nursing and AHP Forum Miss Elaine Horne Elaine.Horne@arh.grampian.scot.nhs.uk 21

22 PROJECT BOARD MEMBERSHIP Steve Hamilton (Dr) MCN Lead Clinician an d Chair Jim Black, Lead GP, CHD & Strok e MCN Jackie Bremner Service Planning Lead, Aberdee n City CHP Steve Brockman Ward Manager, Ward 6, Wooden d Hospital Alastair Cozens (Dr) Consultant in Rehabilitation, Woodend Hospital Jon Cresswell, (Dr) Consultant in Public Health Medicine George Downie, Director of Pharmacy & Medicines Management, Woodend Alison Hamilton Head of Service, Speech and Language Therapy Elaine Horne Stroke Register Co-ordinator, Ward 11, AR I Thérèse Jackson, Consultant Occupational Therapist in Stroke Ruth Lancaster Ward Manager, W12, Stroke Reha bilitation Centre, Mary-Joan MacLeod Consultant, Acute Stroke Unit, ARI Rose McKechnie Ward Sister, Ward 40, ARI Louise Millar, (Dr) Consultant, Dr Gray s Hospital, Elgin Elaine Morrison Ward Sister, Stroke Rehab, Woodend Marie Munro, Nurse Manager, Ward 9, ARI Clark Paterson Finance Manager, Ashgrove House, ARI Sheena Paterson, Sister, Stroke Unit, Ward 11, ARI Sandy Reid Network Manager, CHD & Stroke MCN Margaret Somerville, Regional Manager, Chest, Heart & Stroke Scotland Jack Stuart, General Manager, Aberdeenshire CHP, Steve Wilkinson Consultant Physician, Woodend Hospital David Williams Consultant, Clinical Pharmacology, Ward 12, ARI MCN Stroke Project Board Meetings Thursday 30 November 20 at 2pm Thursday 25 January 2007 at 2pm Thursday 29 March 2007 at 2pm Thursday 31 May2007 at 1.30pm Thursday 27 September 2007 at 2pm Thursday 29 th November 2007 at 2pm WEBSITE Website Minutes, agendas, newsletter, forthcoming events, local and national policies, protocols and guidelines are all available on this website. Links to other websites include the Grampian Intranet and the GP Portal. 22