Greater Manchester Stroke Operational Delivery Network Supporting Stroke Care in Greater Manchester

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1 Supporting Stroke Care in Greater Manchester Dr Jane Molloy ODN Clinical Lead

2 Who are we? Set up in July 2015 A partnership of NHS stroke-care providers across Greater Manchester and Eastern Cheshire Provider-funded Hosted by Salford Royal Foundation Trust

3 We also work closely with: Ambulance Trusts Commissioners Researchers Voluntary sector

4

5 Our governance

6 Our providers 3 Hyper Acute Stroke Units 6 District Stroke Centres 15 community rehabilitation teams

7 Our pathway

8 Supporting the Acute Care Pathway

9 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep 90% 80% 70% 60% 50% 40% HASU DSC 30% 20% 10% 0%

10 CCG SSNAP Scoring Reporting period Apr-Jun 2014 Jul-Sep 2014 Oct-Dec 2014 Jan-Mar 2015 Apr-Jun 2015 Jul-Sep 2015 Oct-Dec 2015 Jan-Mar 2016 Apr-Jul 2016 Bolton CCG D D X D B B B B A Bury CCG D C C B A A A A A Central Manchester CCG D D D C B B B B A Eastern Cheshire CCG D D D D C C B B B Heywood, Middleton and Rochdale CCG C C C B A A A A A North Manchester CCG D C C B A A A A A Oldham CCG C C C B A A A A A Salford CCG C B C B B A A B A South Manchester CCG D D D D C B B B B Stockport CCG D C C D C B B A B Tameside and Glossop CCG D D D D C C B B B Trafford CCG D D C D B B B B A Wigan Borough CCG D D C C B B B B A

11 SSNAP overall scoring within GM A 2 B C D E Jan-Mar 2015 Apr-Jun 2015 Jul-Sep 2015 Oct-Dec 2015 Jan-Mar 2016 Apr-Jul 2016 Aug-Nov 2016

12 Patient Centred HASU Scoring SRFT PAT SHH GM HASU Trend National Average (All teams) 50 Q8 Oct--Dec 14 Q9 Jan-Mar 15 Q10 Apr- June 15 Q11 July- Sept 15 Q12 Oct-Dec Q13 Jan-Mar P14 Apr-July P15 Aug-Nov 16 16

13 Patient Centred DSC/SU Scoring GM DSC Trend National Average (All teams) Q8 Oct--Dec 14 Q9 Jan-Mar 15 Q10 Apr- June 15 Q11 July- Sept 15 Q12 Oct-Dec 15 Q13 Jan-Mar 16 Q14 Apr-July P15 Aug-Nov 16 16

14 Patient Centred HASU Scoring GM v London GM HASU Trend National Average (All teams) London HASU trend Q8 Oct--Dec 14 Q9 Jan-Mar 15 Q10 Apr- June 15 Q11 July- Sept 15 Q12 Oct-Dec 15 Q13 Jan-Mar 16 P14 Apr-July 16 P15 Aug-Nov 16

15 Patient Centred Scoring GM v London (All Units) National Average (All teams) GM all units trend London all units trend Q8 Oct--Dec 14 Q9 Jan-Mar 15 Q10 Apr- June 15 Q11 July- Sept 15 Q12 Oct- Dec 15 Q13 Jan- Mar 16 P14 Apr-July 16 P15 Aug- Nov 16

16 Key changes Increased flow to HASUs (from 60 to 85%) Residual activity in District Stroke Centres but not pathway breaches High false positive rates at HASUs Hugely improved SSNAP scores Overall decreased crude mortality and length of stay Positive patient and clinician feedback Operational challenges remain

17 ODN support Governance structures to enable collective decision making, monitoring of change and holding organisations to account Improving care through audit Service improvement programme Outcome measures Operational processes and protocols Training and education

18 Supporting the Post-Acute Care Pathway

19 The Post-Acute postcode lottery 13 CCGs with a variety of community rehabilitation services/models of care two have no specialised rehabilitation Unequal and inefficient - risk of losing benefits of acute care Collaboratively developed an integrated community stroke team model evolution of ESD Single service specification implement across conurbation

20 Stroke survivors in community needing ICST assessment (re-referral or had stroke out of area) Contact patient/carer by phone within 48 hours of referral and assess within 7 days If ICST intervention needed, apply appropriate pathway and enable life after stroke support as early as possible IAPT Crisis intervention/rapid assessment service Access to medical support Integrated Community Stroke Team (ICST) - Core MDT OT, PT, SaLT Nurse, Clinical Psychologist/Neuro psychology, Physician, Rehabilitation Support Worker/Assistant Practitioner & Social Worker Family & carer support service Communication support service Access to suitable exercise services Stroke survivors discharged from hospital In reach/triage by ICST to support pathway decision Determine and apply appropriate pathway of care following full holistic assessment with family and patient Enable appropriate life after stroke support as early as possible Support services Return to work/vocational support Long term conditions services Orthotics, orthoptics, wheelchair services Spasticity clinics Consultant review Specialist inpatient neuro rehabilitation centre Pathway 1 Therapy at home with ICST support Telephone call to patient/carer for support within 24hrs if appropriate Assess at home within hours depending on clinical reasoning and patient need Treatment begins within 24 hours of assessment for ESD patients and within 7 days for non ESD patients Therapy intensity provided daily across 6 days a week as per guidelines with clinical reasoning/patient choice Intervention provided by ICST for up to 6 months Pathway 2 Therapy at home with joint ICST & reablement rehabilitation support package Joint assessment at home by ICST and reablement team within 24 hours of discharge (or prior to discharge if local practice) to develop joint management plan ICST provide treatment and management plans with therapy practice via reablement workers Therapy provided within 7 days with up to 3 therapy/care visits a day provided by re-ablement service/icst daily across 6 days a week as per guidelines with clinical reasoning/patient choice ICST review goals/visits weekly with max 6 weeks re-ablement support available Step down to pathway 1 if needed Pathway 3 Discharged to residential/nursing home Telephone call to care home within 24hours for triage and management planning Assess within 72 hours of discharge depending on clinical reasoning and patient need. Treatment begins within 7 days of assessment Therapy intensity provided daily across 6 days week as per guidelines with clinical reasoning/patient choice Management plan/reintegration if needed to include seating, mobility, swallow & spasticity Prevention of contractures and shoulder pain Discharge When goals met, maximum 6 months When generic pathways or other life after stroke services are deemed appropriate by the ICST Self-referral back to ICST if needed in future Life after stroke services encouraging self-management and use of community assets Family & carer support (liaise closely with ICST, may attend MDT) Communication & information support Exercise, health & fitness Social groups, peer support, befriending & respite care 6, 12 month and annual review thereafter using GMSAT. Referral back to ICST if needed in future

21 ODN support Stalled under Strategic Clinical Network so took back to GM CCGs Bringing stakeholders together - community teams, NR ODN and voluntary sector Focus on commissioning of integrated model with emphasis on life after stroke services Identifying gaps working to develop solutions e.g. psychology, communication, carer support, RTW etc Opportunities via new GM Health & Social Care Partnership

22 What next ODNs in the new NHS landscape

23 Scope of work Primary prevention atrial fibrillation, hypertension Pre-hospital pathway NWAS Hyperacute care IAT, ICH Rehabilitation standardisation and integration Life after stroke Vocational rehab & psychological support Pan-Manchester protocols ICH, M&M Patient & carer group

24 Why have an ODN - adding value Focal point for stroke in GM and increasing our national profile A voice for patients and carers, and involving the voluntary sector Strategic approach to improving local stroke services across the whole care pathway and providing a clear vision for the future Governance structures through which organisations can hold each to account, with mechanisms to identify and address issues and risks Involving a wide range of stakeholders and providing opportunities for networking and peer support, and sharing of best practice Forums for discussion, agreement, implementation and resolution of operational issues and facilitating service improvements

25 Looking ahead Change via local devolution agenda - where will we fit in the GM Health & Social Care Partnership? What is the SCN and ODN interface who does strategic? What is the interface with Urgent and Emergency Care Networks?

26 Get in touch