Stroke Services Improvement

Stroke PatientImproving Stroke Care Now

NHS Wales has been improving the quality of patient care and reducing avoidable harm through its innovative 1000 Lives Plus national programme. As part of this programme, evidence based patient-level performance targets have been developed for acute, TIA, and early rehabilitation stages of the pathway. These ‘intelligent targets’ are now part of the performance framework for NHS Wales through its Annual Quality Framework, and supported through the central Delivery and Support Unit. In addition to these particular parts of the patient journey, NHS Wales continues to develop intelligent targets for ‘life-after-stroke'.

Background Context

By 2006 the standard of stroke services in Wales had begun to lag significantly behind those in the rest of the UK. It was recognised by the Welsh Assembly Government in the Welsh Health Circulars 058 and 082 published in 2007 that this trend had to be reversed.
 
The More information on the following document  Welsh Health Circular (WHC (07) 058) confirmed that stroke was now a priority for the NHS and social services in Wales. It set out what action was required from commissioners and providers by March 2008. It also announced that a formal programme of work would be published and that the establishment of acute stroke units should be a priority.

This WHC instructed the Wales Centre for Health (WCfH), National Public Health Service for Wales (NPHS) and the National Leadership and Innovation Agency for Healthcare (NLIAH) to establish a formal partnership to:
  • ensure the most appropriate use of resources, skills and expertise within the three organisations
  • foster and develop clinical leadership within stroke services
More information on the following document  WHC (2007) 082, published in December 2007, set out the formal programme of work for 2008-11 to guide and direct the progressive implementation of the standards for stroke care set out in the More information on the following document  National Service Framework for Older People. There were specific actions for the partnership in the WHC, as well as for Local Health Boards, NHS Trusts and social services.
 
The Annual Quality Framework is based on a set of common values and systems thinking which the NHS is expected to adopt. 

Planning Resources

Policy

 

 

Guidance

 

 

Care Pathways

This Stroke Services Improvement Programme Work Stream A was tasked with developing a care pathway for stroke and a set of indicators and outcomes for monitoring progress with the care pathway. It was also tasked with carrying out a gap analysis to compare current service provision with the care pathway. 

Abertawe Bro Morgannwg Health Board document "Seen F.A.S.T. now act Faster" - (Improving Transient Ischaemic Attack (TIA) outcomes for patients living in Swansea through a 'real time' Service) includes a Care Pathway for TIA.

The NICE Stroke pathway covers the diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). It also includes a quality standard that covers care provided to adult stroke patients by healthcare staff during diagnosis and initial management, acute-phase care, rehabilitation and long-term management.

 

 

Services and Performance

Audit

 

 

Stroke Data Sources

Health Maps Wales is a web-based interactive map produced by the NHS Wales Informatics Service. It includes mortality and hospitals admissions data on stroke for various geographies in Wales. The Patient Episode Database Wales (PEDW) provides statistics by principle diagnosis for stroke and TIA.  Primary care data is provided through the The Quality and Outcomes Framework of the GMS contract. The Office for National Statistics and National Centre for Health Outcomes Development are other useful sources of stroke data. You can find out more below:

The NHS Wales Performance Intranet site publishes Health Boards Stroke "bundles of care" performance data. (Resource available only to those with access to NHS Wales network)

Additional Resources

Below you can find current guidelines, reports, clinical evidence, audits and statistics from sources including the American Heart Association, Care Quality Commission, Department of Health, Scottish Intercollegiate Guideline Network, National Audit Office, the BMJ Evidence Centre and the Cochrane Stroke Group.

The Wales Stroke Alliance

The Wales Stroke Alliance is a multi-disciplinary collaborative of doctors, nurses and other health professionals who champion and lead improvements in stroke services

Stroke Services Improvement Programme

The stroke partnership published a Stroke Services Improvement Programme (SSIP) in April 2008. One of the initial five workstreams of this programme was the development of the All Wales Stroke Services Improvement Collaborative (AWSSIC), involving a range of professionals from across Wales to take forward the improvement of acutestroke services. The aim of the first year of AWISSC was to support organisations to develop services which improved the outcomes for people following a stroke by improving the reliability of the care they received in the first seven days following stroke. You can find more information in the document below:
A library of archived documents from the Stroke Services Improvement Programme which was formally closed in 2009 is available via the links below: