Stroke services centralised to ensure equity of access to emergency treatment

Dr kawafi
Stroke services centralised to ensure equity of access to emergency treatment
26 March 2015

All new onset suspected stroke cases in Greater Manchester1 will be treated at specialist hospitals in Salford, Stockport and Bury, under changes to local health services being introduced at the end of March2.

Since 2010, anyone in Greater Manchester calling 999 within four hours of a stroke has been taken to one of the hyperacute centres - with the rest admitted to district stroke centres at their local hospital.   This has meant that, until now, only 30 per cent of strokes are treated at the ‘hyperacute centres’ - where patients can get access to emergency ‘clot-busting’ thrombolysis and immediate brain scans.

Now, local health bosses have announced plans to further centralise stroke services to ensure everyone presenting with new stroke symptoms gets access to the best emergency treatment - no matter where they live.

Opening hours at the hyperacute stroke centres at Fairfield Hospital in Bury and Stepping Hill Hospital in Stockport will be extended to 7am-11pm daily, including weekends, while the centre at Salford Royal will continue to operate on a 24/7 basis3.

All district stroke units at local hospitals will remain open under the plans - but will shift their focus to patient rehabilitation and recovery.

The NHS is investing an additional £2m in local health services to implement the changes - with extra funding partly being used to extend the operating hours at Bury and Stockport.

Alan Campbell, Senior Responsible Officer at Salford CCG which is implementing the Greater Manchester-wide service change, said: “From the end of March this year everyone in Greater Manchester will have access to the same high quality, emergency care if they have a new onset of stroke. It means everyone who has a stroke will be able to access the best practice care processes which are crucial in the first days after a stroke.

“Every year in Greater Manchester approximately 4,000 people have a stroke, and one in eight of these people die within 30 days. Ensuring world-class emergency healthcare for all stroke patients in Greater Manchester is one of our top priorities. And with this change we will make sure everyone has equal access to these critical treatments.”

The only other place in the UK to have implemented a similar change to stroke services is London. Since 2010 all stroke cases in the capital have been given emergency treatment at hyperacute stroke centres. An independent study carried out by University College London, and published in the British Medical Journal4, found the changes resulted in nearly 100 fewer deaths from stroke each year. The same study estimated that, if implemented, a similar change in Greater Manchester could reduce annual stroke deaths by 50.

Dr Khalil Kawafi (pictured) of Fairfield Hospital in Bury, said: “There is strong evidence that these changes will lead to better outcomes for stroke patients in Greater Manchester. We believe they will give people a greater chance of survival and will aid people’s recovery from stroke.

“We’ve listened carefully to the views of groups which represent and support stroke patients before implementing these changes. They are fully behind the plans as they believe they will ensure all patients have access to the best possible treatment in the critical initial period after having a stroke.”

Chris Larkin, Regional Head of Operations at the Stroke Association, said: “We welcome plans to build on the centralisation of emergency stroke care in Greater Manchester. It represents a significant improvement to the way services are provided locally.  Evidence shows that stroke patients treated in a hyperacute stroke unit are more likely to survive and make a good recovery. Giving people specialist care, especially in the critical period soon after symptoms start, can make a big difference. This centralised model has already shown benefits for stroke survivors in London and we are very keen to see this new system deliver better results for stroke patients in Manchester as well.

“It is also important that survivors have access to the long term support they need, to make their best possible recovery at home - in their own community. People don’t want to have to stay in hospital any longer than they have to and we are pleased that these plans reflect those aspirations.”

Kevin Render, patient representative on the implementation board that worked with Greater Manchester CCGs and the Strategic Clinical Network to plan the changes, said: “Having a stroke is a life-threatening medical event that all of us hope we will never have to face. For patients to have the best chance of survival and recovery, however, it is essential that they are treated at a hyperacute stroke unit where they can get access to critical thrombolysis treatment.

“These important changes mean that everyone in Greater Manchester can now be reassured that if they did have a new onset of stroke they will be treated at one of these centres which are dedicated to the treatment of stroke. It means we can achieve true equity in the provision of emergency stroke treatment. In some cases it will mean patients will have to travel further by ambulance to get to the hyperacute unit - but the patients we have spoken to say they are prepared to do this if it means they get the best possible care.”

For more information contact Mark Lupton on 07950 247610 or Claire Norman on 07773 819316 in the NWCSU communications team.

Notes to editors

  1. The centralisation of stroke services in Greater Manchester also includes patients living in parts of East Cheshire.
  2. From April 2015, every new onset suspected stroke case in Greater Manchester will be immediately taken to one of these centres - irrespective of where their stroke happens. This will also include patients who live in the East Cheshire area.  If patients present some time after their symptoms, they may not need to make this longer journey as the benefit of the hyperacute care is in the first few hours after a stroke happens.
  3. The hyperacute stroke centres at Bury and Stockport currently open Monday to Friday from 7am-7pm.

UCL study into stroke services centralisation in London.