Greater Manchester, Lancashire & South Cumbria
Strategic Clinical Network & Senate
Lancashire Collaborative Commissioning Board
PHASE 2 REPORT
Work Programme/ Project: Stroke/TIA Review
SRO: Jan Ledward
CSU Leads: Les Martin, Claire Kindness
SCN Lead: Elaine Day
PERIOD OF REPORT
March 2015
CURRENT STAGE
Phase 2 – Service Spec Development
FOR DECISION
Executive Summary
Overview
Phase 2 of the Stroke/TIA review programme aimed to develop an end to end best practice service specification
for stroke/TIA services in Lancashire. This report presents this specification to the CCB with a number of
proposals around the next steps to be undertaken in preparation for the implementation of the specification.
CCB are asked to:
• Consider and agree the draft service specification and seek views from their CCGs on the
specification.
• Provide any feedback they may have on the specification including the requirement for seven day
access to and service provision across the whole stroke pathway to be mandated within the
specification.
• Agree that the Stroke review Steering Board develop an implementation plan, including a detailed
gap analysis between the current service and the specification, in preparation for the
implementation phase of the programme.
1. Introduction
This report accompanies the draft end to end stroke pathway service specification (Appendix 1) which has been
developed by clinically-led workstream groups, in consultation with patients and other stakeholders, during Phase
2 of the Stroke Review. The service specification encompasses the following pathway phases and is based on
national guidance and best practice:
A.
B.
C.
i.
ii.
iii.
iv.
v.
D.
E.
F.
G.
Primary prevention
Pre-hospital
Acute phase
Hyper Acute Stroke care 0-6 hours
Acute Stroke care 6-72 hours
Acute care and inpatient rehabilitation 72 hours – 7 days
Transient Ischaemic Attack (TIA) services
Specialist Support Services (e.g. neuro and vascular surgery referrals)
Integrated Community Stroke Team
Survivorship
Secondary Prevention
End of Life
2. Updated Position within Stroke Services
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The development of the draft service specification followed phase one of the stroke review which highlighted that
while there is a lot of good work taking place within stroke services in Lancashire and South Cumbria, more can be
done to:
• Prevent strokes
• Improve outcomes for those patients who do suffer a stroke
• Reduce variation
• Make improvements in diagnosis, treatment, therapy, support and the timeliness in which this is provided
More recent stroke service data shows that variation continues, therefore emphasising the importance of the end
to end stroke pathway specification which will set a consistent standard and consistent requirements of all
providers across Lancashire and South Cumbria and support improved outcomes for stroke patients. The tables
below show the performance of the Trusts in Lancashire against ten domains in the sentinel stroke national audit
programme for July to September 2013 compared with July to September 2014.
July to September
2013
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July to September
2014
For each domain and overall, sites have been given a performance level (A-E) which enables their organisation of
stroke care to be compared with other sites. The scores for the ten domains range from 0 to 100 with 100 being
the optimal score. A total organisational score is obtained by calculating the mean average of the ten domain
scores.
3. Finalisation and Agreement of Service Specification
The draft specification has been reviewed and agreed by the Stroke Review Steering Board and CCGs are asked
consider the specification and any comments/input be provided to the CSU team by end of April 2015.
CCGs are also asked to agree the specification subject to any comments they may have.
CCB is asked to consider whether they wish the principle of seven day access to and service provision across the
whole stroke pathway to be mandated within the specification.
4. Communications
Patients have been engaged in the service specification development process via workstream groups, patient
focus groups and the Stroke Review Steering Board. A diagrammatic version of the specification outlining the key
elements of care patients should expect at each phase (Appendix 2) has been developed to support wider
engagement with patients/public and this engagement activity is being planned to take place from mid-May
following agreement of the specification by CCGs and following purdah.
5. Phase 3 Proposal
It is proposed that the review progress to phase three which it is envisaged would focus on making the changes
required to implement the service specification.
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Each of the workstream groups is currently undertaking a gap analysis, comparing current service provision to the
service as outlined in the draft service specification. This work will be completed following finalisation and
agreement of the specification and will form the basis of work to be undertaken during phase three.
It is proposed that the Steering Board will develop a detailed implementation plan for the next phase of the
programme which will consider:
•
•
•
•
Review of the identified gaps between current service provision and the specification requirements
Areas of work to be undertaken, either on a locality basis or as a wider collaborative action, with suggested
prioritisation.
An analysis of the financial implications of the planned changes
The requirement for wider consultation with service users and providers around the planned developments
This will be presented to the CCB in May for agreement.
CCB is requested to:
•
•
•
Consider and agree the draft service specification and seek views from their CCGs on the specification.
Provide any feedback they may have on the specification including the requirement for seven day
access to and service provision across the whole stroke pathway to be mandated within the
specification.
Agree that the Stroke review Steering Board develop an implementation plan, including a detailed gap
analysis between the current service and the specification, in preparation for the implementation phase
of the programme.
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Appendix 1 Stroke Service Specification
Draft (Full) Stroke
Service Specification- MASTER (v1.4) 18.03.15_HS.docx
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Appendix 2 Stroke Service Engagement Diagram
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