The Department of Health (the Department) published the Reshaping Stroke Care Action Plan in June 2022. The Action Plan sets out six priorities to improve stroke services in our hospitals and the community.
Priority Five in the Action Plan sets out a commitment to establish a revised process to identify a preferred option for Hyperacute Stroke Care. We want to ensure that the voice of people with experience of stroke or carers of those who have is reflected within the process.
Further information on all of the priorities identified in the Action Plan is available here.
The Action Plan was developed following a public consultation in 2019 when the Department asked for views on a range of potential improvements to stoke services. You can read more about the consultation below.
Getting Involved
The Department wants to recruit three people with experience of emergency hospital-based stroke services in Northern Ireland within the past 3 years either as a person with direct experience of stroke or as a carer of someone who has had a stroke to join the Project Board. This is an exciting opportunity to use your voice and experience of stroke to help shape the future of hospital-based stroke services. While the positions are voluntary, any cost arising from participation including travel and respite care will be met by the Department.
If you are interested in learning more about this opportunity, please click here.
Current Acute Services
There are acute stroke units in eight hospitals across NI: Royal Victoria Hospital, Antrim Hospital, Causeway Hospital, Ulster Hospital, Craigavon Hospital, Daisy Hill Hospital, Altnagelvin Hospital and the South West Acute Hospital. Due to staffing pressures, there is currently no acute stroke service at Daisy Hill Hospital, with emergency admissions redirected to Craigavon Hospital.
Stroke services across NI have been improving in recent years. However, there is still significant variation in terms of how long it takes to assess and treat patients once they arrive at hospital and in the treatment and aftercare they receive. Ensuring we have the right number of staff with the right skills in each of our current stroke wards is also becoming increasingly difficult. We must do better for people affected by stroke.
Hyperacute Stroke Services
Guidance from the Royal College of Physicians and the National Institute for Health and Care Excellence recommend that stroke services should be provided in a hyperacute setting in the first few days after a stroke. Hyperacute Stroke Care includes both Hyper Acute Stroke Units (HASUs) and Acute Stroke Units (ASUs). HASUs provide intensive support on a 24/7 basis for the first three days after a stroke; ASUs provide care for a further period for those stroke patients who are unable to return home after HASU care.
Evidence from other areas in the UK where hyperacute stroke services have been developed indicates that stroke patients have quicker access to brain scans and treatment, have a reduced chance of mortality and are likely to make a better recovery even if they have to travel further to get there.
Progress so far
In March 2019 the Department published the consultation document, ‘Reshaping Stroke Care; Saving Lives, Reducing Disability’. The document outlined seven proposed commitments which included the establishment of a Network or group of Hyper Acute and Acute Stroke Units to improve outcomes for stroke patients. Six potential Networks were identified. The number and location of hospitals included in each Network varied.
Over 19,000 responses were received, more than two thirds of which rejected all six Networks. This was largely because of concerns about the loss of local stroke services and the potential impact on outcomes of having to travel further to access treatment. Other concerns raised the need to consider the impact of an ageing population on the number of strokes in the future as the risk of stroke increases with age.
The Reshaping Stroke Care consultation document and consultation analysis is available here.
The Revised Process
The Department has listened closely to the concerns raised during the public consultation. While the implementation of Hyperacute Stroke Care in NI offers significant potential to improve outcomes, it is clear that a new way forward is needed to help identify where hyperacute stroke services should be provided in the future.
The Department has established a Hyperacute Stroke Project Board (the Project Board) to oversee a new process. The Project Board is a small group comprising officials from the Department of Health, the Stroke Network and the Public Health Agency.
The new process, agreed by the Project Board, will be taken forward in three phases:
- Phase One: This phase will include two important pieces of work:
- An activity analysis: We will consider all potential locations for Hyperacute Stroke Care; and
- The development of evaluation criteria which will be used to assess each potential Network of Hyperacute Stroke Care.
- Phase Two: Evaluation criteria agreed during phase one will be applied to each proposed Network, leading to a short list of proposed Networks. This short list will then undergo further, more detailed assessment.
- Phase Three: In this phase, we will carry out more detailed analysis of each short-listed Network. This will include considering how long it would take to fully establish each Network and how much it would cost. We will also undertake Equality Impact and Rural screenings where we will examine the impact on local communities of each Network.
It is intended the process will identify the preferred locations for Hyperacute Stroke Care by Summer 2025.