We want you to tell us what you think about our preferred change proposal to develop:
Hyper-acute and acute stroke services are provided from hospitals that treat the sickest of patients:
These hospital stroke services are provided by highly trained and skilled doctors, nurses and therapists who specialise in looking after people who have had a stroke. They work as a multi-disciplinary team to provide the most appropriate care tailored to the needs of individual people.
Two key hospital services for the treatment of strokes are:
and
In addition, these hospital stroke service teams also run transient ischaemic attack (TIA) or ‘mini stroke’ clinics (in outpatient services), where patients whose symptoms have resolved but are still thought to be ‘high risk’ will be seen the next day by a stroke consultant and have appropriate investigation and results for the patient all in the same day.
Prior to the temporary changes made in response to COVID-19, United Lincolnshire Hospitals NHS Trust (ULHT) provided hyper-acute and acute stroke services, as well as TIA clinics from Lincoln County Hospital
and Pilgrim Hospital, Boston. Grantham and District Hospital does not provide these services. If patients with a suspected stroke present at Grantham and District Hospital they are rapidly transferred to the most appropriate site.
A summary of stroke service provision at ULHT’s hospital sites ‘pre COVID-19’ is set out below.
Lincoln County Hospital |
• Hyper-acute stroke service including Thrombolysis • Acute stroke service • TIA clinics |
Pilgrim Hospital, Boston |
• Hyper-acute stroke service including Thrombolysis • Acute stroke service • TIA clinics |
Working alongside the Lincolnshire hospital-based stroke services is the Lincolnshire community stroke rehabilitation service. This service aims to reduce the length of stay of patients within hospital stroke units, to improve the patient and carer experience following a stroke, and to offer a seamless transfer of care for patients from hospital to home.
This section sets out the challenges and opportunities for stroke services and what we hope to achieve by making changes.
Challenges
Opportunities
By making changes, we can look to ensure:
We know that this approach already works well in other services in the county. Through the establishment of the Lincolnshire Heart Centre at Lincoln County Hospital, Lincolnshire residents already have first-hand experience of the benefits to patient care that can be achieved by bringing together and consolidating highly specialist clinical expertise into a centre of excellence.
There has been ongoing engagement with the public throughout the Lincolnshire Acute Services Review programme, particularly through the ‘Healthy Conversation 2019’ engagement exercise.
Some consistent themes in relation to hospital stroke services, including some specifically related to those living in the Boston area, have been shared by the public and stakeholders throughout our engagement to date:
We have consistently looked to take into account all public and stakeholder feedback throughout our work.
Our preferred proposal for change is to establish a ‘centre of excellence’ for hyper-acute and acute stroke services at Lincoln County Hospital, which would be supported by increasing the capacity and capability of the community stroke rehabilitation service. TIA clinics would be unaffected at Pilgrim Hospital, Boston.
This would mean hyper-acute and acute stroke services would be consolidated at Lincoln County Hospital and no longer be provided from Pilgrim Hospital, Boston.
It is anticipated the change would affect, on average, 1 to 2 patients a day. These patients would receive hyper- acute and acute stroke services at an alternative hospital.
A key part of our process to evaluate options to tackle the challenges we face was to hold a clinically- led health system stakeholder workshop and four workshops with randomly selected members of the public.
For Stroke Services two solutions remained following the shortlisting of options:
Attendees at the workshop were asked to think about the advantages and disadvantages of the two proposals against agreed criteria.
The table below summarises the level of stakeholder and public support for each change proposal.
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As we have developed our proposals we have considered the quality and equality impact of the proposal for change for stroke services.
Through our equality impact assessment, we identified two groups of people, one of which is defined by a protected characteristic, which may be more likely to be impacted positively or adversely by this proposal.
These groups are age and those who are economically disadvantaged.
Our observations from these assessments are set out opposite. We will continue to review and develop these, including the impact on different groups of people within our population, with independent support, through our public consultation in light of the feedback we receive.
Potential positive impacts
Potential adverse impacts