How services are currently delivered in South Tyneside and Sunderland
Until recently, we offered a full range of stroke services in both South Tyneside District Hospital and Sunderland Royal Hospital – this covered everything from emergency treatment and specialist stroke nurse practitioners to rehabilitation support and out-of-hours community care. However South Tyneside services have temporarily been relocated to Sunderland due to staff shortages.
The potential service changes relate specifically to hospital service provision. Community-based rehabilitation services will continue to be provided in both South Tyneside and Sunderland.
Why do stroke services need to change?
Although stroke services across South Tyneside and Sunderland generally provide a safe standard of care, provision can differ across the region, with some areas falling short of national guidelines. To ensure a consistent service we need to address a number of challenges:
- low staffing levels and inefficient working arrangements are making it difficult to make much-needed clinical quality improvements
- to improve compliance with national stroke clinical guidelines so that patients are assessed and treated as quickly as possible
- work towards national expectations to deliver seven-day stroke hospital services, with specialist acute stroke centres treating a minimum of 600 patients each year
In a national audit of stroke services carried out by the Royal College of Physicians, stroke services across the country are rated on a scale of A-E. The most recent audit rated our stroke services as level ‘D’. This means that improvements are required in a number of areas – many of which are related to staffing.
Quality of care and number of patients
When doctors see a wide range of cases in sufficient volumes they maintain their clinical skills and, as a result, improve the outcomes for patients. This is known as ‘critical mass’. The Royal College of Physicians recommend a critical mass of 600 patients per year for stroke cases. Over the past few years neither of our areas hasreached the critical mass. Last year South Tyneside treated 283 cases and Sunderland was just short of the target at 569.
Temporary changes to stroke services
In South Tyneside we have been trying to recruit more senior medical staff into the acute stroke service since 2014 but a local and national shortage of stroke specialists means we have not succeeded in filling the vacancies. Given how vulnerable this left the service, all acute stroke care was temporarily centralised at Sunderland Royal Hospital in 2016. This difficult decision was made to improve care until we could develop proposed solutions and carry out this public consultation.
Developing the stroke services options
As part of the temporary changes to hospital stroke services in 2016 we talked to representatives of different clinical groups and patients and carers with experiences of local stroke services. As a result, we felt that locating all elements of stroke care onto a single hospital site was the best way to address local workforce and quality challenges.
The temporary changes have been effective. It has resulted in shorter hospital stays and improved access to a dedicated stroke bed for patients. Stroke clinicians tell us that they are able to provide better patient care under this model but when looking at the longer term we are also considering two alternative options. These options would offer South Tyneside stroke patients the opportunity to be cared for at their local hospital following an initial period of care at Sunderland Royal Hospital whilst their condition is at its most serious.
When considering options we took into consideration the following:
- clinical quality improvements
- staffing levels
- health outcomes of patients
- travel time to the stroke unit
Useful website links
Link to Sentinel Stroke National Audit Programme (SSNAP) data: https://www.strokeaudit.org/results/Clinical-audit/Clinical-CCG-LHB-LCG.aspx
NICE (National Institute for Health and Care Excellence) guidance on the diagnosis and treatment of stroke: https://www.nice.org.uk/guidance/cg68
NICE (National Institute for Health and Care Excellence) stroke patient pathways: https://pathways.nice.org.uk/pathways/stroke