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“Setting up great stroke units may need painful decisions ”

The launch of the National Stroke Strategy in 2007 enabled those of us working in stroke care to start making changes to improve stroke care and stroke services. The follow-up Progress in Improving Stroke Care report published in 2010, showed that while we were improving nationally there was still so much more that we could do.

The launch of the National Stroke Strategy in 2007 enabled those of us working in stroke care to start making changes to improve stroke care and stroke services. The follow-up Progress in Improving Stroke Care report published in 2010, showed that while we were improving nationally there was still so much more that we could do.

So how do we provide the best possible care that includes all the standards set out by the stroke strategy? To most, it involves establishing a fully functioning, 24/7 centre of excellence that provides all the staff and facilities required to deliver excellent stroke care.

However the reality is very different. Developing these services is costly and with the NHS in its current financial climate, trusts are trying to save money, not spend it. The situation is further complicated by stroke services being split over a number of hospital sites or bordering hospital trusts.

Often the outcome is to restructure and amalgamate services, to potentially save money and become more efficient, by condensing the stroke pathway either by reducing or removing services from some places. This can be done across a number of trusts or, in larger trusts, across multiple sites to provide one main site for development.

Naturally, this causes upset to the staff involved and to the patients themselves. For nurses the first question is: will I lose my job? No one should lose their job but they should be prepared for a change of role or environment.

With restructuring services, the pathway will change but it can provide opportunities. For example, a reduction in beds can save money, which can then be used to implement and develop an early supported discharge team or to establish nurse-led transient ischaemic attack clinics. However, the biggest and most important question should be: what will happen to my patients? How will they benefit?

There is always a battle for local services for local people, with the general public protesting against any potential closures or changes to their services. But, to me, the principle of right patient, right bed, right treatment will always outweigh the need for services to be local.

What in fact makes a service local? Is it a 10-minute, 20-minute or a one-hour commute? We all have an idea on the amount of time it is acceptable to travel for treatment. Now, think about that time in terms of the actual treatment you will receive.

Is 10 minutes to the nearest hospital that may or may not have the stroke services you require so important? Or is 30 minutes to the larger, neighbouring hospital that offers 24/7 access to hyper-acute stroke care including CT scans, thrombolysis and a bed on the acute stroke unit more acceptable? I need to know that, if I or one of my family have a stroke, that we will receive the best possible care and treatment. If that means a change in services to develop a centre of excellence, I know which outcome I’m backing.

Rachael Jones is a senior sister in stroke at Solihull Hospital, Heart of England Foundation Trust

Readers' comments (2)

  • Move to East Kent, Rachael, we will look after you!

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  • Sunderland too has 24/7 access to hyper-acute stroke services. The unit can cater for up to 36 patients. We have dedicated CT, MRI and dopplar slots. The North East is also an option!

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