Improving care after stroke an overview of the London stroke Strategy Nick Losseff

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Improving care after stroke an overview of the
London stroke StrategyNick Losseff
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Case for change

• More than 11,000 Londoners suffer a stroke each
  year.
• One person every hour admitted to a London
  hospital one in six dies.
• Second-highest cause of death in London.
• Most common cause of adult disability in London.
• UK has almost double the number of deaths that
  occur in France.
• Evidence shows patients 25 more likely to
  survive or recover if treated in a specialist
  centre.
• Variation in rates of death in different London
  hospitals and people in outer London have most
  limited access to high-quality stroke services.

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Model of care

• Pathway
• POPULATION BASED SOLUTION
• By ambulance to nearest HASU, located no more
  than 30 minutes away.
• Assessment by specialist, access to a CT scan and
  thrombolysis (if appropriate), all within 30
  minutes.
• Admission to a HASU bed high-dependency care for
  the first 72 hours following admission.
• Once stabilised, transfer to a local stroke unit
  for rehabilitation and discharge into appropriate
  community care.

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Healthcare for London

• Stroke is only an exemplar
• Trauma
• Polysystems
• Maternity
• Cancer
• Cardiovascular
• Mental Health

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Darzi vision

• Reorganisation of provision - transformational
• Inequality
• Reliance on hospitals
• Fragmentation
• Duplication
• London is littered with failed strategies

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Financial problems

• Looming winter (paralysis)
• Can we afford to do it ?
• Cannot afford not to

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Drive

• Informed commissioning
• Patient engagement
• Clinical engagement
• Organisational altruism

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Pace of change
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HASUs
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SU and TIA services
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The Practical Front

• The whole pathway
• Awareness
• Prevention
• Rehabilitation
• Care

• Right place at the right time
• Networks
• Incentivise behaviour
• More to do

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Vulnerable areas

• Manpower

• Geographic

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Rehabilitation

• Networks have undertaken review
• Indentify gaps
• Need more than there is not enough
• Responsive flexible quality appropriate
  provided

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Value for money

• Uplift 23 M
• London cost 180 M
• Clearly we need to get better value for money
  from the NHS, so we applaud any drive for greater
  efficiency, but it is extraordinary to take an
  axe to the hospital budget rather than to the
  bloated health bureaucracy Andrew Lansley

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Saving as opposed to growth

• Top quartile performance by everyone would save ½
  of what is needed
• Productivity / Innovation
• No shortage of good practice

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Conclusion Quantum leap