Maintaining the pace of change: activities across the networks

1. Maintaining the pace of change: activities across the networks Jacqueline Briggs South West Stroke Research Network Manager

2. Overview

3. Avon, Gloucestershire, Wiltshire and Somerset Cardiac & Stroke Network Peninsula Heart & Stroke Network Dorset Cardiac & Stroke Network South West Stroke Research Network

4. Networks? An extended group of people with similar interests or concerns who interact and remain in informal contact for mutual assistance or support. A system of people or things: a large and widely distributed group of people or things such as stores, colleges, or churches that communicate with one another and work together as a unit or system The treatment, care and rehabilitation of cardiac and stroke patients involves a diverse range of organisations. The role of the Network is to bring these organisations together, with patients and carers to improve services. AGWS C&S Network Website 2011 The Clinical Research Network. Supporting research to make patients, and the NHS, better NIHR 2011

5. South West Strategic Health Authority Stroke continues to be a regional priority with good progress in part of the care pathway particularly discharge and community care Networks and the SHA are working together to try and improve performance related to Stroke vital signs particularly the sign that 80% of patients admitted with a stroke spend 90% of their hospital stay in designated stroke facilities – set out in the Operating Framework for the NHS 2011-12 Ongoing improvement in reporting systems / datasets remains the other key area of work Individual Networks also have regional priorities………………… With Thanks to:Richard Gleave - Director of Project Improvement

6. Dorset Stroke Network • Dorset Improving Psychological Support after Stroke Project(NHS improvement Pilot project) • showing significant improvements in levels and quality of psychological screening and support in the community setting utilising better collaborative working within existing teams • Direct to CT/Acute Stroke Unit pathways (RBCH) • Know Your Pulse & TIA video Campaigns: the Life Channel • The Network developed 2 campaigns to raise awareness of the importance checking your pulse and TIA signs and symptoms which ran in GP surgeries across the county • Phantom Head (DCH) • The radiology department at Dorset County Hospital trained all of their radiographers in CT head using a phantom head funded through the Network DIPSS training - rehabilitation With Thanks to: Sara Leonard – Network Manager Francis Avis – PPI Lead

7. Roll out of the assessment bed (PHT) Following a successful pilot at Poole Hospital NHS Foundation Trust, the stroke assessment bed has been rolled out across the whole county Training Accreditation (UKFST) Network wide collaboration to develop three stroke training programmes (care of the stroke survivor, psychological support after stroke and managing aphasia) for out of hospital care, submitted for UK Forum for Stroke Training (UKFST) accreditation. GRASP-AF So far, the Network has recruited 36% of practices to download the GRASP-AF toolkit. Since August, Dorset has seen a 5% increase in Warfarin prescribing. Patient and Public Involvement Model Quoted as example of good practice by National Audit Office – February 2010 Presented at National UK Stroke Forum in Glasgow – December 2010 Care Quality Commission Life after Stroke Review The organisations within the Network were ranked as some of the best in the country for their stroke care in the recent CQC review Dorset Stroke Network (2) Francis Avis presenting at UKSF on PPI

8. Peninsula Heart & Stroke Network • Continuing to provide Service Improvement Managersin most key clinical / geographical areas to support local priorities and work programmes • Clinical Education Facilitators in most main Peninsula sites facilitating the implementation of stroke competencies in acute and community organisations and nursing homes – over 2000 people have received training in a number of different formats • Advising Commissionerson the local application of the NICE quality Standard • Supporting the development of pilot modelsfor Early Supported Discharge e.g. North Devon for 12/12 With Thanks to: Martin James – Network Lead Michelle Roe – Network Manager PENINSULA HEART & STROKE NETWORK

9. Peninsula Heart and Stroke Network(2) • Development of clinical guidelinese.g. Hemicraniectomy referral guidelines and providing advice on new technologies such as Direct Thrombin Inhibitors • Supporting the implementation of GRASP-AF toolin primary care • Developing information packs on AF for primary care • Management guidelines, Treatment Decision Tree, Patient decision aid for Antithrombotic Therapy. • Continued development of the Peninsula Stroke data setand facilitation of data collection • Supporting organisationsin National projects e.g. A project at the RD&E looking at increased access to TIA clinics PENINSULA HEART & STROKE NETWORK

10. AGWS Cardiac & Stroke Network • Thrombolysis • - Working collaboratively across 9 acute hospital sites has enabled AGWS Cardiac & Stroke Network to deliver 24/7 Thrombolysis in 7/9 sites. • - The Network Stroke Consultant rota supports all sites on a 24/7 basis, with Thrombolysis being delivered via all emergency departments. • - Between April 2010 and March 2011, over 200 patients received the service, about 22% doing so via the Network Stroke Rota. • Using data to improve clinical care • - The network has been working with trusts to enable the use of data collection to support improvements in clinical care. • - As part of the Accelerating Stroke Improvement Incentive Scheme Trajectoriesprogramme (ASIIST), the network asked trusts to compete to demonstrate the most improved care. • 1st place - Salisbury Foundation Trust • 2nd place - University Hospitals Bristol • 3rd place - Great Western Hospital in Swindon With Thanks to: Sunita Berry – Network Director

11. AGWS Cardiac & Stroke Network (2) • Atrial Fibrillation • A successful atrial fibrillation project has enabled the AGWS Network to claim the top spot in the National Improvement Programme for atrial fibrillation. • - 6/8 PCTs in the Network have participated with 17,569 patients have been registered with the GRASP-AF tool. • - This is a contribution of over one-third of all patients registered on GRASP. • Early results show that between 3-5% of additional patients in the network are now receiving anticoagulation. • - Further development of the project in 2011/12 will aim to concentrate on increasing the numbers receiving anticoagulants and recording and improving the time spent in therapeutic range for patients. • Care Quality Commission Life after Stroke Review • - PCTs in the AGWS network performed particularly well. • - 6/8 PCTs were classed as being amongst the best of the 152 PCTs reviewed. • - One PCT was judged as better and another, fair. • - Swindon PCT which was ranked 15th in the national survey

12. Recruitment From April to March 2010/11 83% into category 3 RCT’s Involved with expanded area 1008 B A S E L I N E 112 300 476 555 1008 81.6% increase overall - 59% in original area - 152% in expanded area

13. Royal Devon and Exeter site team win the Pharma Times Clinical Research Site of the Year award Jan 2011

14. ‘The contribution from SW sites (to the IRIS study) Bath, Torbay, Bournemouth has been fantastic with these three sites accounting for 50% total UK randomisations’ Professor Gary Ford – SRN Director

15. 1008 in total – April to March 2010/11 32% SoS 12% LotsCare 12% Clots3 Stroke Oxygen Supplementation Study - A randomised controlled study of the benefits and risks of routine oxygen treatment after acute stroke Clots 3 – A randomised Trial to establish the effectiveness of intermittent pneumatic compression to prevent post stroke DVT LotsCare – Evaluating the clinical and cost effectiveness of a patient and carer centred system of Longer Term Stroke Care delivered by a single stroke care coordinator

16. Patient, Carer and Public Involvement • PCPI Lead – Tim Ayers – Nurse Consultant and PCPI coordinator Gwenda Pay • Integrated into network activities and structure • Four lay members on both the management group and PCPI Working Group that oversees network PCPI activities • Database of over 160 people commenting on our activities and research in the region • Wider opportunities for lay members to work with e.g. Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC) and the Stroke Association to help promote stroke research Members of PCPI working Group at a recent meeting

17. Examples of studies developed in the south west Working with the Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC – part of NIHR) 1. The ReTrain Study of effectiveness and cost effectiveness of Action for Rehabilitation from Neurological Injury (ARNI) for survivors six months on from stroke: exploratory and multi-centre pragmatic randomised clinical trial comparing ARNI individual, ARNI group and usual care. 2. Stroke Thrombolysis project – constructing a model that predicts the population benefit from Thrombolysis and a similar model to support improvements in hospital delivery of Thrombolysis Reach to Grasp ProjectDr Ailie Turton – University of the West of EnglandFunded and currently in set up

18. Summary of our development……

19. People to thank….. • The SW SRN and Peninsula Heart and Stroke Network clinical lead, Dr Martin James for his continuing support, leadership, patience and encouragement • The three lead practitioners for the SWSRN Leigh Barron, Liz Whelan and Anna Orpen, and good luck to Leigh later this month as she gets married! • To the management group of the SWSRN and the SW Networks Clinical Lead and Managers group for help with organising this event • To the session chairs • To everyone involved in supporting network activities, both clinical and research across the area and to the stroke patients who take part in our activities and studies

20. We are all trying to maintain the pace of change….