Summary report on the National Sentinel Stroke Audit 2001/02

National Sentinel Stroke Audit Phase 1 Organisational audit 2008

Report for England, Wales and Northern Ireland

Prepared on behalf of The Intercollegiate Stroke Working Party

Royal College of Physicians of London

August 2008

TABLE OF CONTENTS Title Page Table of contents 2 Report authors 3 Glossary 4 Definitions 6 Executive Summary including Priority Findings and Recommendations for Action 9 Chapter One – Background and presentation of results 19 Chapter Two – Organisation of Stroke Care Nationally as at 1 April 2006 20 Chapter Three – Organisation of Stroke Care by domains 27 Domain 1 Acute Stroke Care Organisation 28

Domain 2 Organisation of Care 31 Domain 3 Consultant physician time (overall) 34 Domain 4 Interdisciplinary Services (Stroke Units only) 35 Domain 5 TIA/Neurovascular services 36 Domain 6 Continuing Education and research in stroke 38 Domain 7 Team working –Team meetings 40 Domain 8 Communication with Patients and Carers 41 Scanning services 42

Chapter Four – National results by region 43 Appendix Questionnaire used for data collection

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NATIONAL SENTINEL AUDIT OF STROKE 2008 – Organisational audit REPORT PREPARED BY Mrs Alex Hoffman LCST MSc Stroke Programme Manager, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians Ms Fatima Wurie BSc (Hons) National Stroke Audit Co-ordinator Clinical Effectiveness and Evaluation Unit, Royal College of Physicians Mr Robert Grant BSc DipStat Medical Statistician, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians Mr Derek Lowe MSc/C Stat Medical Statistician, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians Dr Anthony Rudd FRCP Chair of the Intercollegiate Stroke Group, Associate Director for Stroke (CEEU), Consultant Stroke Physician, Guy’s and St Thomas’ Hospital This report is a concise version of a generic format of the trust report which is available by written request to the Stroke Programme, Clinical Effectiveness and Evaluation Unit, Royal College of Physicians 11 St Andrews Place London NW1 4LE.

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GLOSSARY ABCD2 score Prognostic scores to identify people at high risk of stroke after

transient ischaemic attack. It is calculated based on: A – age ( ≥60 years, 1 point) B – blood pressure at presentation (≥ 140/90 mm Hg, 1 point) C – clinical features (unilateral weakness, 2 points or speech disturbance without weakness, 1 point) D – duration of symptoms (≥ 60 minutes 2 points or 10 – 59 minutes, 1 point) The calculation of ABCD2 also includes the presence of diabetes (1 point). Total scores range from 0 (low risk) to 7 (high risk).

Carer Someone (commonly the patient’s spouse, a close relative or a

friend) who provides ongoing, unpaid support and personal care at home

Carotid Carotid endarterectomy is a surgical procedure in which a Endarterectomy stenosis (narrowing) or ulceration of an atherosclerotic plaque

in the carotid artery is removed. CT scan A CT scan (computerised tomography) of the head.

A CT scan X-rays the body from many angles. The X-ray beams are detected by the scanner and analyzed by a computer. The computer compiles the images into a picture of the body area being scanned. These images can be viewed on a monitor or reproduced as photographs.

Domain The organisation of stroke care was divided into key areas for

summary presentation of results Inter Quartile Range The IQR is the range between 25th and 75th centile which (IQR) is equivalent to the middle half of all values Magnetic Resonance A non-invasive procedure that produces a picture of the Imaging (MRI) inside of the head without exposure to ionising radiation (X

rays) Median The median is the middle point of a data set; half of the values

are below this point, and half are above this point National Clinical A National evidence based guidelines for stroke care Guidelines For published by the Intercollegiate Working Party Stroke (2008) for Stroke third edition 2008 http://www.rcplondon.ac.uk/pubs National Sentinel National audit at a specific point in time to identify levels of Audit practice and service provision across the country National Service The NSF for older people was published in March Framework for 2001. It set national standards and service models Older People of care across health and social services for all older Department of people whether they live at home, in residential care

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http://www.healthcentral.com/mhc/top/003337.cfm

Health (NSF) or are being cared for in hospital. http//:www.publications.doh.gov.uk/nsf/olderpeople/index.htm

National Stroke Strategy A best practice guidance document published in December

2007. It is intended to provide a quality framework to secure improvements to stroke services, to provide guidance and support to commissioners and strategic health authorities and social care, and inform the expectations of patients and their families by providing a guide to high quality health/social care http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081062

Neurovascular An outpatient clinic for patients with Transient Ischaemic Clinic Attacks or minor stroke for further investigation Organisational Audit of the service organisation, particularly relevant in stroke audit due to the evidence supporting organised stroke services. Organisational The data was analysed using a formula to combine Score similar questions into an overall score for domains or key areas

in the organisation of care. A score of 100 is the optimal score Secondary Measures to prevent recurrence of the same illness prevention Stroke Research A nationally funded organisation to increase participation in Network stroke research http://www.uksrn.ac.uk/ Stroke Unit Stroke Unit Trialists' Collaboration Trialists’ Organised inpatient (stroke unit) care for stroke (Cochrane Collaboration Review). In: The Cochrane Library, Issue 3, 2004. (SUTC) Chichester, UK: John Wiley & Sons, Ltd. Thrombolysis The use of drugs to break up a blood clot Transient Ischaemic A transient ischaemic attack is less severe than a stroke Attack (TIA) in that all the symptoms disappear within a day (and often last

for less than half an hour) Trusts In the context of the UK’s National Health Service (NHS), trusts

are organisational units, eg hospital trusts, community trusts, primary care trusts or combinations thereof. In this report it usually refers to hospitals

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http://www.uksrn.ac.uk/

Definitions of models of care The definition of a stroke unit (as used in this audit) is adapted from the National Service Framework for Older People (Chapter 5) 2001: Stroke unit - a multidisciplinary team including specialist nursing staff based in a discrete ward which has been designated for stroke patients. This category includes the following sub-divisions: Acute stroke units (ASU) accepts patients acutely but discharged or transferred early (usually within 7 days). This could include an “intensive” model of care with continuous monitoring and high nurse staffing levels. Rehabilitation stroke units (RSU) which accept patients after a delay of often 2 days or more and has a focus on rehabilitation. Combined stroke units (CSU) (ie no separation between acute and rehabilitation beds) that accept patients acutely but also provide rehabilitation for at least several weeks if necessary. SUTC Key characteristics of all stroke units Five key characteristics were chosen from the Stroke Unit Trialists' Collaboration (SUTC) http://www.update-software.com/abstracts/AB000197.htm and subsequent papers, as markers of stroke unit organisation. The audit has assessed how many of these are in place. The 5 characteristics are:

• Consultant physician with responsibility for stroke • Formal links with patient and carer organisations • Multidisciplinary meetings at least weekly to plan patient care • Provision of information to patients about stroke • Continuing education programmes for staff

Criteria for judging quality of acute and combined stroke units To evaluate specifically the quality of acute and combined stroke unit organisation we determined whether the following 5 criteria were met. These characteristics are not all evidence based but were developed using the consensus of an expert working group – the Intercollegiate Stroke Working Party:

• Continuous physiological monitoring (ECG, oximetry, blood pressure) • Access to scanning within 3 hours of admission • Policy for direct admission from A&E/front door • Specialist ward rounds at least 5 times a week • Acute stroke protocols/guidelines

Early Supported Discharge Teams There are as yet no definitions as to the constitution of an ideal early supported discharge team, but the research evidence suggests that medical, nursing and therapy input are all desirable and that the team should be a specialist team for stroke and not a group of therapists providing care to a range of different clinical conditions

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http://www.update-software.com/abstracts/AB000197.htm

Useful addresses

Information about local health services for stroke patients should be available from your GP, local hospital, primary care trust, strategic health authority and local branches of the Stroke Association. You can get contact details for all these agencies from NHS Direct: www.nhsdirect.nhs.uk

Carer groups http://www.relres.org Chest, Heart and Stroke Association Scotland www.chss.org.uk Chest, Heart and Stoke Association Northern Ireland www.nichsa.com Connect www.ukconnect.org Department of Health stroke strategy http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Stroke/fs/en Different Strokes www.differentstrokes.co.uk Disabled Living Foundation www.dlf.org.uk Incontact www.incontact.org Northern Ireland Chest, Hearth and Stroke Association www.nichsa.com Patient and carer version of the Intercollegiate Stroke Guidelines third edition which incorporates the National Institute for Health and Clinical Excellence Recommendations for TIA and acute stroke www.rcplondon.ac.uk/ceeu_stroke_home.htm Speakability www.speakability.org.uk Stroke Association www.stroke.org.uk UK stroke research network http://www.uksrn.ac.uk/

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http://www.nhsdirect.nhs.uk/

http://www.relres.org/

http://www.chss.org.uk/

http://www.nichsa.com/

http://www.ukconnect.org/

http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/Stroke/fs/en

http://www.differentstrokes.co.uk/

http://www.dlf.org.uk/

http://www.incontact.org/

http://www.nichsa.com/

http://www.rcplondon.ac.uk/ceeu_stroke_home.htm

http://www.speakability.org.uk/

http://www.stroke.org.uk/

http://www.uksrn.ac.uk/

EXECUTIVE SUMMARY Background The National Sentinel Audit of Stroke has taken place on a two-year cycle since 1998. As in the previous round the results for organisation of care are being published separately from the clinical process standards. Clinical data will be collected from October 2008 and reported to trusts in February 2009. No references have been quoted in the report for reasons of space. All relevant evidence is available in the third edition of the National Clinical Guidelines for Stroke (2008) http://www.rcplondon.ac.uk and the National Stroke Strategy 2007 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081062 Aims

1. To audit against the National Clinical Guidelines for Stroke 2. To enable Trusts to benchmark the quality of their stroke services nationally

and regionally 3. To measure the rate of changes in stroke service organisation and quality of

care for stroke patients since the National Audit Office Report 4. To measure the extent to which the recommendations made in the 2006

national sentinel audit have been implemented. Participation All applicable hospitals that admit patients for stroke in England, Wales, Northern Ireland, Isle of Man and the Channel Islands took part. Participation in this audit contributes to the core standards for Healthcare Commission indicators. The total number of participating sites was 224 with 189 in England, 20 in Wales, 12 in Northern Ireland, and 3 in the Channel Islands. The data were collected between 3rd April 2008 and 2nd May 2008 and represent the organisation of services as at 1st April 2008. Organisation of the Audit This audit was funded by the Healthcare Commission and run by the Clinical Effectiveness and Evaluation unit (CEEu) of the Royal College of Physicians London. It was co-ordinated by the CEEu and data was collected within Trusts using a standardised method. Data collection was overseen at a Trust level by a lead clinician for stroke who was responsible for the quality of data supplied. The project was guided by a multidisciplinary steering group responsible for the Stroke Programme - the Intercollegiate Working Party for Stroke (ICWP) (Appendix 1). The steering group oversaw the preparation, conduct, analysis and reporting of the audit. It should be noted that the data are collected by the clinicians or audit staff from their own trusts and there is no formal external validation.

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http://www.rcplondon.ac.uk/

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081062

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081062

PRIORITY FINDINGS AND RECOMMENDATIONS FOR ACTION Summary and Recommendations For the first time since we started conducting national audit of stroke in England, Wales and Northern Ireland 10 years ago there is reason for optimism. Stroke is now high on the political agenda of all three countries and the National Stroke Strategies in England, Wales and Northern Ireland have set agendas that have wide support of the professionals involved in stroke care and if implemented should result in services that are the envy of the world. This report already shows that there has been a major improvement in the organisation of care across the whole stroke pathway since 2006 with some areas, particularly acute stroke care and the management of transient ischaemic attack, demonstrating dramatic changes. Involvement of the strategic health authorities and the cardiac and stroke networks in planning the delivery of comprehensive high quality stroke care for all is to be welcomed and will, we predict, result in continuing rapid improvements. There is however no room for complacency and the recommendations that follow identify many areas where considerably more work and commitment is needed. There are also still some individual sites delivering stroke care that still need to wake to the realisation that stroke is a treatable disease that should be recognised as a medical emergency and that patients with residual disability need high quality rehabilitation services and longer term support. For those services that are struggling to make effective change there are a number of mechanisms to assist them. The Royal College of Physicians in partnership with the British Association of Stroke Physicians and the Stroke Association offer peer review visits and the Stroke and Cardiac Networks have staff that can provide help in engineering change. Hyperacute Stroke Care If patients with stroke present to a specialist service rapidly then there is a better chance that they will receive appropriate treatment that will reduce longer term disability (thrombolysis, better control of unstable physiology and prevention of early complications). In order to achieve this there needs to be better public and professional awareness of the symptoms of stroke and how to respond when it does occur. There needs to be an educated and responsive paramedic service and well organised care for the patient when they arrive at the hospital. Thrombolysis for stroke is highly effective but only if given to the right patients in the right way. There are major risks of introducing thrombolysis if the service is not organised to deliver high quality acute care by physicians and nurses trained and experienced in identifying which patients are appropriate and then carefully monitoring its delivery. We would plead that hospitals do not rush into providing thrombolysis before the other components of the service are functioning well. There are greater benefits to the stroke population as a whole by having an effective acute stroke unit delivering ‘basic’ stroke care than by having a thrombolysis service without the other components. This audit unfortunately suggests that in some cases thrombolysis may have been introduced too early.

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Key findings from the audit

• The number of units providing thrombolysis for stroke is increasing rapidly. 86 units in England say they provide thrombolysis and 10 have arrangements with a neighbouring hospital, however 31 of these have actually treated 3 or fewer patients over the last year with 10 units not actually having treated anyone. Therefore about 30% of all sites could be said to be actively thrombolysing.

• Many units have only just set up their services so it is to be expected that

when the audit is conducted again in April 2009 the numbers will have increased considerably. Very few units 13 (7% of 183) in England treated more than 20 patients. Provision of thrombolysis in Wales remains very low. However stroke care in Wales is now high on the list of political priorities and it can be expected that major improvements will be seen over the next two years. A total of 870 patients received thrombolysis in England, Wales and Northern Ireland in the last year which represents about 0.8% of stroke admissions. While still very low this number has increased four-fold since the last audit in 2006.

• National guidelines recommend direct admission of stroke patients to an

acute stroke unit. This model is only used in 16% of hospitals with 81% going to a generic admission unit. This is second best. It is unlikely that such units are always going to have access to the essential specialist stroke nursing that is so important in the management of acute stroke. This is particularly important where patients are being given very high risk treatment such as thrombolysis.

• There are increasing numbers of hospitals with acute stroke beds. 96% of

hospitals in England offer specialist acute stroke care with 54% having an acute stroke unit and 47% a combined stroke unit. The figures are much lower in Wales and Northern Ireland. The 5 acute criteria used by the audit to assess the intensity of care provided in these units are not all evidence based but have been derived from the expert opinion of the Intercollegiate Stroke Working Party. With only about 40% of units providing all 5 of the acute criteria it is perhaps time that nationally agreed criteria to define the type of care that a patient can expect to receive on admission to an acute stroke bed be developed.

• While thrombolysis services are increasing rapidly the total number of

patients receiving treatment remains low. We should be aiming for at least 10% of stroke admissions being thrombolysed nationally This is the level that many centres in America, Australia and Mainland Europe achieve, as well as some centres inmthe UK. It is vital however that this is delivered safely by experienced teams. Given that a number of hospitals are using non stroke specialist staff to deliver thrombolysis there should be a mechanism in place to ensure that those people on the rota have the appropriate expertise to give the treatment safely.

• The number of units offering a 24 hour seven day a week thrombolysis

service remains low. It is likely given the relatively small number of clinicians available to deliver the treatment that this will only be achieved by centralising hyper-acute stroke care in a small number of units. One way of increasing access to specialist care to deliver acute stroke assessment and treatment is through the use of telemedicine both to view brain scans and to assess the


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patients clinically. A significant number of hospitals now provide access to their Patient Archiving and Communication System (PACS) remotely but development of remote clinical assessment remains rare.

• The rate of improvement in the development of arrangements with ambulance

services for the management of stroke patients is striking. It is surprising however that so many sites that are offering thrombolysis have not discussed the plans with the paramedic service and organised for the patients to be brought rapidly to hospital

Recommendations

1. All patients with acute stroke should be admitted directly to an acute stroke unit equipped and staffed to be able to deliver high quality care

2. Thrombolysis should only be provided when all the other components of acute stroke care are of high quality

3. Definitions for high quality acute stroke care should be agreed and regularly audited

4. All patients receiving thrombolysis should be prospectively audited to monitor the quality of the process of care and outcomes.

5. Paramedic services should be seen as an integral part of the acute stroke service and should be involved in the design and delivery.

Imaging All patients with suspected stroke should have brain imaging and in the majority of cases this needs to be conducted rapidly - within 24 hours after admission. For the majority CT scanning is sufficient however some stroke patients will require MR imaging and this needs to be readily available. Patients with TIA who need brain imaging should wherever possible have MR rather than CT. For high risk patients (ABCD2 score of 4 or more) this should be performed along with carotid imaging within 24 hours of the onset of symptoms. Key findings from the audit

• All hospitals now provide CT scanning and the vast majority also MRI and carotid doppler. There remains a problem in providing rapid access to brain imaging particularly outside normal working hours and at weekends although there has been some improvement since 2006 particularly for CT scanning and carotid doppler. Access to imaging continues to present a major barrier to the delivery of high quality care to all stroke patients.

• With new standards being set for the urgent management of TIA, which

require access to MRI and carotid imaging within 24 hours for high risk patients there will need to be a major reorganisation of imaging facilities to ensure that these standards can be met.

Recommendation

1. All hospitals managing stroke and TIA patients need to ensure they comply with the recommendations in the NICE guidelines for Acute Stroke and TIA and the recent Department of Health document on Imaging patients with stroke (Implementing the National Stroke Strategy – an imaging guide DH 2008)

Stroke Units Stroke unit care is the single most beneficial intervention that can be provided. The precise components of care that make stroke units effective are still debatable but


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there is consensus over some of the key features that have been used in this audit to try to define quality. Key findings from the audit

• The number of stroke units and the size of those units has been steadily increasing with time. There is now nearly universal stroke unit provision in England and a small increase in Wales since 2006. There has also been a slight increase in the size of stroke units in England from a median of 24 to 26 beds and a median of 1 bed per stroke in-patient on the day the audit form was completed.

• 7% (15/207) of hospitals providing stroke unit care only provide rehabilitation

stroke unit beds. Nationally, there are 1445 ASU beds, 2262 RSU beds and 2109 CSU beds, making 5816 stroke unit beds of any type up from 5523 in 2006. Nationally, on the day of audit there were 6177 stroke patients on site, and there were 5816 stroke unit beds, an overall ratio of 0.94 beds per stroke patient. If this ratio is calculated for each site the site median was 1.00 (n=207 sites, IQR 0.87 – 1.20), up from 0.77 in 2004 and 0.89 in 2006.

• Nationally, on the day of audit there were 275 TIA patients on site, and 5816

stroke unit beds, an overall ratio of 0.89 beds per stroke and TIA patient. If this ratio is calculated for each site the site median was 0.97 (n=207, IQR 0.84 – 1.15).

• Therefore overall there were 6452 patients with either stroke or TIA in hospital

in England, Wales and Northern Ireland on the day of the audit. 1502 of these patients were not in a stroke unit bed (23%). Nationally 15% (866/5816) of stroke unit beds did not have stroke or TIA patients in them. This suggests that there is the nonsensical situation of stroke unit beds being occupied by non stroke patients while the stroke patients are somewhere else less appropriate within the hospital. There are nearly enough stroke unit beds nationally to accommodate all stroke patients (Maybe a little bit of common sense and simple management skills could make a major difference to patient outcomes).

• Improvements are evident in multidisciplinary working with more professions

attending the meetings and every unit holding multidisciplinary meetings at least weekly. Stroke units have clearly made considerable efforts to improve the quality of care they provide with the majority now meeting the 5 SUTC characteristics used in the audit to define quality.

• Of particular concern is the large number of rehabilitation stroke units that

exclude patients on the basis of them having no rehabilitation potential (50/56). There are very few stroke patients that will not benefit in some way from the expertise of a stroke unit. Even those who are likely to require institutional care may benefit from interventions that may improve their longer-term quality of life. Such as provision of appropriate seating, management of continence and prevention of common complications such as spasticity and contractures. Judging a person’s rehabilitation potential is anyway fraught with difficulty when performed early after a stroke. The Stroke Unit Trialists’ Collaboration (SUTC) data suggest that all patients benefit from specialist stroke unit care regardless of age, sex or stroke severity. Therefore if a hospital has sufficient beds of the appropriate type then there is no justification for selecting patients.


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• Where there is weekend rehabilitation provided (19% of all sites) this is provided largely by rehabilitation support workers rather than qualified therapists.

Recommendations

1. All stroke patients (except those requiring higher level care such as ITU) should be managed on a stroke unit

2. Hospitals should rapidly rectify the situation that there are patients without stroke occupying beds on the stroke unit while stroke patients are managed off the unit

3. Stroke services should urgently review policies that exclude certain groups from admission to the stroke unit. The most prevalent reason stated was ‘no rehabilitation potential’. There is no evidence to support such a policy and patients perhaps most likely to benefit from stroke unit care and most likely to be harmed by inexperienced care are being denied appropriate assessment and treatment

4. Stroke services should be regularly monitoring the quality of care they are providing against the standards identified in National Clinical Guidelines and the National Stroke Strategy

5. Development of seven day rehabilitation services should be made a priority

Staffing The number and quality of staff managing stroke patients is the most important factor in the delivery of high quality care but defining appropriate staffing levels is difficult. Recommendations are available for medical consultant provision but there is less information available for nurses and therapists. Key findings from the audit

• Virtually all hospitals now have specialist consultant input to their stroke service. The median number of consultant sessions in England has increased by two since 2006.

• Nurse staffing ratios are improving slowly as are all the therapy profession

posts The striking statistic for nurse staffing in acute stroke units is that there is a median of 1.8 (IQR 1.5-2.5) qualified nurses per 10 acute stroke unit beds. This is far too low for a group of patients who should be receiving level 2 (equivalent to HDU) nursing care. The recommended number should be 5 qualified nurses. There is in addition a median of 1.7 care assistants, however the role of unqualified staff in such an acute setting is limited. There are wide variations between units which are unlikely to be explained solely by differences in case mix. Overall there has been a small increase in total staff in line with the increase in stroke beds.

• There remain quite wide variations in the level of staffing by nurses, doctors

and therapists on stroke units. The most striking observations are the dire shortage of psychology services (needed to define cognitive deficits, to work with other professionals to maximise rehabilitation potential, to help with the management of mood disorders and provide support to patients and carers dealing with a major life event), orthotics (essential for the provision of aids for rehabilitation) and podiatry. We have not obtained data on the provision of orthoptic services but there is no doubt that they are in short supply as well when needed to assist with visual defects commonly associated with stroke. Dietetic services, although at least registering a presence in the data, are also insufficient given that up to half of stroke patients will have difficulties with


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swallowing and malnutrition is a common consequence of stroke with a major negative impact on recovery.

• The more mainstream therapies (physiotherapy, occupational therapy and

speech and language therapy) are also likely to be underprovided. There is considerable research evidence to show a link between the intensity of rehabilitation provided after a stroke and the amount of recovery. Current staffing levels would not for example permit 45 minutes of rehabilitation from each specialty to each patient requiring input per day. This should be the minimum level of treatment that is provided on stroke units.

• Provision of a social worker who has specific responsibility for the stroke unit

and is therefore able to work as a full member of the multidisciplinary team is essential. It is not provided on nearly a quarter of stroke units in England and half in Wales. As in previous years Northern Ireland out-performs the other countries in this aspect.

• One third of stroke services now have access to clinical psychology services

although usually at very low levels of intensity. There is virtually complete coverage with physiotherapy, speech and language therapy and occupational therapy. Provision of a 7 day service for any of these specialists is rare with only 5% of services offering a 7 day physiotherapy service and even less for OT and SALT.

• Nearly all hospitals (98%) now have a consultant with specialist knowledge of

stroke. The median number of sessions is only 6 (IQR 4-10) compared to the recommendation from the British Association of Stroke Physicians for an average district of 20. The number of training posts remains low but is growing fast, aided by the direct funding of a number of posts by the Department of Health.

• The numbers of stroke specialist roles in nursing and therapy are increasing.

71% (160) had either a stroke co-ordinator or stroke specialist nurse, or both. 23% (51) had none of the five specialists. Six sites had 4 out of 5, nobody had all five. There needs to be an expansion in specialist staffing so that there is at least one non medical stroke specialist in each trust.

Recommendations

1. Levels of nurse staffing on acute stroke units needs to be increased in many units to provide the intensity of supervision and care that patients require in the first day or two of their admission. It is suggested that a ratio of one nurse to two patients should be the target for acute stroke units as it is for High Dependency Units. This applies to acute stroke units not delivering thrombolysis as well as those that do.

2. All stroke teams should have sufficient access to clinical psychology, orthoptics, orthotics, dietietics and podiatry to meet the needs of their patients. The audit suggests that there is a considerable investment needed for these specialties

3. Social worker involvement as an integral part of the stroke team is essential and should be mandatory for every stroke service


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Community Stroke Care The transition of care between hospital and the community is an aspect of stroke care organisation that is at risk of being neglected while acute stroke care is being developed. It is however vital not just to meet the needs of the patient being discharged home but also to ensure that the in-patient facilities are available for those people that need them most during the acute phase of the illness. Key findings from the audit

• There is strong evidence to support the use of early supported discharge to save resources as well as improve clinical outcomes. It is a model strongly supported by the National Stroke Strategy. Only a third of services in England, 58% for Northern Ireland and only 10% in Wales have such a service. This is clearly an area where there needs to be further investment in the short term to produce longer term savings.

• Only 23% of the 70 early supported discharge teams that are in existence

have the minimum staffing complement for effective care based upon the models that have been tested in randomised controlled trials (specialist doctor, nurse and two of the three therapists)

• 70% of sites have a specialist team for post discharge rehabilitation (not early

supported discharge). However when asked to define the composition of these teams it emerged that 30% were staffed only with generic therapists and cannot therefore be defined as specialist teams. Therefore according to our calculations only 49% of all sites have specialist post discharge teams.

• One area where service provision often seems to fail people is in enabling

patients of working age to get back to work. 43% of sites do not provide access to specific vocational training

Recommendations

1. Early supported discharge services should be made available for all patients

2. There should be adequate services staffed by professionals experienced in the management of stroke to provide longer term care for patients with stroke in the community

Discharge Planning and Involvement of Patients and Carers in Management Expert patients and carers are more likely to be more satisfied with their care and be able to access the appropriate services. For many carers looking after someone with stroke is extremely stressful and levels of physical and psychological morbidity are much higher than in age matched populations. It is therefore important that information and training are provided to all patients and carers throughout the course of the illness. Key findings from the audit

• Most, though not all, stroke units provide patients and carers with information to enable them to understand their stroke, treatment options and how to access the care that they might benefit from. With the increasing centralisation of care on stroke units it does appear that those patients not fortunate enough to be provided with stroke unit care are being neglected in some of the most basic aspects of management.

• Most discharge summaries include the key pieces of information that primary

care will need in order to ensure that there is effective continuity of care. It is


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surprising that only two-thirds of patients are given a copy. There is no reason why this should not be routine practice.

• There has been a growth in the number of community user groups and

systems in place to enable users to have a say in the way that services are delivered.

• Only 44% of units have surveyed patient views on the service over the last

year. Such surveys can provide invaluable information on how care can be improved and should be conducted on a regular basis.

• Year on year improvements are seen in all aspects of care relating to

communication. There remain some units where there appears to be resistance to making relatively easy changes that can have a major impact on the quality of care a patient receives

Recommendation

1. All trusts should have active user involvement in developing, running and monitoring their stoke services

2. Particular care should be given to providing information to patients and carers in an appropriate format

Neurovascular Services Following a TIA there is a high risk of a completed stroke within the first month, with the highest risk being in the early days. It is therefore important that appropriate secondary prevention is started as soon as possible. Key findings from the audit

• There has been an impressive improvement in the delivery of care for patients with TIA over the last two years

• There has been a big expansion of neurovascular services since the 2006

audit with 94% of sites offering a service and with a median of 2 clinics per week. The median waiting time is down to 7 days. Although much improved there is still a need to increase speed of access for high risk patients with less than half the services being able to see and manage high risk patients within 24 hours. For those that cannot achieve this target nearly half will take a week or longer with some running to many weeks.

Recommendation

1. All services managing patients with TIA should have systems in place that are able to see and implement management plans in line with the recommendations in the National Stroke Strategy and the NICE guidelines for Acute Stroke and TIA. That means being able to deal with high risk patients within 24 hours and lower risk patients in a maximum of a week

Training Continuing professional development is vital for all staff working with stroke patients. It is a field where there is a rapid expansion in evidence both in the area of service organisation and for individual treatments. Continuing education is also important for the retention and recruitment of high quality staff


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Key finding from the audit • Most stroke units offer training to their staff in the management of stroke.

However given that many stroke patients are still being managed outside stroke units there is still a need to keep the non specialist staff trained in stroke care. Only 54% of units provide such training.

Recommendation

1. The training needs of staff in stroke management should be met for all staff caring for stroke patients, not just those working on the stroke unit

Research Stroke research lags behind many diseases despite its importance in terms of impact on the population and its use of resources. The Stroke Research Network has now been operational for two years and has raised the profile of stroke research considerably. Not only is it important to increase the evidence base for stroke treatment but there is plenty of evidence to show that research active sites deliver higher quality clinical care than those who do not participate. Key findings from the audit

• The levels of participation in stroke research remains low although it is encouraging that about three quarters of all units in England and Northern Ireland are involved in at least one study. Stroke research in Wales is less well developed.

• The Stroke Research Network is clearly having an impact on research

activity. The percentage of hospitals with three or more studies in total almost doubled from 22% in 2006 to 41% in 2008. There is still capacity for expansion with one third of sites not contributing any research activity. It is striking how few therapists and psychologists are undertaking any research.

Recommendation

1. Research should be an integral part of all stroke services and there should be encouragement and resources provided to enable therapists to become more research active


17

Top Ten Recommendations

1. All patients with acute stroke should be admitted directly to an acute stroke

unit equipped and staffed to be able to deliver high quality care 2. Thrombolysis should only be provided when all the other components of

acute stroke care are of high quality 3. All hospitals managing stroke and TIA patients need to ensure they comply

with the recommendations in the NICE guidelines for Acute Stroke and TIA for imaging and the recently published document from the Department of Health on Imaging after Stroke and TIA

4. Development of seven day rehabilitation services should be made a priority 5. Stroke services should urgently review policies that exclude certain groups

from admission to the stroke unit. The most prevalent reason stated was ‘no rehabilitation potential’. There is no evidence to support such a policy and patients perhaps most likely to benefit from stroke unit care and most likely to be harmed by inexperienced care are being denied appropriate assessment and treatment

6. Hospitals should rapidly rectify the situation that there are patients without

stroke occupying beds on the stroke unit while stroke patients are managed off the unit

7. Levels of nurse staffing on acute stroke units needs to be increased in many

units to provide the intensity of supervision and care that patients require in the first day or two of their admission. This applies to acute stroke units not delivering thrombolysis as well as those that do

8. Social worker involvement as an integral part of the stroke team is essential

and should be mandatory for every stroke service 9. Early supported discharge services should be made available for all patients 10. All services managing patients with TIA should have systems in place that are

able to see and implement management plans in line with the recommendations in the National Stroke Strategy and the NICE guidelines for Acute Stroke and TIA. That means being able to deal with high risk patients within 24 hours and lower risk patients in a maximum of a week


18

chapter 1 BACKGROUND AND PRESENTATION OF RESULTS Background to the national sentinel stroke audit The National Sentinel Audit of Stroke has taken place on a two-year cycle since 1998. As in the previous round the results for organisation of care are being published separately from the clinical process standards. Clinical data will be collected from October 2008 and reported in February 2009. No references have been quoted in the report for reasons of space. The audit compares the service organisation with standards derived from research evidence for organisation of stroke care delivery set out in the National Clinical Guidelines for Stroke 2004 (website www.rcplondon.ac.uk/pubs/books/stroke/index.htm) Further information on methods can be obtained from the Royal College of Physicians. Presentation of results Chapter 2 provides a breakdown of results by country. The Islands refers to the Isle of Man, States of Jersey and States of Guernsey. Chapter 3 compares the results of the 2008 audit with the 2006 and 2004 audits for those standards where comparison is possible. Standards are grouped into domains broadly following the pattern set out in 2002. However a decision was taken to update these domains to reflect the changes in practice in acute care and TIA/neurovascular services. It will therefore not be possible to compare directly the 2008 total organisational score with scores from 2006 and 2004. Comparison will be made in terms of the quartiles sites were in for 2008 and 2006. The algorithm for the new domains and total organisational score is available on request. National results are presented as percentages, and site variation is summarised by the median and Inter-Quartile Range (IQR). Ratios of staffing numbers per 10 stroke unit beds are given rather than staffing numbers per se so as to allow an interpretation more relevant to National standards.

--------------------------------------------------------------------------------------------------- Chapter 1 Background and Presentation of results

19

http://www.rcplondon.ac.uk/pubs/books/stroke/index.htm

chapter 2 ORGANISATION OF STROKE CARE NATIONALLY All hospitals took part – the third time that 100% participation has been achieved. The total number of participating sites in 2008 was 224: England 189, Wales 20, Northern Ireland 12 and the Islands 3. Stroke Unit Provision There is now near universal stroke unit provision in England and a small increase in Wales since 2006. There has also been a slight increase in the size of stroke units from a median of 24 to 26 beds and there was a median of 1 bed per stroke in-patient on the day the audit form was completed in England. However the number of stroke units with the 5 key SUTC characteristics we are using to define the quality of a stroke unit is still not good enough

5 SUTC key characteristics of all stroke units Five key characteristics were chosen from the Stroke Unit Trialists' Collaboration (SUTC) and subsequent papers, as markers of good stroke unit organisation. The audit has assessed how many of these are in place. These will be referred to in the document as the 5 SUTC characteristics and are:

• Consultant physician with responsibility for stroke • Formal links with patient and carer organisations • Multidisciplinary meetings at least weekly to plan patient care • Provision of information to patients about stroke • Continuing education programmes for staff

Table 1 Stroke Unit Provision in UK hospitals All sites

(224) England

(189) Wales (20)

N. Ireland (12)

Islands (3)

% of sites with stroke unit 2008

91% (207/224)

96% (186/189)

45% (10/20)

92% (11/12)

0 (0/3)

% of sites with stoke unit 2006

92%

98%

50%

92%

33%

Median (IQR) number of stroke beds in stroke units per site 2008

26 26 (20 – 36) (n=186)

19 (10 – 30) (n=10)

18 (11 – 24) (n=11) -

Median number of stroke beds in stroke units 2006 24 24 20 12 8

% of sites with stroke units who have all 5 SUTC Key Characteristics

72% (150/207)

73% (135/186)

80% (8/10)

64% (7/11)

N/A N/A

Ratio: Median (IQR) number of stroke unit beds per stroke inpatient (on site on the day the audit form was completed)

1.0 (0.87-1.20) 1.0 (0.88 – 1.18) 0.84 (0.65 – 1.16) 1.10 (0.87 – 1.36) N/A

--------------------------------------------------------------------------------------------------- Chapter 2 Organisation of stroke care nationally

20

Acute and combined stroke units 96% of hospitals in England and 92% in Northern Ireland offer specialist acute stroke care with 54% having an acute stroke unit and 47% a combined stroke unit. The figures are much lower in Wales (29%). Less than half the units in England offer all of the 5 acute criteria used to define the quality of acute units.

The 5 acute critera for acute and combined stroke units are:

• Continuous physiological monitoring (ECG, oximetry, blood pressure) • Access to scanning within 3 hours of admission • Direct admission from A&E/front door • Specialist ward rounds at least 5 times a week • Acute stroke protocols/guidelines

9 sites, 6 in England and 3 in Wales only provided rehabilitation services and were excluded from the denominator

Table 2 acute stroke unit and combined stroke unit provision in UK hospitals

All sites

England

Wales

N. Ireland

% of sites with acute stroke unit 50% (108) 54% (99) 29% (5) 33% (4)

Median (IQR) number of stroke beds in acute stroke units per site

12 (6-17) 12 (8-19) 10 (6-16) 9 (5-17)

% of acute units beds with all 5 acute criteria

44% (631/1445)

43% (575/1351)

41% (22/54)

85% (34/40)

All sites

England

Wales

N. Ireland

% of sites with combined stroke unit 44% (94) 48% (87) 0% (0) 58% (7)

Median (IQR) number of stroke beds in combined stroke units per site

21 (16-25) 23 (18 - 28) - 12 (10-18)

% of combined stroke unit beds with all 5 acute criteria

40% (835/2109)

41% (823/2013)

- -

13% (12/96)

% of sites with an acute or a combined stroke unit 2008 86% (192) 96% (176) 29% (5) 92% (11)


21

Whole Time Equivalents (WTE) for staff on stroke units These data are presented as ratios of staff per ten stroke unit beds There remain quite wide variations in the level of staffing by nurses, doctors and therapists on stroke units. There are no data available to indicate the ‘ideal’ staffing ratios however the most striking observations are the dire shortage of psychology services (needed to define cognitive deficits, to work with other professionals to maximise rehabilitation potential, to help with the management of mood disorders and provide support to patients and carers dealing with a major life event), orthotics (essential for the provision of aids for rehabilitation) and podiatry. We have not obtained data on the provision of orthoptic services but there is no doubt that they are in short supply as well as when needed to assist with visual defects commonly associated with stroke. Dietetic services, although at least registering a presence in the data, are also insufficient given that up to half of stroke patients will have difficulties with swallowing and given that malnutrition is a common consequence of stroke that has a major negative impact on recovery. The more mainstream therapies (physiotherapy, occupational therapy and speech and language therapy) are also likely to be underprovided. There is considerable research evidence to show a link between the intensity of rehabilitation provided after a stroke and the amount of recovery. Current staffing levels would not for example permit 45 minutes of rehabilitation from each specialty to each patient requiring input per day. This should be the minimum level of treatment that is provided on stroke units.

The Islands have been removed from the table below as none of them have a stroke unit Table 3 Whole time equivalents (WTEs)* for staff in stroke units

All sites (207 sites)

England (186 sites)

Wales (10 sites)

N. Ireland (11 sites)

Median (IQR) number of qualified nurses/assistants on duty per 10 beds

3.2 (2.9-3.8) 3.2 (2.8 - 3.8) 3.1 (2.8 - 3.3) 3.3 (3.0 – 4.1)

Median (IQR) number of junior doctor sessions per 10 beds

6.0 (4 – 9.4) 6.3 (4.0 – 9.4) 5.2 (2.8 – 10.0) 4.6 (3.9 – 6.4)

Median (IQR) WTE per 10 beds for:

Clinical Psychology 0.0 (0 – 0.7) 0.0 (0.0 – 0.1) 0.0 (0.0 – 0.1) 0.0 (0.0 – 0.0)

Dietetics 0.1 (0.1 – 0.2) 0.1 (0.1 – 0.2) 0.1 (0.1 – 0.4) 0.2 (0.1 – 0.3)

Occupational Therapy 1.0 (0.7 – 1.4) 1.0 (0.8 – 1.4) 0.8 (0.6 – 1.1) 0.6 (0.5 – 1.3)

Physiotherapy 1.3 (1.0 – 1.7) 1.4 (1.0 – 1.7) 1.1 (0.8 – 1.6) 1.2 (0.9 – 1.7)

Speech & Language Therapy 0.3 (0.2 – 0.5) 0.4 (0.2 – 0.5) 0.3 (0.2 – 0.6) 0.3 (0.2 – 0.5)

Pharmacists 0.1 (0.1 – 0.2) 0.1 (0.1 – 0.2) 0.1 (0.1 – 0.3) 0.1 (0.1 – 0.2)

Orthotists 0 (0.0 – 0.0) 0.0 (0.0 – 0.0) 0.0 (0.0 – 0.0) 0.0 (0.0 – 0.0)

Foot health / podiatrists 0 (0.0 – 0.0) 0.0 (0.0 – 0.0) 0.0 (0.0 – 0.0) 0.0 (0.0 – 0.0)

* WTEs are presented as ratios of staff per ten stroke unit beds to allow comparison


22

Access to social work expertise on stroke unit Provision of a social worker who has specific responsibility for the stroke unit and is therefore able to work as a full member of the multidisciplinary team is essential but is not provided on nearly a quarter of stroke units in England and half in Wales. As in previous years Northern Ireland out-performs the other countries. Table 4 Provision of social work expertise on stroke unit

All sites

England

Wales

N. Ireland

% with ready access to social work expertise on stroke unit

90% (207) 79% (147/186) 50% (5/10) 100% (11/11)

Other models of stroke care Information was collected on additional specialist service provision for stroke patients (see Appendix for definitions of teams and specialist roles within the audit questionnaire). Early Supported Discharge Teams and Specialist Community/Domiciliary Rehabilitation Teams There is strong evidence to support the use of early supported discharge to save resources as well as improve clinical outcomes. It is a model strongly supported by the National Stroke Strategy. Only a third of services in England, 58% in Northern Ireland and only 10% in Wales have such a service. This is clearly an area where there needs to be further investment in the short term to produce longer term savings. Table 5 Early supported discharge provision in UK hospitals

% (n) with: All sites (224)

England (189)

Wales (20)

N. Ireland (12)

Islands (3)

An early supported discharge team 31 % (70) 32% (61) 10% (2) 58% (7) 0% (0)

A specialist community/domiciliary rehabilitation team

70% (156) 72% (137) 70% (14) 33% (4) 33% (1)

Sites with generic staff only in the specialist community stroke team (ie no neuro-rehabilitation or stroke staff)

30 % (47/156)

23% (32/137)

100% (14/14)

25% (1/4)

0% (0/1)


23

Specialist medical staff Virtually all hospitals now have specialist consultant input to their stroke service. The median number of consultant sessions in England has increased by two since 2006

Table 6 Consultant physician provision in UK hospitals

All hospitals

(224)

England (189)

Wales (20)

N. Ireland

(12)

Islands (3)

% of sites with a consultant physician with specialist knowledge of stroke formally recognised as having principal responsibility for stroke services

98 (220) 98 (186) 95 (19) 100 (12) 100 (3)

Accredited specialist registrar in post registered for stroke specialist training 12 (26) 13 (24) 0 (0) 8 (1) 33 (1)

Number of formal sessions per week of consultant physician time for stroke management (including outpatient clinics) Median (IQR)

6 (4-10)

7 (5-10)

3 (2-5)

6 (4-8)

Too few to calculate

Patients thrombolysed The number of units providing thrombolysis for stroke is increasing rapidly. 86 units in England say they provide thrombolysis and 10 have arrangements with a neighbouring hospital, however 31 of these have actually treated 3 or fewer patients over the last year with 10 units not actually having treated anyone. Therefore about 30% of all sites could be said to be actively thrombolysing. Many units have only just set up their services so it is to be expected that when the audit is conducted again in April 2009 the numbers will have increased considerably. Very few units (13 (7% of 183) in England treated more than 20 patients. Provision of thrombolysis in Wales remains very low. However stroke care in Wales is now high on the list of political priorities and it can be expected that major improvements will be seen over the next two years. A total of 870 patients received thrombolysis in England, Wales and Northern Ireland in the last year which represents about 0.8% of stroke admissions. While still very low this number has increased four-fold since the last audit in 2006.

Table 7 Patients thrombolysed in UK hospitals

All sites (215)

England (183)

Wales (17)

N. Ireland (12)

Islands (3)

hospitals offering thrombolysis

42% ( 91) 47% (86) 12% (2) 25% (3) 0% (0)

Numbers of patients thrombolysed by sites in last 12 months: 0 patients 14% (13) 12% (10) 0% (0) 0% (0) 100% (3) 1-3 patients 26% (24) 24% (21) 50% (1) 67% (2) 0% (0) 4-10 patients 33% (30) 33% (28) 50% (1) 33% (1) 0% (0) 11-20 patients 15% (14) 16% (14) 0% (0) 0% (0) 0% (0) >20 patients 14% (13) 15% (13) 0% (0) 0% (0) 0% (0)

10 sites stated that they had an arrangement with another site for patients to be thrombolysed and these were all in England. 9 sites were excluded because they offer rehabilitation services only (6 in England and 3 in Wales)


24

Research studies The levels of participation in stroke research remains low although it is encouraging that about three quarters of all units in England and Northern Ireland are involved in at least one study. Stroke research in Wales is less developed.

Table 8 Participation in research in UK hospitals

All Sites (224)

England (189)

Wales (20)

N. Ireland (12)

Islands (3)

% of hospitals with ONE or more research studies

68% (152) 72% (136) 35% (7) 75% (9) 0% (0)

% of hospitals with THREE or more research studies

41% (92) 47% (88) 10% (2) 17% (2) 0% (0)


25

Organisational score A scoring system has been developed to enable Trusts to compare their organisation of stroke care with other Trusts. The scores for 8 separate components of organisation each range from 0 to 100 with 100 being the optimal score. This score is the average of 8 separate components of organisation Acute care organisation, Organisation of care, Consultant physician time (overall), Interdisciplinary Services (Stroke Unit), TIA / Neurovascular service, Continuing education in stroke, Team working (Team meetings), Communication with Patients and Carers domains. The 2008 domains differ from domains of previous rounds - the domains covering record keeping and agreed assessment measures have been removed. For further details of how the score is calculated contact [email protected] Organisation scores: Figure 1 Total organisational score 2008 in UK hospitals by country:

Organisational total score 20081009080706050403020100

Country

Wales

England

N Ireland

Islands

Figure 2 Organisation scores by region 2008 (including the SHA s for England):

Organisational total score 200810080604020

East Midlands

East of England

London

North East

North West

South Central

South East Coast

South West

West Midlands

Yorkshire and The Humber

Islands

NI: Eastern Health and Social Services …

NI: Northern Health and Social Services …

NI: Southern Health and Social Services …

NI: Western Health and Social Services …

Wales Mid and West

Wales North

Wales South East

--------------------------------------------------------------------------------------------------- Chapter 2 Organisation of stroke care regionally

26

chapter 3 ORGANISATION OF STROKE CARE BY DOMAINS A scoring system was developed in 2002 to enable trusts to compare their organisation with the national data. The optimal best score was 100 and results were presented according to 9 domains. The system was updated in 2008 and expanded to include Acute and TIA/neurovascular services. There are now 8 domains. 1. Acute Stroke Care 2. Organisation of Care 3. Consultant physician time (overall) 4. Inter disciplinary Services (for sites with a stroke unit) 5. TIA/neurovascular Services 6. Continuing Education in stroke 7. Team working –Team meetings 8. Communication with Patients and Carers This table describes how sites compared and is the basis of the tables summarising overall hospital performance tables in chapter four. Table 9 Results for each domain nationally giving median and interquartile ranges

Lower scores 2008 audit

Intermediate scores

Higher scores

D1* Acute care organisation 37% scored 0 or 17

42% scored 33, 50 or 67

21% scored 83 or 100

D2 Organisation of care 30% scored 0, 14, 29 or 43

53% scored 57 or 71

17% scored 86 or 100

D3 Consultant physician time (previously called “inter-disciplinary services, overall”)

26% scored 0 to 63

49% scored 75 or 88

25% scored 100

D4 Interdisciplinary services (Stroke Unit)

25% scored 0 - 48

51% scored 49-66

25% scored 67-100

D5 ** TIA/ Neurovascular clinic 24% scored 0 - 63

47% scored 69 - 94

29% scored 100

D6 Continuing education 23% scored 0 - 42

51% scored 50-83

25% scored 100

D7 Team meetings 25% scored 0 - 81

66% scored 88 or 94

10% scored 100

D8 Communication with patients & carers

25% scored 6 - 52

49% scored 54 - 86

26% scored 87-100

Organisational audit total score 25% scored 15 - 61

50% scored 61 - 77

25% scored 78 - 95

* The 9 rehabilitation only sites do not score on this domain. ** The 7 rehabilitation only sites which do not have a TIA service do not score on this domain. Depending on these site characteristics, a site’s total score can be the average of 6, 7 or 8 domains. The median total organisational score was 69. The inter-quartile range was from 61 to 78, the 10th to 90th centile range from 48 to 83, range from 15 to 95.

--------------------------------------------------------------------------------------------------- Chapter 3 Organisation of stroke care by domains

27

Domain 1 – Acute stroke care Description of domain This domain includes the presence of either an acute or combined stroke unit, a measure of the quality of these units (eg whether physiological monitoring is present), joint protocols with ambulance services for emergency/rapid transfer to hospitals and whether the Trust offers thrombolysis and if so, the number of patients thrombolysed in the previous six months. Evidence is strong that appropriate patients who receive thrombolysis have better outcomes than those who do not. The drug received a provisional license in Europe four years ago and following careful auditing by the SITS-MOST organisation has now been granted a full licence. Only 16% of patients are likely to be admitted directly to an acute stroke unit. 8 out of 10 are more likely to be admitted to a medical assessment unit or admission ward. Acute and Combined stroke units The rate of improvement in the development of the management of stroke patients is striking. It is surprising that so many sites that are offering thrombolysis have not discussed the plans with the paramedic service and organised for the patients to be brought rapidly to hospital Table 10 Thrombolysis provision

National 2008 (215 hospitals)

% Thrombolysis provided for stroke patients at individual site 42%

Of the 124 sites who did not thrombolyse, 10 said they had an arrangement with another trust

Table 11 Changes over time for acute provision 2004 2006 2008 % having arrangements with local ambulance service for emergency/rapid transfer to hospital for acute stroke over and above the regular system

4% 12% 49%

% where Trust offers thrombolysis at site N/A 18% 42%

Table 12 Quality of acute or combined stroke units measured by acute characteristics

Acute Stroke Unit National (116 acute stroke units)

a) Continuous physiological monitoring (ECG, oximetry, blood pressure) 75% (87) b) Access to scanning within 3 hours of admission 84% (98) c) Policy for direct admission from A&E/front door 58% (67) d) Specialist ward rounds at least 5 times a week 78% (91) e) Acute stroke protocols/guidelines 100% (116)

All 5 Acute Stroke Unit acute criteria 42% (49)

Combined Stroke Unit National

(103 combined stroke units)

a) Continuous physiological monitoring (ECG, oximetry, blood pressure) 65% (67) b) Access to scanning within 3 hours of admission 78% (80) c) Policy for direct admission from A&E/front door 64% (66) d) Specialist ward rounds at least 5 times a week 74% (76) e) Acute stroke protocols/guidelines 99% (102)

All 5 Acute Stroke Unit acute criteria 39% (40)


28

Table 13 Changes over time acute and combined stroke unit provision 2004 2006 2008 % Acute stroke unit % Combined stroke unit

34% 16%

50% 26%

50% 44%

The greatest increase in acute stroke provision is through increasing the number of combined stroke units. These may have fewer acute criteria than acute stroke units alone (39% have all 5 criteria compared with 42% of acute stroke units. Thrombolysis While thrombolysis services are increasing rapidly the total number of patients receiving treatment remains low. We should be aiming for at least 10% of stroke admissions being thrombolysed. It is vital however that this is delivered safely by experienced teams Table 14 Number of patients thrombolysed

(215 hospitals)

median (IQR)

Number of patients thrombolysed per site during past year– out of 91 sites offering thrombolysis 6 (2-14)

Number of patients thrombolysed per site at another trust in the past year – out of 10 sites with arrangements for thrombolysis elsewhere 3 (1-4)

Figure 3 Number of patients thrombolysed on and off site

Number of patients thrombolysed on-site and off-site5550454035302520151050

England


Northern Ireland


Wales


29

Thrombolysis service organisation The number of units offering a 24 hour seven day a week thrombolysis service remains low.Given the relatively small number of clinicians available to deliver the treatment that this will only be achieved by centralising hyper-acute stroke care in a small number of units. Given that a number of hospitals are using non stroke specialist staff to deliver thrombolysis there needs to be a mechanism in place to ensure that those people on the rota have the appropriate expertise to give the treatment safely. Table 15 The availability of thrombolysis on weekdays and weekends (91 sites) Weekdays % and number of hospitals 1-8 hours per day 59% (54) 9-23 hours per day 19% (17) 24 hours per day 22% (20)

Weekends 0 hours per day 73% (66) 1-8 hours per day 3% (3) 9-23 hours per day 2% (2) 24 hours per day 22% (20) The median hours of thrombolysis availability per day was 8 during weekdays (IQR 8-12 hours), and 0 at weekends (IQR 0-8). 89/91 sites which offer thrombolysis have some formal rota of specialists who are trained to administer thrombolysis. The median (IQR) number of doctors on the rota is 3 (2-5).


30

Domain 2 Organisation of care Description of domain This domain incorporates the formal services for stroke care within both acute and community settings and maps specialist bed capacity for the number of patients with stroke in the trust. 7% of hospitals providing stroke unit care only provide rehabilitation stroke unit beds. Nationally, there are 1445 ASU beds, 2262 RSU beds and 2109 CSU beds, making 5816 stroke unit beds of any type. Table 16 Stroke Unit type across all hospitals

Type of Stroke Unit National (224 hospitals)

Acute Stroke Unit (ASU) 50% (108/215)*

Rehabilitation Stroke Unit (RSU) 50% (113)

Combined Stroke Unit (CSU) 44% (94/215)* * 9 sites provide only rehabilitation services and are therefore excluded from the denominator for this question

Type of stroke unit National median (IQR) beds per unit

Acute Stroke Unit (116 units) 12 (6-17)

Rehabilitation Stroke Unit (144 units) 16 (11-20)

Combined Stroke Unit (103 units)

21 (16-25)

Figure 4 Total number of beds of each stroke unit type within each site

N o

f site

s

40

35

30

25

20

15

10

5

011

6

16

18

27

30

9

Total beds in all ASUs within each site706050403020100

Total beds in all RSUs within each site706050403020100

N o

f site

s

40

35

30

25

20

15

10

5

01111

32

1

11

28

35

23

5

1


31

Total beds in all CSUs within each site706050403020100

N o

f site

s

40

35

30

25

20

15

10

5

0111

4

6

18

33

15

11

3

1

Table 17 Changes in provision of acute aspects of care 2004 to 2008 2004 2006 2008 % having arrangements with local ambulance service for emergency/rapid transfer to hospital for acute stroke over and above the regular system

4% 12% 49%

% where Trust offers thrombolysis at site NA 18% 42%

% Acute stroke unit % Combined stroke unit

34% 16%

50% 26%

50% 44%

Table 18 Changes in provision of stroke units 2002 to 2008

2002 2004 2006 2008

% sites with Stroke Unit 73% 79% 91% 92%

Median (IQR) number of stroke beds 20 (14-27) 20 (15-29) 24 (16-30) 25 (20-34)

Admission Criteria for Stroke Units The Stroke Unit Trialists Collaboration (SUTC) data suggest that all patients benefit from specialist stroke unit care regardless of age, sex or stroke severity. Therefore if a hospital has sufficient beds of the appropriate type then there is no justification for selecting patients. 34% of hospitals operated selection criteria compared with 43% of hospitals in 2002 and 67% in 2004.


32

Other models of stroke care There are 2 additional teams who can play an important role in the rehabilitation of stroke patients. Early supported discharge teams and specialist stroke teams. The former enable patients to return home early with support and the latter provide continued rehabilitation. Early Supported discharge Team 31% of hospitals have a specialist early supported discharge team Only a third of districts have an early supported discharge team. If hospitals are going to be able to provide the acute and rehabilitation care on specialist units to all patients that require it length of stay in hospital needs to be reduced, as it is unlikely there will be a big expansion of in-patient resources. The most effective way of achieving this without compromising care is through the development of stroke specialist early supported discharge teams. Only 23% of the 70 teams that are in existence have what we have defined as being the minimum staffing complement for effective care based upon the models that have been tested in randomised controlled trials (specialist doctor, nurse and two of the three therapists)

Table 19 Composition of early supported discharge teams

Regular members of the early supported discharge team: % of hospitals with this member

Specialist doctor 31% Specialist nurse 51% Social worker 51% Speech & Language therapist 79% Physiotherapist 100% Occupational therapist 100% Dietitian 39% Psychologist 23% Other* 40% Specialist doctor & nurse & two of the three therapists in the team 23%

Specialist Community Stroke Team 70% of sites have a specialist team for post discharge rehabilitation (not early supported discharge). However when asked to define the composition of these teams it emerged that 30% were staffed only with generic therapists and cannot therefore be defined as specialist teams. Therefore according to our calculations only 49% (109/224) of all sites actually had specialist post discharge teams. Table 20 Composition of Specialist Community Stroke Team

National (224 sites)

Presence of specialist community/domiciliary rehabilitation team for longer term management in area 70%

Stroke rehabilitation specialist staff 40%

Neuro rehabilitation specialist staff 52%

Generic rehabilitation specialist staff 59% Non specialist generic rehabilitation only team (ie no neuro-rehabilitation or stroke staff) 30%


33

Domain 3 – Consultant physician time (overall) Description of domain This domain describes and quantifies the specialist medical care available for participating hospitals with and without a stroke unit. It also includes the ratio of senior doctor sessions to stroke unit beds Nearly all hospitals (98%) now have a consultant with specialist knowledge of stroke. The median number of programmed activities is only 6 (IQR 4-10) compared to the recommendation of two whole time equivalents from the British Association of Stroke Physicians for an average district with a population of 250,000. The number of training posts remains low but is growing fast, aided by the direct funding of a number of posts by the Department of Health. Table 21 Provision of senior medical staff between 2002 and 2006

2004 2006 2008 Consultant physician with specialist knowledge of stroke formally recognised as having principal responsibility for stroke services

90% 98% 98%

Number of formal sessions per week of senior doctor time for stroke management:

% with no consultant sessions 7% 2% 1% % with no staff grade sessions 68% 61% 68%

% with no clinical assistant sessions 90% 91% 94% Changes over time 2002 2004 2006 2008 Consultant physician with specialist knowledge of stroke formally recognised as having principal responsibility for stroke services

80% 90% 98% 98%


34

Domain 4 Inter disciplinary Services (for sites with a stroke unit) Description of the domain The composition of the multidisciplinary team and staffing establishment in the stroke units are described and the ratio of staff to stroke unit beds quantified. Research shows patients with acute stroke should be offered organised inpatient care, which is typically provided by a co-ordinated multidisciplinary team operating within a discrete stroke ward. Nurse staffing ratios are improving slowly as are all the therapy profession posts and orthotics and foot health are establishing a foothold Table 22 Changes in establishment of multidisciplinary team members on stroke units between 2004 and 2006 2004 2006 2008 Qualified nurse/care assistants at 10am: Median (IQR) 7 (5-10) 7 (6-11) 8 (6-12) Staff establishment:

Clinical Psychology 28% 31% 36 Dietetics 85% 85% 96

Occupational Therapy 97% 99.5% 100 Physiotherapy 99% 99.5% 100

Speech and Language Therapy 92% 94% 99 Pharmacy NA 75% 86 Orthotics NA 7% 19

Foot health NA 11% 19


35

Domain 5 TIA/Neurovascular services Description of the domain This domain includes the provision of services for patients with transient ischaemic attack. The risk of stroke within the first four weeks after TIA can be as high as 20%. It is therefore vital that patients with TIA are seen urgently, investigated and a management plan put into place. Where significant carotid stenosis is found, carotid endarterectomy should be performed as soon as possible. National Clinical Guidelines for Stroke (2008) recommend that patients with TIA are seen, investigated and treated in a neurovascular clinic within one week of the onset of symptoms. There has been an impressive improvement in the delivery of care for patients with TIA over the last two years Table 23 Provision of neurovascular/TIA services 94% of hospitals (211/224) now provide a TIA service on site.

(224 sites)

Neurovascular Clinic % YES 95% (200/211)

Clinics within 4 week period Median (IQR) % more than 4 clinics

8 (4-12) 69%

(137/200)

New patients seen in last 4 weeks: Median (IQR) 31 (20-45)

Current average waiting time for an appointment for clinic

Median (IQR) of average times 7 days (5-12)

High Risk TIA patients In the light of the new guidelines for acute stroke and TIA and the Stroke Strategy, this year hospitals were asked whether they were able to see, investigate and initate treatment for all their high risk patients within 24 hours of referral. High risk was defined as as an abcd2 score of 4 or more. Less than half (45%) of hospitals 96/211 said that they could achieve this standard and 89% said they did so by admitting the patients. The table below outlines the time taken in the remaining 115 hospitals (55%) who do not achieve the standard Table 24 High Risk TIA patients

Timescale if all the high risk TIA patients are not seen, investigated and treatment initiated within 24 hours:

Less than 1 week of referral 54% (62/115)

1-2 weeks after referral 30% (35/115)


More than 4 weeks after referral 3% (4/115)


36

Low risk TIA patients The standard for seeing, investigating and initiating treatment for all low risk patients is within one week. This was achieved in just over half of hospitals 54% (113/112). Only 9% admitted patients. The table below outlines the time taken in the remaining 98 hospitals (46%) who do not achieve the standard Table 25 Low risk TIA patients

Timescale if all the low risk TIA patients are not seen, investigated and treatment initiated within one week:



More than 4 weeks after referral 13% (13/98)


37

Domain 6 Continuing Education in stroke Description of the domain This indicates whether the staff expertise in stroke care is updated through education and training. Regular programmes of education and training are cited as a key feature in randomised stroke unit trials. This year participation in research studies has been included. The numbers of education programmes for stroke on stroke units have improved. There remains a problem for staff managing stroke patients elsewhere in the hospital. Table 26 Development of continuing education programmes on stroke units between 2004 and 2008

Stroke Unit 2004 2006 2008

In-house programme for qualified staff 79% 91%

In-house training unqualified staff 82% 88% 94%*

*qualified and unqualified staff not differentiated in this round Table 27 Participation in research studies

Number of clinical stroke research studies with formal research ethics committee approval and patient consent (or relative assent) registered with Research and Development Department (on the day you complete this form)

National

Acute studies % ONE or more 58% (125/215) (excludes 9 rehabilitation only sites) % THREE or more 22% (48/215)

Rehabilitation studies % ONE or more 39% (87/223)

% THREE or more 5% (12/223)

Prevention studies % ONE or more 30% (68/223)


Other studies % ONE or more 19% (43/223)


% ONE or more 68% (152) Total studies (SUM of acute, rehab, prevention & other studies) % THREE or more 41% (92)


38

Table 28 Staff in (whole time equivalents) funded for clinical stroke research studies

How much time (in whole time equivalents (WTE) and however funded) is spent on clinical stroke related research studies with formal ethics committee approval and where patient consent (or relative assent) is required? Please give us a total and then estimate by type of profession


Total, all professionals % ANY 59% (133/224) % 1.0 WTE or more 21% (46/224) Doctor % ANY 44% (98/223) % 1.0 WTE or more 9% (19/223) Nurse % ANY 43% (95/223) % 1.0 WTE or more 14% (32/223) Occupational Therapy % ANY 9% (19/223) % 1.0 WTE or more 1% (3/223) Physiotherapy % ANY 15% (33/223) % 1.0 WTE or more 3% (6/223) Speech & Language Therapy % ANY 9% (20/223)

% 1.0 WTE or more 1% (3/223) Psychologist % ANY 4% (9/223) % 1.0 WTE or more 1% (3/223) Dietitian % ANY 0.4% (1/223) % 1.0 WTE or more 0% (0/223) Other % ANY 13% (30/223) % 1.0 WTE or more 5% (11/223)


39

Domain 7 Team working –Team meetings Description of the domain This domain reviews the frequency of team meetings for the interchange of information about individual patients and the range of disciplines involved. Weekly team meetings have been identified as one of the significant factors in a co-ordinated stroke service leading to improved clinical outcomes. (SUTC) It is gratifying that all stroke units now hold team meetings and in most cases nurses, doctors, physiotherapists, occupational therapists and speech therapists do attend. There remains a problem with input from social work, clinical psychology and dietetics. Table 29 Changes in provision and composition of team meetings on stroke units between 2002 and 2008

Service characteristic Stroke Unit

2002 2004 2006 2008 Team meetings once weekly 82 96 100 100 Clinical Psychology 13 17 18 19 Dietetics 37 47 61 59 Medicine (Senior Doctor) 81 93 98 98 Nursing 84 96 100 99.5 Occupational Therapy 82 95 99 100 Physiotherapy 83 96 100 100 Social Work 59 69 77 79 Speech & Language Therapy 63 74 82 86


40

Domain 8 Communication with Patients and Carers Description of the domain This comprehensive domain covers the organisational arrangements for patients to access information and for the organisation to communicate with user groups. The display of patient information including literature, patient versions of guidelines and local agencies helps to promote patients’/carers’ understanding and enables shared decision making when treatment options are involved. Educating and informing patients and carers should be seen as a key role of health professionals managing patients with stroke. Over two-thirds of units now have a community user group which is a major shift since the last audit Year on year improvements are seen in all aspects of care relating to communication. There remain some units where there appears to be resistance to making relatively easy changes that can have a major impact on the quality of care a patient receives. Table 30 Development of patient information structures between 2004 and 2008

2004 2006 2008 Stroke service has formal links with patients and carers organisations for communication on service provision, audit and future plans: 69% 73% 81%

Presence of a community user group for stroke: 59% 68% 75%

2004 2006 2008 % of hospitals with the following characteristic on their Stroke Unit

Patient access to management plan 66% 73% 80%

Patient information literature displayed in unit on: Condition specific literature on stroke 98% 99% N/A Patient versions of national or local guidelines/ standards 52% 59% 77 Social Services local Community Care arrangements 71% 82% 81 The Benefits Agency 72% 76% 80 Secondary prevention advice 76% 94% N/A How to complain 92% 99% N/A


41

SCANNING SERVICES Various questions were asked about the availability of imaging services both in weekdays and at weekends. Inpatient services are summarised below All hospitals now provide CT scanning and the vast majority also MRI and carotid doppler. There remains a problem in providing rapid access to brain imaging particularly at weekends although there has been some improvement since 2006 particularly for CT scanning and carotid doppler. Access to imaging remains a major barrier to the delivery of high quality care to all stroke patients at all times. With new standards being set for the urgent management of TIA, which require access to MRI and carotid imaging within 24 hours for high risk patients there will need to be a major reorganisation of imaging facilities to ensure that these standards can be met. Table 31 Access to CT, MRI and Carotid Dopper imaging 100% of hospitals have access to Computerised Tomography (CT scanning) and 99% to Magnetic Resonance Imaging (MRI) and Carotid Doppler. The current average waiting times for these services are shown in the table below comparing provision on weekdays and at weekends

Computerised Tomography

Magnetic Resonance

Image

Carotid Doppler


% and (number)


% and (number)


% and (number)

Current average waiting time: Weekdays 0-4 hours 5-24 hours 25-48 hours More than 48 hours

21% 70% 9%

0.5%

(45) (150) (19) (1)

3% 22% 47% 28%

(6) (47) (100) (60)

6% 28% 31% 35%

(12) (60) (66) (74)

Current average waiting time: Weekends 0-4 hours 5-24 hours 25-48 hours More than 48 hours

11% 40% 36% 13%

(24) (86) (77) (28)

1% 2% 13% 85%

(2) (4) (27) (180)

0.5% 1%

13% 85%

(1) (2) (28)

(181)


42

Chapter 4 National Organisational Audit results by Region This section should be read in combination with the previous chapters so that the results can be interpreted taking into account methodology, case ascertainment and clinical relevance. For a description of the full question wording see the proforma in appendix 1. The description of the overall score is provided on page 27

--------------------------------------------------------------------------------------------------- Chapter 4 National key results by region

43

----------------------------------------------------------------------------------------------------------------------------------------------------- 44 Chapter 4 Summary of key organisational results by named hospital

chapter 4 HOSPITAL RESULTS BY SHA AND COUNTRY SHA/Country NB STATUS AS AT 1ST APRIL 2008 For interpretation see questionnaire and definitions Table 32 summary of key organisational results by hospital for stroke unit provision, provision of thrombolysis and quality and other models of care This table includes the number of stroke units (reported by each of the 3 different types), the number of key stroke unit characteristics as chosen by the Stroke Unit Trialists’ Collaboration (SUTC), the number of acute criteria applicable to acute and combined stroke units which judge the quality of acute stroke units and whether patients are thrombolysed on or off site and other stroke care models used to facilitate early supportive discharge

Site name (name of trust or hospital within a trust)

Num

ber o

f Acu

te S

troke

U

nits

Num

ber o

f Reh

abilit

atio

n St

roke

Uni

ts

Num

bero

f Com

bine

d St

roke

Uni

ts

Num

ber o

f SU

TC k

ey

stro

ke u

nit f

eatu

res

(max

5)

Num

ber o

f AS

Us

at th

is

site

with

all

five

acut

e cr

iteria

Num

ber o

f CS

Us

at th

is

site

with

all

five

acut

e cr

iteria

Spe

cial

ist C

omm

unity

/ D

omic

iliar

y R

ehab

Tea

m

Team

sta

ffed

by s

troke

or

neur

olog

ical

spe

cial

ists

Ear

ly S

uppo

rted

Dis

char

ge T

eam

Thro

mbo

lysi

s se

rvic

e ei

ther

on

site

or a

form

al

arra

ngem

ent w

ith a

noth

er

site

National results (%) of sites 50% 50% 44% 73%

have all 5

42% have all 5

39% have all 5

70% have a team

70% of those with a team have

31%

East Midlands Chesterfield Royal Hospital NHS Foundation Trust 1 0 0 5 0 N/A Yes No No No

Derby Hospitals NHS Foundation Trust 1 1 0 5 1 N/A Yes Yes No Yes Kettering General Hospital NHS Trust 1 0 0 5 0 N/A Yes Yes No No Leicestershire County and Rutland PCT 0 2 0 4 N/A N/A No N/A No N/A Northampton General Hospital NHS Trust 0 0 2 5 N/A 0 Yes No No No Nottingham University Hospitals NHS Trust 1 3 0 5 1 N/A Yes Yes No Yes Sherwood Forest Hospitals NHS Foundation Trust 1 1 0 3 0 N/A No N/A No No

United Lincolnshire Hospitals NHS Trust (Grantham and District Hospital) 0 0 0 N/A N/A N/A Yes Yes Yes No

United Lincolnshire Hospitals NHS Trust (Lincoln County) 0 0 1 5 N/A 1 No N/A No No



Num

ber o

f Acu

te S

troke

U

nits

Num

ber o

f Reh

abilit

atio

n St

roke

Uni

ts

Num

bero

f Com

bine

d St

roke

Uni

ts

Num

ber o

f SU

TC k

ey

stro

ke u

nit f

eatu

res

(max

5)

Num

ber o

f AS

Us

at th

is

site

with

all

five

acut

e cr

iteria

Num

ber o

f CS

Us

at th

is

site

with

all

five

acut

e cr

iteria

Spe

cial

ist C

omm

unity

/ D

omic

iliar

y R

ehab

Tea

m

Team

sta

ffed

by s

troke

or

neur

olog

ical

spe

cial

ists

Ear

ly S

uppo

rted

Dis

char

ge T

eam

Thro

mbo

lysi

s se

rvic

e ei

ther

on

site

or a

form

al

arra

ngem

ent w

ith a

noth

er

site


have all 5

42% have all 5

39% have all 5

70% have a team


31%

United Lincolnshire Hospitals NHS Trust (Louth County Hospital) 0 1 0 4 N/A N/A No N/A No N/A

United Lincolnshire Hospitals NHS Trust (Pilgrim Hospital) 0 0 1 3 N/A 1 Yes No No Yes

University Hospitals of Leicester NHS Trust 1 0 3 5 1 0 No N/A No Yes East of England Basildon & Thurrock University Hospitals NHS Foundation Trust 0 0 2 4 N/A 0 No N/A No Yes

Bedford Hospital NHS Trust 0 0 1 5 N/A 0 Yes Yes Yes No Cambridge University Hospitals NHS Foundation Trust 0 0 1 3 N/A 1 No N/A Yes Yes

East & North Hertfordshire NHS Trust 0 0 1 4 N/A 0 No N/A No Yes Essex Rivers Healthcare NHS Trust 0 0 1 5 N/A 1 Yes Yes No No Hinchingbrooke Health Care NHS Trust 0 0 1 3 N/A 0 Yes Yes Yes Yes Ipswich Hospital NHS Trust 0 0 1 2 N/A 0 Yes Yes No Yes James Paget University Hospitals NHS Foundation Trust 0 0 1 5 N/A 0 Yes Yes No No

Luton and Dunstable Hospital NHS Foundation Trust 0 0 1 5 N/A 1 Yes Yes No Yes

Mid Essex Hospital Services NHS Trust 0 0 1 5 N/A 0 No N/A No Yes Norfolk & Norwich University Hospital NHS Trust 1 0 0 5 0 N/A No N/A No Yes

Peterborough and Stamford Hospitals NHS Foundation Trust 0 0 1 4 N/A 0 No N/A No Yes

Princess Alexandra Hospital NHS Trust 1 1 1 5 1 1 No N/A No No



Num

ber o

f Acu

te S

troke

U

nits

Num

ber o

f Reh

abilit

atio

n St

roke

Uni

ts

Num

bero

f Com

bine

d St

roke

Uni

ts

Num

ber o

f SU

TC k

ey

stro

ke u

nit f

eatu

res

(max

5)

Num

ber o

f AS

Us

at th

is

site

with

all

five

acut

e cr

iteria

Num

ber o

f CS

Us

at th

is

site

with

all

five

acut

e cr

iteria

Spe

cial

ist C

omm

unity

/ D

omic

iliar

y R

ehab

Tea

m

Team

sta

ffed

by s

troke

or

neur

olog

ical

spe

cial

ists

Ear

ly S

uppo

rted

Dis

char

ge T

eam

Thro

mbo

lysi

s se

rvic

e ei

ther

on

site

or a

form

al

arra

ngem

ent w

ith a

noth

er

site


have all 5

42% have all 5

39% have all 5

70% have a team


31%

Queen Elizabeth Hospital King's Lynn NHS Trust 0 0 1 4 N/A 0 No N/A No No

Southend University Hospital NHS Foundation Trust 0 0 1 5 N/A 1 Yes Yes Yes Yes

West Hertfordshire Hospitals NHS Trust (Hemel Hempstead Hospital) 0 0 1 5 N/A 1 Yes No Yes No

West Hertfordshire Hospitals NHS Trust (Watford General Hospital) 0 0 1 5 N/A 1 Yes Yes No Yes

West Suffolk Hospitals NHS Trust 1 1 0 5 0 N/A Yes No No Yes Islands Health & Social Services Department (Guernsey) 0 0 0 N/A N/A N/A No N/A No No

Isle of Man Department of Health and Social Security 0 0 0 N/A N/A N/A No N/A No No

States of Jersey Health & Social Services 0 0 0 N/A N/A N/A Yes Yes No No London Barking Havering and Redbridge Hospitals NHS Trust (King George) 0 0 1 5 N/A 0 Yes Yes No No

Barking Havering and Redbridge Hospitals NHS Trust (Queens Hospital) in collaboration with Havering PCT

0 0 1 5 N/A 0 Yes Yes No No

Barnet and Chase Farm Hospitals NHS Trust (Barnet Hospital) jointly with Barnet Primary Care Trust (Finchley Memorial Hospital)

1 1 0 4 0 N/A No N/A No No

Barnet and Chase Farm Hospitals NHS Trust (Chase Farm Hospital) 1 1 0 5 0 N/A Yes No Yes No



Num

ber o

f Acu

te S

troke

U

nits

Num

ber o

f Reh

abilit

atio

n St

roke

Uni

ts

Num

bero

f Com

bine

d St

roke

Uni

ts

Num

ber o

f SU

TC k

ey

stro

ke u

nit f

eatu

res

(max

5)

Num

ber o

f AS

Us

at th

is

site

with

all

five

acut

e cr

iteria

Num

ber o

f CS

Us

at th

is

site

with

all

five

acut

e cr

iteria

Spe

cial

ist C

omm

unity

/ D

omic

iliar

y R

ehab

Tea

m

Team

sta

ffed

by s

troke

or

neur

olog

ical

spe

cial

ists

Ear

ly S

uppo

rted

Dis

char

ge T

eam

Thro

mbo

lysi

s se

rvic

e ei

ther

on

site

or a

form

al

arra

ngem

ent w

ith a

noth

er

site


have all 5

42% have all 5

39% have all 5

70% have a team


31%

Barts and The London NHS Trust jointly with Tower Hamlets PCT 1 1 0 5 1 N/A Yes Yes Yes Yes

Bromley Hospitals NHS Trust 0 1 0 5 N/A N/A Yes No No No Chelsea and Westminster Hospital NHS Foundation Trust 0 0 1 5 N/A 1 Yes Yes No Yes

Ealing Hospital NHS Trust 1 0 0 4 0 N/A No N/A No No Epsom and St Helier University Hospitals NHS Trust (Epsom Hospital) 0 0 1 3 N/A 0 Yes Yes Yes No

Epsom and St Helier University Hospitals NHS Trust (St Helier Hospital) 0 0 1 5 N/A 1 Yes Yes No Yes

Guy's & St Thomas' Hospital NHS Foundation Trust 1 1 0 5 1 N/A Yes Yes Yes Yes

Hillingdon Hospital NHS Trust 0 0 1 4 N/A 0 No N/A No No Homerton University Hospital NHS Foundation Trust 0 0 1 4 N/A 0 Yes Yes Yes No

Imperial College Healthcare NHS Trust 0 2 3 5 N/A 3 Yes Yes No Yes King's College Hospital NHS Foundation Trust 1 1 0 5 1 N/A Yes Yes Yes Yes Kingston Hospital NHS Trust 1 5 1 4 1 1 Yes Yes No Yes Mayday Healthcare NHS Trust 1 1 0 5 1 N/A Yes Yes No Yes Newham University Hospital NHS Trust 1 1 0 5 0 N/A No N/A No No North Middlesex University Hospital NHS Trust & Haringey PCT combined 1 1 0 4 1 N/A Yes Yes No No

North West London Hospitals NHS Trust (Central Middlesex Hospital including Willesden Community Hospital (Brent PCT))

1 0 0 4 0 N/A Yes Yes Yes Yes

North West London Hospitals NHS Trust (Northwick Park Hospital) 0 0 1 2 N/A 1 Yes Yes Yes Yes



Num

ber o

f Acu

te S

troke

U

nits

Num

ber o

f Reh

abilit

atio

n St

roke

Uni

ts

Num

bero

f Com

bine

d St

roke

Uni

ts

Num

ber o

f SU

TC k

ey

stro

ke u

nit f

eatu

res

(max

5)

Num

ber o

f AS

Us

at th

is

site

with

all

five

acut

e cr

iteria

Num

ber o

f CS

Us

at th

is

site

with

all

five

acut

e cr

iteria

Spe

cial

ist C

omm

unity

/ D

omic

iliar

y R

ehab

Tea

m

Team

sta

ffed

by s

troke

or

neur

olog

ical

spe

cial

ists

Ear

ly S

uppo

rted

Dis

char

ge T

eam

Thro

mbo

lysi

s se

rvic

e ei

ther

on

site

or a

form

al

arra

ngem

ent w

ith a

noth

er

site


have all 5

42% have all 5

39% have all 5

70% have a team


31%

Queen Elizabeth Hospital NHS Trust 0 0 1 5 N/A 0 Yes Yes No No Queen Mary's Sidcup NHS Trust 0 0 1 3 N/A 0 No N/A No No Royal Free Hampstead NHS Trust 0 0 1 5 N/A 1 Yes Yes No Yes St George's Healthcare NHS Trust 1 2 0 5 1 N/A Yes Yes No Yes University College London Hospitals NHS Foundation Trust 1 0 1 5 1 0 Yes No No Yes

University Hospital Lewisham NHS Trust 0 0 1 5 N/A 0 Yes Yes No No West Middlesex University Hospital NHS Trust 1 1 0 5 0 N/A Yes Yes No No Whipps Cross University Hospital NHS Trust 1 1 0 5 1 N/A No N/A No No Whittington Hospital NHS Trust 3 1 0 4 3 N/A No N/A Yes Yes Northern Ireland: Eastern Health and Social Services Board Belfast Health and Social Care Trust (Belfast City Hospital) 1 1 0 5 1 N/A No N/A Yes Yes

Belfast Health and Social Care Trust (Mater Hospital) 0 0 1 4 N/A 0 Yes Yes No No

Belfast Health and Social Care Trust (Royal Group of Hospitals) 1 1 0 4 0 N/A No N/A Yes Yes

South Eastern Health and Social Care Trust (Lagan Valley Hospital) 0 0 1 5 N/A 0 No N/A Yes No

South Eastern Health and Social Care Trust (Ulster Community and Hospitals) 0 0 1 5 N/A 0 Yes Yes Yes No

Northern Ireland: Northern Health and Social Services Board Northern Health and Social Care Trust (Causeway) 0 0 0 N/A N/A N/A No N/A No No

Northern Health and Social Care Trust (United Hospitals) 1 2 0 3 1 N/A No N/A Yes No



Num

ber o

f Acu

te S

troke

U

nits

Num

ber o

f Reh

abilit

atio

n St

roke

Uni

ts

Num

bero

f Com

bine

d St

roke

Uni

ts

Num

ber o

f SU

TC k

ey

stro

ke u

nit f

eatu

res

(max

5)

Num

ber o

f AS

Us

at th

is

site

with

all

five

acut

e cr

iteria

Num

ber o

f CS

Us

at th

is

site

with

all

five

acut

e cr

iteria

Spe

cial

ist C

omm

unity

/ D

omic

iliar

y R

ehab

Tea

m

Team

sta

ffed

by s

troke

or

neur

olog

ical

spe

cial

ists

Ear

ly S

uppo

rted

Dis

char

ge T

eam

Thro

mbo

lysi

s se

rvic

e ei

ther

on

site

or a

form

al

arra

ngem

ent w

ith a

noth

er

site


have all 5

42% have all 5

39% have all 5

70% have a team


31%

Northern Ireland: Southern Health and Social Services Board Southern Health and Social Care Trust (Craigavon Area) 1 3 0 5 1 N/A No N/A Yes No

Southern Health and Social Care Trust (Newry & Mourne) 0 0 1 5 N/A 0 Yes Yes Yes Yes

Northern Ireland: Western Health and Social Services Health Board Western Health and Social Care Trust (Altnagelvin Hospitals) 0 0 1 5 N/A 0 No N/A No No

Western Health and Social Care Trust (Southern Sector - Erne) 0 0 1 5 N/A 1 Yes No No No

Western Health and Social Care Trust (Southern Sector - Omagh/Tyrone County Hospital)

0 0 1 3 N/A 0 No N/A No No

North East City Hospitals Sunderland NHS Foundation Trust 1 1 0 3 1 N/A No N/A Yes Yes

County Durham and Darlington NHS Foundation Trust (Bishop Auckland General Hospital)

0 0 1 5 N/A 1 Yes Yes No Yes

County Durham and Darlington NHS Foundation Trust (University Hospital North Durham)

1 1 0 5 0 N/A Yes Yes No Yes

Gateshead Health NHS Foundation Trust 1 1 0 5 1 N/A No N/A Yes Yes Newcastle upon Tyne Hospitals NHS Foundation Trust 1 2 0 4 0 N/A Yes Yes Yes Yes

North Tees and Hartlepool NHS Foundation Trust (University Hospital of Hartlepool) 0 0 1 5 N/A 1 Yes Yes Yes Yes



Num

ber o

f Acu

te S

troke

U

nits

Num

ber o

f Reh

abilit

atio

n St

roke

Uni

ts

Num

bero

f Com

bine

d St

roke

Uni

ts

Num

ber o

f SU

TC k

ey

stro

ke u

nit f

eatu

res

(max

5)

Num

ber o

f AS

Us

at th

is

site

with

all

five

acut

e cr

iteria

Num

ber o

f CS

Us

at th

is

site

with

all

five

acut

e cr

iteria

Spe

cial

ist C

omm

unity

/ D

omic

iliar

y R

ehab

Tea

m

Team

sta

ffed

by s

troke

or

neur

olog

ical

spe

cial

ists

Ear

ly S

uppo

rted

Dis

char

ge T

eam

Thro

mbo

lysi

s se

rvic

e ei

ther

on

site

or a

form

al

arra

ngem

ent w

ith a

noth

er

site


have all 5

42% have all 5

39% have all 5

70% have a team


31%

North Tees and Hartlepool NHS Foundation Trust (University Hospital of North Tees) 0 0 1 5 N/A 1 Yes Yes Yes Yes

Northumbria Healthcare NHS Foundation Trust (Hexham General Hospital) 0 0 1 5 N/A 0 Yes Yes No Yes

Northumbria Healthcare NHS Foundation Trust (North Tyneside District General Hospital)

0 0 1 5 N/A 0 Yes Yes Yes Yes

Northumbria Healthcare NHS Foundation Trust (Wansbeck General Hospital) 0 0 1 5 N/A 0 Yes Yes Yes Yes

South Tees Hospitals NHS Trust (The James Cook University Hospital) in collaboration with MPCT and R&CPCT

1 2 0 5 1 N/A Yes Yes No Yes

South Tees Hospitals Trust (Friarage Hospital) in collaboration with Rutson Rehabilitation Unit (NY and YPCT)

1 1 0 4 0 N/A No N/A No Yes

South Tyneside NHS Foundation Trust 1 1 0 5 1 N/A Yes Yes Yes No North West Aintree University Hospitals NHS Foundation Trust 0 0 1 5 N/A 1 No N/A Yes Yes

Blackpool, Fylde & Wyre Hospitals NHS Trust 0 0 1 4 N/A 1 No N/A Yes Yes Bolton Hospitals NHS Trust 1 1 0 5 0 N/A Yes Yes Yes No Central Manchester and Manchester Children's University Hospital NHS Trust 1 1 0 5 0 N/A Yes Yes Yes Yes

Countess of Chester Hospital NHS Foundation Trust 1 1 0 5 1 N/A Yes Yes No Yes

East Cheshire NHS Trust 1 1 0 5 0 N/A Yes Yes No No



Num

ber o

f Acu

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Num

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Num

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Spe

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ith a

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er

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have all 5

42% have all 5

39% have all 5

70% have a team


31%

East Lancashire Hospitals NHS Trust (Royal Blackburn Hospital) 1 1 0 4 0 N/A Yes Yes Yes No

Lancashire Teaching Hospitals NHS Foundation Trust (Chorley and South Ribble District General Hospital)

0 0 0 N/A N/A N/A Yes Yes Yes No

Lancashire Teaching Hospitals NHS Foundation Trust (Royal Preston Hospital) 0 1 0 5 N/A N/A Yes Yes No No

Mid Cheshire Hospitals NHS Trust 1 2 0 3 0 N/A Yes No No No Morecambe Bay Hospitals NHS Trust (Furness General Hospital) 1 1 0 5 0 N/A Yes Yes Yes No

Morecambe Bay Hospitals NHS Trust (Royal Lancaster Infirmary) 0 0 1 4 N/A 0 No N/A No No

Morecambe Bay Hospitals NHS Trust (Westmorland General Hospital) 0 0 1 4 N/A 0 No N/A No No

North Cheshire Hospitals NHS Trust 1 1 0 5 1 N/A Yes Yes No No North Cumbria Acute Hospitals NHS Trust (Cumberland Infirmary) 0 1 1 5 N/A 0 No N/A No No

North Cumbria Acute Hospitals NHS Trust (West Cumberland Hospital) 1 1 0 5 1 N/A No N/A No No

Pennine Acute Hospitals NHS Trust (Fairfield General Hospital) 1 1 0 5 0 N/A No N/A No No

Pennine Acute Hospitals NHS Trust (North Manchester General) 1 1 0 5 0 N/A Yes Yes No No

Pennine Acute Hospitals NHS Trust (Rochdale Infirmary) 1 1 0 5 1 N/A Yes Yes Yes No

Pennine Acute Hospitals NHS Trust (Royal Oldham Hospital) 0 0 1 5 N/A 0 Yes Yes No No



Num

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Num

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Num

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Spe

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ith a

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have all 5

42% have all 5

39% have all 5

70% have a team


31%

Royal Liverpool & Broadgreen University Hospitals NHS Trust 1 1 0 5 1 N/A No N/A Yes Yes

Salford Royal NHS Foundation Trust 1 1 0 4 1 N/A Yes Yes No Yes Southport and Ormskirk Hospital NHS Trust 0 1 1 5 N/A 1 Yes Yes Yes No St Helens & Knowsley Hospitals NHS Trust 1 1 0 5 1 N/A Yes No Yes Yes Stockport NHS Foundation Trust 0 0 1 5 N/A 1 Yes Yes Yes Yes Tameside and Glossop Acute Services NHS Trust 0 0 1 5 N/A 0 No N/A No No

Tameside and Glossop PCT 0 1 0 4 N/A N/A Yes No No N/A Trafford Healthcare NHS Trust 1 1 0 5 0 N/A No N/A Yes No University Hospital of South Manchester NHS Foundation Trust 0 0 1 5 N/A 0 Yes No No No

Wirral University Teaching Hospital NHS Foundation Trust 1 1 0 5 1 N/A Yes No No Yes

Wrightington, Wigan and Leigh NHS Trust 1 1 0 5 0 N/A Yes Yes No No South Central Basingstoke and North Hampshire NHS Foundation Trust 1 1 0 5 0 N/A Yes Yes No Yes

Buckinghamshire Hospitals NHS Trust (Amersham & Wycombe Hospitals) 0 0 1 5 N/A 0 Yes Yes No Yes

Buckinghamshire Hospitals NHS Trust (Stoke Mandeville Hospital) 0 0 1 5 N/A 0 Yes Yes No Yes

Heatherwood & Wexham Park Hospitals NHS Foundation Trust 0 0 2 5 N/A 0 No N/A No No

Isle of Wight NHS Primary Care Trust 0 0 1 5 N/A 0 No N/A No No Milford Stroke Unit (New Forest PCT) 0 1 0 4 N/A N/A Yes No Yes No



Num

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Num

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have all 5

42% have all 5

39% have all 5

70% have a team


31%

Milton Keynes Hospital NHS Foundation Trust 1 0 0 5 0 N/A Yes Yes No No Oxford Radcliffe Hospitals NHS Trust (Horton Hospital) 0 0 1 4 N/A 0 Yes No No Yes

Oxford Radcliffe Hospitals NHS Trust (John Radcliffe Hospital) 0 0 1 5 N/A 1 No N/A No Yes

Portsmouth Hospitals NHS Trust jointly with Hampshire and Portsmouth City PCTs 2 4 0 5 0 N/A Yes Yes Yes No

Royal Berkshire NHS Foundation Trust 1 2 0 5 0 N/A Yes Yes No No Southampton University Hospitals NHS Trust 1 0 0 4 0 N/A Yes Yes No Yes Tannersbrook Stroke Unit (Southampton City PCT) 0 1 0 5 N/A N/A Yes Yes No N/A

Winchester and Eastleigh Healthcare NHS Trust 0 0 1 5 N/A 1 Yes No No No

South East Coast Ashford and St Peter's Hospital NHS Trust 1 1 0 5 1 N/A Yes Yes No No Brighton & Sussex University Hospitals NHS Trust (Brighton) 0 0 1 5 N/A 0 Yes Yes Yes No

Brighton & Sussex University Hospitals NHS Trust (Princess Royal Hospital Haywards Heath)

0 0 1 4 N/A 0 No N/A No Yes

Dartford & Gravesham NHS Trust 0 0 1 5 N/A 0 Yes Yes No No East Kent Hospitals NHS Trust (Kent & Canterbury Hospital) 0 0 1 5 N/A 1 Yes No No Yes

East Kent Hospitals NHS Trust (Queen Elizabeth The Queen Mother Hospital) 0 0 1 4 N/A 0 No N/A No Yes

East Kent Hospitals NHS Trust (William Harvey Hospital) 0 0 1 5 N/A 1 Yes Yes No Yes



Num

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have all 5

42% have all 5

39% have all 5

70% have a team


31%

East Sussex Hospitals NHS Trust (Conquest Hospital) 0 0 1 5 N/A 1 Yes Yes Yes No

East Sussex Hospitals NHS Trust (Eastbourne Hospital) 1 1 0 5 0 N/A No N/A No No

Frimley Park Hospitals NHS Foundation Trust 1 1 0 5 0 N/A Yes No No Yes Maidstone and Tunbridge Wells NHS Trust (Kent & Sussex Hospital) 1 1 0 5 0 N/A Yes Yes No No

Maidstone and Tunbridge Wells NHS Trust (Maidstone Hospital) 0 0 0 N/A N/A N/A Yes Yes No No

Medway Maritime Hospital, Medway PCT & Swale PCT 1 2 0 5 1 N/A Yes Yes Yes Yes

Royal Surrey County Hospital NHS Trust 0 0 1 5 N/A 1 Yes Yes Yes Yes Royal West Sussex Trust 1 1 0 5 1 N/A Yes No No No Surrey & Sussex Healthcare NHS Trust 0 1 1 5 N/A 0 Yes Yes No No Worthing & Southlands Hospitals NHS Trust 1 1 0 5 1 N/A Yes Yes No Yes South West Dorset County Hospital NHS Foundation Trust 1 1 0 5 0 N/A Yes No No Yes Gloucestershire Hospitals NHS Foundation Trust (Cheltenham General Hospital) 0 0 1 5 N/A 0 Yes Yes No No

Gloucestershire Hospitals NHS Foundation Trust (Gloucestershire Royal Hospital) 0 0 1 5 N/A 1 Yes No No Yes

North Bristol NHS Trust 1 2 0 5 1 N/A Yes Yes Yes Yes Northern Devon Healthcare NHS Trust in collaboration with North Devon Primary Care Trust

1 1 0 5 0 N/A Yes No No Yes

Plymouth Hospitals NHS Trust 1 0 0 5 0 N/A Yes Yes No Yes



Num

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have all 5

42% have all 5

39% have all 5

70% have a team


31%

Plymouth Primary Care Trust 0 1 0 5 N/A N/A Yes No No N/A Poole Hospital NHS Foundation Trust 1 1 0 5 1 N/A Yes No No Yes Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust 1 1 0 5 1 N/A Yes Yes No Yes

Royal Cornwall Hospitals NHS Trust 2 1 0 5 0 N/A Yes Yes No No Royal Devon & Exeter NHS Foundation Trust in collaboration with Devon Primary Care Trust

0 2 1 5 N/A 1 Yes No No Yes

Royal United Hospital Bath NHS Trust in collaboration with Bath & North East Somerset PCT and Wiltshire PCT

1 2 0 5 0 N/A Yes Yes No No

Salisbury NHS Foundation Trust 0 0 1 4 N/A 1 Yes Yes No Yes South Devon Healthcare NHS Foundation Trust combined with Devon PCT 0 1 1 5 N/A 1 Yes Yes Yes Yes

Swindon & Marlborough NHS Trust (in collaboration with Swindon PCT) 1 1 0 4 0 N/A Yes Yes Yes No

Taunton and Somerset NHS Foundation Trust 0 0 1 2 N/A 0 No N/A No Yes United Bristol Healthcare NHS Trust 1 1 0 5 0 N/A Yes No No Yes Weston Area Health Trust 1 1 0 5 0 N/A Yes No Yes No Yeovil District Hospital NHS Foundation Trust 1 0 0 5 1 N/A Yes No No Yes Wales Mid and West Abertawe Bro Morgannwg University NHS Trust (Neath Port Talbot Hospital) 0 0 0 N/A N/A N/A No N/A No No

Abertawe Bro Morgannwg University NHS Trust (Princess of Wales Hospital) 0 0 0 N/A N/A N/A No N/A No No



Num

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Num

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have all 5

42% have all 5

39% have all 5

70% have a team


31%

Carmarthenshire NHS Trust (Prince Philip Hospital) 0 0 0 N/A N/A N/A Yes No Yes No

Carmarthenshire NHS Trust (West Wales General Hospital) 0 0 0 N/A N/A N/A Yes No No No

Ceredigion & Mid-Wales NHS Trust 1 1 0 2 0 N/A No N/A No No Pembrokeshire & Derwen NHS Trust 1 0 0 5 0 N/A Yes No No No Powys Local Health Board 0 0 0 N/A N/A N/A Yes No No N/A Swansea NHS Trust (Morriston Hospital) 0 0 0 N/A N/A N/A Yes No No No Swansea NHS Trust (Singleton Hospital) 0 0 0 N/A N/A N/A No N/A No No Wales North Conwy & Denbighshire NHS Trust 0 1 0 5 N/A N/A Yes No No No North East Wales NHS Trust 0 1 0 5 N/A N/A Yes No No N/A North West Wales NHS Trust (Bangor Hospital) 0 0 0 N/A N/A N/A No N/A No No

North West Wales NHS Trust (Llandudno Hospital) 0 0 0 N/A N/A N/A Yes No No No

Wales South East Cardiff and Vale NHS Trust (Llandough Hospital) 0 1 0 5 N/A N/A Yes No No No

Cardiff and Vale NHS Trust (University Hospital Wales) 1 1 0 5 0 N/A No N/A Yes Yes

Gwent Healthcare NHS Trust (Caerphilly District Miner's Hospital) 0 0 0 N/A N/A N/A Yes No No No

Gwent Healthcare NHS Trust (Nevill Hall Hospital) 1 0 0 4 0 N/A Yes No No No



Num

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f Acu

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Num

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have all 5

42% have all 5

39% have all 5

70% have a team


31%

Gwent Healthcare NHS Trust (St Woolos Hospital, Royal Gwent & Caerphilly District Miner's Hospital)

1 2 0 5 1 N/A Yes No No No

North Glamorgan NHS Trust 0 1 0 5 N/A N/A Yes No No N/A Pontypridd & Rhondda NHS Trust 0 1 0 5 N/A N/A Yes No No Yes

West Midlands Burton Hospitals NHS Trust 1 1 0 5 0 N/A No N/A No No Dudley Group of Hospitals NHS Trust 1 1 0 5 1 N/A Yes Yes No Yes George Eliot Hospital NHS Trust 0 1 1 5 N/A 1 Yes Yes Yes Yes Heart of England NHS Foundation Trust (Good Hope Hospital) 1 1 0 5 0 N/A Yes Yes No Yes

Heart of England NHS Foundation Trust (Birmingham Heartlands and Solihull Hospitals)

1 1 1 5 1 0 Yes Yes Yes Yes

Hereford Hospitals NHS Trust 1 0 0 5 0 N/A Yes Yes No No Mid Staffordshire General Hospitals NHS Trust 0 2 0 4 N/A N/A No N/A No Yes

Royal Wolverhampton Hospitals NHS Trust jointly with Wolverhampton Health Care NHS Trust

1 1 0 4 1 N/A Yes Yes Yes Yes

Sandwell and West Birmingham Hospitals NHS Trust (City Hospital) 2 1 0 4 1 N/A Yes Yes Yes Yes

Sandwell and West Birmingham Hospitals NHS Trust (Sandwell District Hospital) 1 1 0 3 0 N/A Yes No Yes No

Shrewsbury & Telford Hospital NHS Trust 1 1 1 3 0 0 No N/A No No



Num

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f Acu

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Num

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have all 5

42% have all 5

39% have all 5

70% have a team


31%

South Birmingham Primary Care Trust 0 1 0 4 N/A N/A Yes Yes No N/A South Warwickshire General Hospitals NHS Trust 1 1 0 5 0 N/A No N/A Yes Yes

University Hospitals Coventry and Warwickshire NHS Trust 1 0 1 5 0 0 No N/A No Yes

University Hospital Birmingham NHS Foundation Trust 1 0 0 3 1 N/A Yes Yes No Yes

University Hospital of North Staffordshire NHS Trust combined with North Staffordshire Combined Healthcare NHS Trust

0 1 2 5 N/A 2 No N/A Yes Yes

Walsall Hospitals NHS Trust 0 0 1 5 N/A 1 Yes Yes Yes Yes Worcestershire Acute Hospitals NHS Trust (Alexandra Hospital Redditch) 1 0 0 5 0 N/A Yes Yes No No

Worcestershire Acute Hospitals NHS Trust (Worcester Royal Hospital) 1 1 0 5 0 N/A No N/A No Yes

Yorkshire and The Humber Airedale NHS Trust 1 0 1 5 1 0 Yes No No No Barnsley Hospital NHS Foundation Trust 1 1 0 5 1 N/A No N/A Yes No Bradford Teaching Hospitals NHS Foundation Trust 1 1 0 5 0 N/A Yes Yes No No

Calderdale & Huddersfield NHS Foundation Trust 1 2 0 5 0 N/A Yes No No No

Doncaster & Bassetlaw Hospitals NHS Foundation Trust (Bassetlaw District General Hospital)

1 1 1 5 0 0 Yes Yes Yes No



Num

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f Acu

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Num

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abilit

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Num

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Num

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f CS

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at th

is

site

with

all

five

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e cr

iteria

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unity

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ther

on

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form

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ngem

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ith a

noth

er

site


have all 5

42% have all 5

39% have all 5

70% have a team


31%

Doncaster & Bassetlaw Hospitals NHS Foundation Trust (Doncaster Royal Infirmary & Montagu Hospital)

1 1 0 3 0 N/A Yes Yes No No

Harrogate and District NHS Foundation Trust 0 0 1 5 N/A 1 No N/A No No Hull and East Yorkshire Hospitals NHS Trust 1 4 0 5 0 N/A No N/A No Yes Leeds Teaching Hospitals NHS Trust 3 2 0 5 2 N/A Yes Yes Yes Yes Mid Yorkshire Hospitals NHS Trust 1 1 2 5 0 0 Yes Yes Yes No Northern Lincolnshire and Goole Hospitals NHS Foundation Trust (Diana Princess of Wales Hospital)

0 0 1 5 N/A 0 Yes Yes No No

Northern Lincolnshire and Goole Hospitals NHS Foundation Trust (Scunthorpe General) 0 0 1 4 N/A 0 Yes Yes Yes No

Rotherham NHS Foundation Trust 0 0 1 5 N/A 0 No N/A Yes Yes Scarborough and North East Yorks Health Care NHS Trust 0 0 1 4 N/A 0 No N/A No Yes

Sheffield Teaching Hospitals NHS Foundation Trust 2 2 0 4 0 N/A Yes No Yes Yes

York Hospitals NHS Foundation Trust 1 1 0 5 0 N/A Yes Yes No No


Summary of key organisational results by hospital in SHA/Country This table includes average estimated waiting times for scan, whether the trust has a neurovascular/TIA clinic and involvement with patients. The total organisational score is an aggregated score across all domains. The best organised 25% of hospitals are in the upper quartile designated by the symbol , the least well organised hospitals for stroke care are in the lower quartile designated with the symbol , the middle half lie between the

two designated by the diamond Table 33 Summary of key organisational results by hospital including waiting times for scan, presence of neurovascular/TIA clinic and involvement with patients.


Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

kend

s

Ave

rage

MR

I sca

n w

aitin

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ays

Ave

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aitin

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ser

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aitin

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e

All

high

risk

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pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

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ed

with

in o

ne w

eek

Patie

nt /

care

r vie

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soug

ht o

n se

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e

Rep

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ced

with

in 1

2 m

onth

s an

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ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

East Midlands Chesterfield Royal Hospital NHS Foundation Trust

5-24 hours

25-48 hours

>48 hours

>48 hours Yes Yes 7 Yes Yes Yes No

Derby Hospitals NHS Foundation Trust

5-24 hours

5-24 hours

5-24 hours

>48 hours Yes Yes 7 No No Yes Yes

Kettering General Hospital NHS Trust

0-4 hours

5-24 hours

5-24 hours


Leicestershire County and Rutland PCT

>48 hours

>48 hours

>48 hours

>48 hours N/A No N/A N/A N/A No No N/A

Northampton General Hospital NHS Trust

5-24 hours

5-24 hours

25-48 hours

>48 hours Yes Yes 7 No Yes Yes No

Nottingham University Hospitals NHS Trust

5-24 hours

5-24 hours

25-48 hours

>48 hours Yes Yes 2 Yes Yes Yes Yes

Sherwood Forest Hospitals NHS Foundation Trust

5-24 hours

25-48 hours

>48 hours

>48 hours Yes Yes 12 No No No No

United Lincolnshire Hospitals NHS Trust (Grantham and District Hospital)

5-24 hours

25-48 hours

25-48 hours

>48 hours Yes Yes 14 No No Yes No



Ave

rage

CT

scan

wai

ting

time

wee

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Ave

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wai

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ser

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av

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All

high

risk

TIA

pat

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igat

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with

in 2

4 ho

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All

low

risk

TIA

pat

eint

s se

en a

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vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

United Lincolnshire Hospitals NHS Trust (Lincoln County)

25-48 hours

0-4 hours

>48 hours


United Lincolnshire Hospitals NHS Trust (Louth County Hospital)

>48 hours

>48 hours

>48 hours


United Lincolnshire Hospitals NHS Trust (Pilgrim Hospital)

0-4 hours

5-24 hours

5-24 hours


University Hospitals of Leicester NHS Trust

5-24 hours

25-48 hours

>48 hours


East of England Basildon & Thurrock University Hospitals NHS Foundation Trust

25-48 hours

25-48 hours

25-48 hours

>48 hours Yes Yes 7 Yes Yes No No

Bedford Hospital NHS Trust 0-4 hours

5-24 hours

25-48 hours


Cambridge University Hospitals NHS Foundation Trust

5-24 hours

25-48 hours

25-48 hours


East & North Hertfordshire NHS Trust

5-24 hours

25-48 hours

25-48 hours

>48 hours Yes Yes 8 Yes Yes Yes No N/A

Essex Rivers Healthcare NHS Trust

5-24 hours

25-48 hours

25-48 hours

>48 hours Yes Yes 5 Yes No Yes Yes

Hinchingbrooke Health Care NHS Trust

5-24 hours

>48 hours

25-48 hours


Ipswich Hospital NHS Trust 5-24 hours

25-48 hours

5-24 hours

25-48 hours Yes Yes 5 No Yes No No



Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

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s

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I sca

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aitin

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ays

Ave

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I sca

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Neu

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ser

vice

Neu

rova

scul

ar c

linic

av

erag

e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

James Paget University Hospitals NHS Foundation Trust

5-24 hours

5-24 hours

25-48 hours


Luton and Dunstable Hospital NHS Foundation Trust

5-24 hours

25-48 hours

25-48 hours


Mid Essex Hospital Services NHS Trust

0-4 hours

5-24 hours

25-48 hours


Norfolk & Norwich University Hospital NHS Trust

25-48 hours

>48 hours

25-48 hours


Peterborough and Stamford Hospitals NHS Foundation Trust

5-24 hours

5-24 hours

25-48 hours


Princess Alexandra Hospital NHS Trust

5-24 hours

5-24 hours

>48 hours


Queen Elizabeth Hospital King's Lynn NHS Trust

5-24 hours

5-24 hours

>48 hours


Southend University Hospital NHS Foundation Trust

0-4 hours

5-24 hours

5-24 hours


West Hertfordshire Hospitals NHS Trust (Hemel Hempstead Hospital)

0-4 hours

0-4 hours

0-4 hours


West Hertfordshire Hospitals NHS Trust (Watford General Hospital)

5-24 hours

5-24 hours

>48 hours


West Suffolk Hospitals NHS Trust

5-24 hours

>48 hours

25-48 hours

>48 hours N/A No N/A N/A N/A Yes No



Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

kend

s

Ave

rage

MR

I sca

n w

aitin

g tim

e w

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ays

Ave

rage

MR

I sca

n w

aitin

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e w

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Neu

rova

scul

ar c

linic

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ser

vice

Neu

rova

scul

ar c

linic

av

erag

e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

Islands Health & Social Services Department (Guernsey)

0-4 hours

0-4 hours

25-48 hours

>48 hours No Yes N/A No Yes Yes No

Isle of Man Department of Health and Social Security

5-24 hours

5-24 hours

25-48 hours


States of Jersey Health & Social Services

0-4 hours

0-4 hours

5-24 hours

25-48 hours Yes Yes 7 No Yes Yes No

London Barking Havering and Redbridge Hospitals NHS Trust (King George)

5-24 hours

5-24 hours

25-48 hours


Barking Havering and Redbridge Hospitals NHS Trust (Queens Hospital) in collaboration with Havering PCT

5-24 hours

5-24 hours

25-48 hours

25-48 hours Yes Yes 3 Yes Yes Yes No N/A

Barnet and Chase Farm Hospitals NHS Trust (Barnet Hospital) jointly with Barnet Primary Care Trust (Finchley Memorial Hospital)

0-4 hours

5-24 hours

5-24 hours


Barnet and Chase Farm Hospitals NHS Trust (Chase Farm Hospital)

5-24 hours

25-48 hours

25-48 hours


Barts and The London NHS Trust jointly with Tower Hamlets PCT

0-4 hours

0-4 hours

5-24 hours

25-48 hours Yes Yes 0 Yes Yes Yes Yes



Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

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Ave

rage

MR

I sca

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ays

Ave

rage

MR

I sca

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aitin

g tim

e w

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Neu

rova

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ar c

linic

TIA

ser

vice

Neu

rova

scul

ar c

linic

av

erag

e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

Bromley Hospitals NHS Trust

25-48 hours

>48 hours

>48 hours

>48 hours No Yes N/A No No Yes No

Chelsea and Westminster Hospital NHS Foundation Trust

0-4 hours

0-4 hours

25-48 hours


Ealing Hospital NHS Trust 5-24 hours

5-24 hours

25-48 hours

25-48 hours No Yes N/A No Yes Yes Yes

Epsom and St Helier University Hospitals NHS Trust (Epsom Hospital)

25-48 hours

25-48 hours

>48 hours


Epsom and St Helier University Hospitals NHS Trust (St Helier Hospital)

5-24 hours

25-48 hours

25-48 hours

>48 hours Yes Yes 8 No Yes Yes Yes

Guy's & St Thomas' Hospital NHS Foundation Trust

0-4 hours

0-4 hours

5-24 hours


Hillingdon Hospital NHS Trust

5-24 hours

5-24 hours

5-24 hours


Homerton University Hospital NHS Foundation Trust

5-24 hours

5-24 hours

>48 hours


Imperial College Healthcare NHS Trust

0-4 hours

0-4 hours

5-24 hours

5-24 hours Yes Yes 4 Yes Yes Yes Yes N/A

King's College Hospital NHS Foundation Trust

0-4 hours

0-4 hours

0-4 hours


Kingston Hospital NHS Trust

0-4 hours

5-24 hours

25-48 hours


Mayday Healthcare NHS Trust

5-24 hours

25-48 hours

>48 hours




Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

kend

s

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eekd

ays

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eeke

nds

Neu

rova

scul

ar c

linic

TIA

ser

vice

Neu

rova

scul

ar c

linic

av

erag

e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

Newham University Hospital NHS Trust

0-4 hours

0-4 hours

5-24 hours


North Middlesex University Hospital NHS Trust & Haringey PCT combined

0-4 hours

0-4 hours

25-48 hours

>48 hours Yes Yes 14 Yes No Yes No

North West London Hospitals NHS Trust (Central Middlesex Hospital including Willesden Community Hospital (Brent PCT))

5-24 hours

5-24 hours

25-48 hours

>48 hours N/A No N/A N/A N/A No No

North West London Hospitals NHS Trust (Northwick Park Hospital)

5-24 hours

5-24 hours

25-48 hours


Queen Elizabeth Hospital NHS Trust

5-24 hours

25-48 hours

25-48 hours


Queen Mary's Sidcup NHS Trust

25-48 hours

0-4 hours

>48 hours


Royal Free Hampstead NHS Trust

5-24 hours

5-24 hours

0-4 hours

5-24 hours Yes Yes 6 Yes Yes Yes No

St George's Healthcare NHS Trust

5-24 hours

5-24 hours

5-24 hours


University College London Hospitals NHS Foundation Trust

0-4 hours

0-4 hours

25-48 hours

0-4 hours Yes Yes 7 Yes No Yes Yes

University Hospital Lewisham NHS Trust

5-24 hours

5-24 hours

25-48 hours


West Middlesex University Hospital NHS Trust

5-24 hours

5-24 hours

25-48 hours




Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

kend

s

Ave

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MR

I sca

n w

aitin

g tim

e w

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ays

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eeke

nds

Neu

rova

scul

ar c

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TIA

ser

vice

Neu

rova

scul

ar c

linic

av

erag

e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

Whipps Cross University Hospital NHS Trust

0-4 hours

0-4 hours

>48 hours


Whittington Hospital NHS Trust

0-4 hours

0-4 hours

25-48 hours

25-48 hours Yes Yes 7 Yes Yes No No

Northern Ireland: Eastern Health and Social Services Board Belfast Health and Social Care Trust (Belfast City Hospital)

5-24 hours

>48 hours

25-48 hours


Belfast Health and Social Care Trust (Mater Hospital)

25-48 hours

25-48 hours

>48 hours


Belfast Health and Social Care Trust (Royal Group of Hospitals)

5-24 hours

5-24 hours

>48 hours


South Eastern Health and Social Care Trust (Lagan Valley Hospital)

5-24 hours

25-48 hours

>48 hours


South Eastern Health and Social Care Trust (Ulster Community and Hospitals)

5-24 hours

25-48 hours

25-48 hours


Northern Ireland: Northern Health and Social Services Board Northern Health and Social Care Trust (Causeway)

5-24 hours

5-24 hours

>48 hours

>48 hours No Yes N/A No No Yes Yes

Northern Health and Social Care Trust (United Hospitals)

5-24 hours

25-48 hours

>48 hours


Northern Ireland: Southern Health and Social Services Board Southern Health and Social Care Trust (Craigavon Area)

5-24 hours

25-48 hours

25-48 hours




Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

kend

s

Ave

rage

MR

I sca

n w

aitin

g tim

e w

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ays

Ave

rage

MR

I sca

n w

aitin

g tim

e w

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Neu

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scul

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TIA

ser

vice

Neu

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scul

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av

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e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

Southern Health and Social Care Trust (Newry & Mourne)

5-24 hours

25-48 hours

>48 hours

>48 hours No Yes N/A Yes No Yes Yes

Northern Ireland: Western Health and Social Services Board Western Health and Social Care Trust (Altnagelvin Hospitals)

5-24 hours

>48 hours

25-48 hours

>48 hours Yes Yes 7 Yes No No No

Western Health and Social Care Trust (Southern Sector - Erne)

5-24 hours

5-24 hours

25-48 hours


Western Health and Social Care Trust (Southern Sector - Omagh/Tyrone County Hospital)

5-24 hours

5-24 hours

Not provided

Not provided

Yes Yes 4 No Yes Yes Yes

North East City Hospitals Sunderland NHS Foundation Trust

5-24 hours

5-24 hours

>48 hours


County Durham and Darlington NHS Foundation Trust (Bishop Auckland General Hospital)

0-4 hours

5-24 hours

0-4 hours


County Durham and Darlington NHS Foundation Trust (University Hospital North Durham)

5-24 hours

5-24 hours

>48 hours


Gateshead Health NHS Foundation Trust

0-4 hours

5-24 hours

5-24 hours




Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

kend

s

Ave

rage

MR

I sca

n w

aitin

g tim

e w

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ays

Ave

rage

MR

I sca

n w

aitin

g tim

e w

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Neu

rova

scul

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TIA

ser

vice

Neu

rova

scul

ar c

linic

av

erag

e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

Newcastle upon Tyne Hospitals NHS Foundation Trust

5-24 hours

5-24 hours

25-48 hours

>48 hours Yes Yes 6 Yes Yes No Yes

North Tees and Hartlepool NHS Foundation Trust (University Hospital of Hartlepool)

5-24 hours

5-24 hours

>48 hours


North Tees and Hartlepool NHS Foundation Trust (University Hospital of North Tees)

5-24 hours

5-24 hours

>48 hours


Northumbria Healthcare NHS Foundation Trust (Hexham General Hospital)

5-24 hours

5-24 hours

25-48 hours


Northumbria Healthcare NHS Foundation Trust (North Tyneside District General Hospital)

5-24 hours

5-24 hours

25-48 hours


Northumbria Healthcare NHS Foundation Trust (Wansbeck General Hospital)

5-24 hours

5-24 hours

25-48 hours


South Tees Hospitals NHS Trust (The James Cook University Hospital) in collaboration with MPCT and R&CPCT

0-4 hours

5-24 hours

5-24 hours




Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

kend

s

Ave

rage

MR

I sca

n w

aitin

g tim

e w

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Ave

rage

MR

I sca

n w

aitin

g tim

e w

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Neu

rova

scul

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TIA

ser

vice

Neu

rova

scul

ar c

linic

av

erag

e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

South Tees Hospitals Trust (Friarage Hospital) in collaboration with Rutson Rehabilitation Unit (NY and YPCT)

5-24 hours

25-48 hours

25-48 hours


South Tyneside NHS Foundation Trust

5-24 hours

5-24 hours

5-24 hours


North West Aintree University Hospitals NHS Foundation Trust

0-4 hours

0-4 hours

25-48 hours


Blackpool, Fylde & Wyre Hospitals NHS Trust

5-24 hours

25-48 hours

>48 hours


Bolton Hospitals NHS Trust 5-24 hours

5-24 hours

25-48 hours


Central Manchester and Manchester Children's University Hospital NHS Trust

5-24 hours

25-48 hours

5-24 hours


Countess of Chester Hospital NHS Foundation Trust

0-4 hours

25-48 hours

25-48 hours


East Cheshire NHS Trust 5-24 hours

5-24 hours

5-24 hours


East Lancashire Hospitals NHS Trust (Royal Blackburn Hospital)

5-24 hours

>48 hours

>48 hours

>48 hours Yes Yes 10 No No Yes Yes N/A



Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

kend

s

Ave

rage

MR

I sca

n w

aitin

g tim

e w

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ays

Ave

rage

MR

I sca

n w

aitin

g tim

e w

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nds

Neu

rova

scul

ar c

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TIA

ser

vice

Neu

rova

scul

ar c

linic

av

erag

e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

Lancashire Teaching Hospitals NHS Foundation Trust (Chorley and South Ribble District General Hospital)

25-48 hours

>48 hours

>48 hours


Lancashire Teaching Hospitals NHS Foundation Trust (Royal Preston Hospital)

5-24 hours

>48 hours

25-48 hours


Mid Cheshire Hospitals NHS Trust

5-24 hours

25-48 hours

25-48 hours


Morecambe Bay Hospitals NHS Trust (Furness General Hospital)

5-24 hours

25-48 hours

25-48 hours


Morecambe Bay Hospitals NHS Trust (Royal Lancaster Infirmary)

5-24 hours

5-24 hours

25-48 hours

>48 hours No Yes N/A No No No No

Morecambe Bay Hospitals NHS Trust (Westmorland General Hospital)

5-24 hours

25-48 hours

25-48 hours


North Cheshire Hospitals NHS Trust

0-4 hours

5-24 hours

25-48 hours


North Cumbria Acute Hospitals NHS Trust (Cumberland Infirmary)

0-4 hours

5-24 hours

5-24 hours

25-48 hours Yes Yes 5 No Yes Yes No

North Cumbria Acute Hospitals NHS Trust (West Cumberland Hospital)

0-4 hours

5-24 hours

25-48 hours




Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

kend

s

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eekd

ays

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eeke

nds

Neu

rova

scul

ar c

linic

TIA

ser

vice

Neu

rova

scul

ar c

linic

av

erag

e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

Pennine Acute Hospitals NHS Trust (Fairfield General Hospital)

5-24 hours

5-24 hours

25-48 hours


Pennine Acute Hospitals NHS Trust (North Manchester General)

5-24 hours

25-48 hours

>48 hours


Pennine Acute Hospitals NHS Trust (Rochdale Infirmary)

0-4 hours

5-24 hours

5-24 hours

25-48 hours Yes Yes 14 Yes No Yes No

Pennine Acute Hospitals NHS Trust (Royal Oldham Hospital)

5-24 hours

5-24 hours

>48 hours


Royal Liverpool & Broadgreen University Hospitals NHS Trust

5-24 hours

25-48 hours

25-48 hours


Salford Royal NHS Foundation Trust

5-24 hours

25-48 hours

5-24 hours


Southport and Ormskirk Hospital NHS Trust

5-24 hours

5-24 hours

25-48 hours


St Helens & Knowsley Hospitals NHS Trust

5-24 hours

5-24 hours

5-24 hours


Stockport NHS Foundation Trust

5-24 hours

25-48 hours

25-48 hours


Tameside and Glossop Acute Services NHS Trust

5-24 hours

5-24 hours

25-48 hours


Tameside and Glossop PCT

Not provided

Not provided

Not provided

Not provided

N/A No N/A N/A N/A Yes Yes N/A



Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

kend

s

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eekd

ays

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eeke

nds

Neu

rova

scul

ar c

linic

TIA

ser

vice

Neu

rova

scul

ar c

linic

av

erag

e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

Trafford Healthcare NHS Trust

25-48 hours

>48 hours

>48 hours


University Hospital of South Manchester NHS Foundation Trust

5-24 hours

5-24 hours

25-48 hours


Wirral University Teaching Hospital NHS Foundation Trust

5-24 hours

25-48 hours

25-48 hours


Wrightington, Wigan and Leigh NHS Trust

5-24 hours

5-24 hours

25-48 hours


South Central Basingstoke and North Hampshire NHS Foundation Trust

5-24 hours

25-48 hours

>48 hours


Buckinghamshire Hospitals NHS Trust (Amersham & Wycombe Hospitals)

5-24 hours

25-48 hours

5-24 hours

25-48 hours Yes Yes 13 No No Yes No

Buckinghamshire Hospitals NHS Trust (Stoke Mandeville Hospital)

5-24 hours

25-48 hours

5-24 hours

25-48 hours Yes Yes 16 No No Yes Yes

Heatherwood & Wexham Park Hospitals NHS Foundation Trust

5-24 hours

25-48 hours

25-48 hours


Isle of Wight NHS Primary Care Trust

5-24 hours

25-48 hours

25-48 hours


Milford Stroke Unit (New Forest PCT)

0-4 hours

25-48 hours

>48 hours


Milton Keynes Hospital NHS Foundation Trust

5-24 hours

25-48 hours

5-24 hours




Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

kend

s

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eekd

ays

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eeke

nds

Neu

rova

scul

ar c

linic

TIA

ser

vice

Neu

rova

scul

ar c

linic

av

erag

e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

Oxford Radcliffe Hospitals NHS Trust (Horton Hospital)

5-24 hours

25-48 hours

>48 hours

>48 hours Yes Yes 7 No No Yes No N/A

Oxford Radcliffe Hospitals NHS Trust (John Radcliffe Hospital)

5-24 hours

5-24 hours

25-48 hours


Portsmouth Hospitals NHS Trust jointly with Hampshire and Portsmouth City PCTs

5-24 hours

5-24 hours

25-48 hours


Royal Berkshire NHS Foundation Trust

5-24 hours

25-48 hours

5-24 hours


Southampton University Hospitals NHS Trust

25-48 hours

25-48 hours

>48 hours


Tannersbrook Stroke Unit (Southampton City PCT)

25-48 hours

25-48 hours

>48 hours


Winchester and Eastleigh Healthcare NHS Trust

5-24 hours

5-24 hours

5-24 hours


South East Coast Ashford and St Peter's Hospital NHS Trust

0-4 hours

0-4 hours

25-48 hours


Brighton & Sussex University Hospitals NHS Trust (Brighton)

0-4 hours

0-4 hours

5-24 hours


Brighton & Sussex University Hospitals NHS Trust (Princess Royal Hospital Haywards Heath)

5-24 hours

25-48 hours

25-48 hours

>48 hours No Yes N/A Yes Yes Yes No



Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

kend

s

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eekd

ays

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eeke

nds

Neu

rova

scul

ar c

linic

TIA

ser

vice

Neu

rova

scul

ar c

linic

av

erag

e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

Dartford & Gravesham NHS Trust

5-24 hours

25-48 hours

>48 hours


East Kent Hospitals NHS Trust (Kent & Canterbury Hospital)

5-24 hours

5-24 hours

25-48 hours


East Kent Hospitals NHS Trust (Queen Elizabeth The Queen Mother Hospital)

0-4 hours

5-24 hours

5-24 hours


East Kent Hospitals NHS Trust (William Harvey Hospital)

5-24 hours

5-24 hours

25-48 hours


East Sussex Hospitals NHS Trust (Conquest Hospital)

25-48 hours

>48 hours

>48 hours


East Sussex Hospitals NHS Trust (Eastbourne Hospital)

25-48 hours

>48 hours

25-48 hours


Frimley Park Hospitals NHS Foundation Trust

0-4 hours

0-4 hours

5-24 hours


Maidstone and Tunbridge Wells NHS Trust (Kent & Sussex Hospital)

5-24 hours

5-24 hours

>48 hours

>48 hours No Yes N/A No No Yes Yes

Maidstone and Tunbridge Wells NHS Trust (Maidstone Hospital)

5-24 hours

25-48 hours

25-48 hours


Medway Maritime Hospital, Medway PCT & Swale PCT

5-24 hours

>48 hours

25-48 hours


Royal Surrey County Hospital NHS Trust

0-4 hours

0-4 hours

5-24 hours




Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

kend

s

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eekd

ays

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eeke

nds

Neu

rova

scul

ar c

linic

TIA

ser

vice

Neu

rova

scul

ar c

linic

av

erag

e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

Royal West Sussex Trust 5-24 hours

5-24 hours

5-24 hours


Surrey & Sussex Healthcare NHS Trust

5-24 hours

25-48 hours

5-24 hours


Worthing & Southlands Hospitals NHS Trust

25-48 hours

>48 hours

25-48 hours


South West

Dorset County Hospital NHS Foundation Trust

25-48 hours

>48 hours

25-48 hours


Gloucestershire Hospitals NHS Foundation Trust (Cheltenham General Hospital)

5-24 hours

25-48 hours

>48 hours


Gloucestershire Hospitals NHS Foundation Trust (Gloucestershire Royal Hospital)

0-4 hours

5-24 hours

5-24 hours


North Bristol NHS Trust 0-4 hours

0-4 hours

25-48 hours


Northern Devon Healthcare NHS Trust in collaboration with North Devon Primary Care Trust

5-24 hours

25-48 hours

25-48 hours


Plymouth Hospitals NHS Trust

5-24 hours

25-48 hours

5-24 hours


Plymouth Primary Care Trust

5-24 hours

25-48 hours

25-48 hours

25-48 hours N/A No N/A N/A N/A Yes No



Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

kend

s

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eekd

ays

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eeke

nds

Neu

rova

scul

ar c

linic

TIA

ser

vice

Neu

rova

scul

ar c

linic

av

erag

e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

Poole Hospital NHS Foundation Trust

5-24 hours

25-48 hours

25-48 hours


Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust

5-24 hours

25-48 hours

5-24 hours

25-48 hours Yes Yes 4 No Yes Yes Yes

Royal Cornwall Hospitals NHS Trust

25-48 hours

>48 hours

>48 hours


Royal Devon & Exeter NHS Foundation Trust in collaboration with Devon Primary Care Trust

25-48 hours

25-48 hours

>48 hours

>48 hours Yes Yes 2 Yes Yes Yes No N/A

Royal United Hospital Bath NHS Trust in collaboration with Bath & North East Somerset PCT and Wiltshire PCT

5-24 hours

5-24 hours

25-48 hours


Salisbury NHS Foundation Trust

5-24 hours

25-48 hours

25-48 hours


South Devon Healthcare NHS Foundation Trust combined with Devon PCT

5-24 hours

5-24 hours

25-48 hours


Swindon & Marlborough NHS Trust (in collaboration with Swindon PCT)

5-24 hours

25-48 hours

5-24 hours

25-48 hours Yes Yes 21 No No Yes Yes

Taunton and Somerset NHS Foundation Trust

5-24 hours

25-48 hours

>48 hours


United Bristol Healthcare NHS Trust

0-4 hours

5-24 hours

25-48 hours




Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

kend

s

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eekd

ays

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eeke

nds

Neu

rova

scul

ar c

linic

TIA

ser

vice

Neu

rova

scul

ar c

linic

av

erag

e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

Weston Area Health Trust 5-24 hours

5-24 hours

>48 hours


Yeovil District Hospital NHS Foundation Trust

5-24 hours

5-24 hours

5-24 hours


Wales Mid and West Abertawe Bro Morgannwg University NHS Trust (Neath Port Talbot Hospital)

5-24 hours

25-48 hours

>48 hours

>48 hours No Yes N/A No Yes Yes Yes

Abertawe Bro Morgannwg University NHS Trust (Princess of Wales Hospital)

5-24 hours

25-48 hours

>48 hours


Carmarthenshire NHS Trust (Prince Philip Hospital)

5-24 hours

5-24 hours

25-48 hours


Carmarthenshire NHS Trust (West Wales General Hospital)

5-24 hours

5-24 hours

0-4 hours


Ceredigion & Mid-Wales NHS Trust

0-4 hours

5-24 hours

>48 hours

>48 hours Yes Yes 7 No Yes No No

Pembrokeshire & Derwen NHS Trust

5-24 hours

5-24 hours

25-48 hours


Powys Local Health Board >48 hours

>48 hours

>48 hours


Swansea NHS Trust (Morriston Hospital)

5-24 hours

25-48 hours

>48 hours


Swansea NHS Trust (Singleton Hospital)

5-24 hours

>48 hours

25-48 hours


Wales North Conwy & Denbighshire NHS Trust

5-24 hours

>48 hours

25-48 hours




Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

kend

s

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eekd

ays

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eeke

nds

Neu

rova

scul

ar c

linic

TIA

ser

vice

Neu

rova

scul

ar c

linic

av

erag

e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

North East Wales NHS Trust

5-24 hours

>48 hours

25-48 hours


North West Wales NHS Trust (Bangor Hospital)

5-24 hours

25-48 hours

25-48 hours

25-48 hours N/A No N/A N/A N/A Yes No

North West Wales NHS Trust (Llandudno Hospital)

>48 hours

>48 hours

Not provided

Not provided

N/A No N/A N/A N/A Yes No

Wales South East Cardiff and Vale NHS Trust (Llandough Hospital)

5-24 hours

>48 hours

>48 hours


Cardiff and Vale NHS Trust (University Hospital Wales)

5-24 hours

>48 hours

0-4 hours


Gwent Healthcare NHS Trust (Caerphilly District Miner's Hospital)

25-48 hours

>48 hours

>48 hours

>48 hours Yes Yes 15 No No Yes No N/A

Gwent Healthcare NHS Trust (Nevill Hall Hospital)

5-24 hours

5-24 hours

25-48 hours


Gwent Healthcare NHS Trust (St Woolos Hospital, Royal Gwent & Caerphilly District Miner's Hospital)

5-24 hours

25-48 hours

25-48 hours

>48 hours Yes Yes 10 Yes No Yes Yes N/A

North Glamorgan NHS Trust

5-24 hours

5-24 hours

>48 hours


Pontypridd & Rhondda NHS Trust

25-48 hours

>48 hours

>48 hours


West Midlands

Burton Hospitals NHS Trust 5-24 hours

25-48 hours

25-48 hours




Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

kend

s

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eekd

ays

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eeke

nds

Neu

rova

scul

ar c

linic

TIA

ser

vice

Neu

rova

scul

ar c

linic

av

erag

e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

Dudley Group of Hospitals NHS Trust

5-24 hours

25-48 hours

>48 hours


George Eliot Hospital NHS Trust

5-24 hours

5-24 hours

25-48 hours


Heart of England NHS Foundation Trust (Good Hope Hospital)

5-24 hours

25-48 hours

25-48 hours


Heart of England NHS Foundation Trust (Birmingham Heartlands and Solihull Hospitals)

0-4 hours

0-4 hours

5-24 hours

25-48 hours Yes Yes 14 Yes No Yes No

Hereford Hospitals NHS Trust

5-24 hours

>48 hours

5-24 hours


Mid Staffordshire General Hospitals NHS Trust

5-24 hours

25-48 hours

25-48 hours


Royal Wolverhampton Hospitals NHS Trust jointly with Wolverhampton Health Care NHS Trust

5-24 hours

25-48 hours

>48 hours


Sandwell and West Birmingham Hospitals NHS Trust (City Hospital)

5-24 hours

25-48 hours

5-24 hours

>48 hours Yes Yes 14 Yes No No No

Sandwell and West Birmingham Hospitals NHS Trust (Sandwell District Hospital)

25-48 hours

>48 hours

25-48 hours


Shrewsbury & Telford Hospital NHS Trust

5-24 hours

25-48 hours

>48 hours


South Birmingham Primary Care Trust

>48 hours

>48 hours

>48 hours




Ave

rage

CT

scan

wai

ting

time

wee

kday

s

Ave

rage

CT

scan

wai

ting

time

wee

kend

s

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eekd

ays

Ave

rage

MR

I sca

n w

aitin

g tim

e w

eeke

nds

Neu

rova

scul

ar c

linic

TIA

ser

vice

Neu

rova

scul

ar c

linic

av

erag

e w

aitin

g tim

e

All

high

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in 2

4 ho

urs

All

low

risk

TIA

pat

eint

s se

en a

nd in

vest

igat

ed

with

in o

ne w

eek

Patie

nt /

care

r vie

ws

soug

ht o

n se

rvic

e

Rep

ort p

rodu

ced

with

in 1

2 m

onth

s an

alys

ing

patie

nt /

care

r vie

ws

Ove

rall

posi

tion

in 2

008

Ove

rall

posi

tion

in 2

006

South Warwickshire General Hospitals NHS Trust

5-24 hours

>48 hours

>48 hours


University Hospitals Coventry and Warwickshire NHS Trust

5-24 hours

5-24 hours

25-48 hours


University Hospital Birmingham NHS Foundation Trust

5-24 hours

25-48 hours

25-48 hours

25-48 hours Yes Yes 7 No No No No

University Hospital of North Staffordshire NHS Trust combined with North Staffordshire Combined Healthcare NHS Trust

0-4 hours

0-4 hours

>48 hours


Walsall Hospitals NHS Trust

5-24 hours

25-48 hours

>48 hours


Worcestershire Acute Hospitals NHS Trust (Alexandra Hospital Redditch)

5-24 hours

25-48 hours

5-24 hours

>48 hours Yes Yes 6 Yes Yes No Yes

Worcestershire Acute Hospitals NHS Trust (Worcester Royal Hospital)

5-24 hours

>48 hours

25-48 hours


Yorkshire and The Humber

Airedale NHS Trust 0-4 hours

5-24 hours

5-24 hours


Barnsley Hospital NHS Foundation Trust

5-24 hours

>48 hours

25-48 hours




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006

Bradford Teaching Hospitals NHS Foundation Trust

5-24 hours

25-48 hours

>48 hours


Calderdale & Huddersfield NHS Foundation Trust

5-24 hours

5-24 hours

25-48 hours


Doncaster & Bassetlaw Hospitals NHS Foundation Trust (Bassetlaw District General Hospital)

0-4 hours

5-24 hours

5-24 hours


Doncaster & Bassetlaw Hospitals NHS Foundation Trust (Doncaster Royal Infirmary & Montagu Hospital)

5-24 hours

25-48 hours

25-48 hours


Harrogate and District NHS Foundation Trust

0-4 hours

5-24 hours

5-24 hours


Hull and East Yorkshire Hospitals NHS Trust

5-24 hours

5-24 hours

>48 hours


Leeds Teaching Hospitals NHS Trust

5-24 hours

5-24 hours

25-48 hours


Mid Yorkshire Hospitals NHS Trust

5-24 hours

25-48 hours

>48 hours


Northern Lincolnshire and Goole Hospitals NHS Foundation Trust (Diana Princess of Wales Hospital)

5-24 hours

25-48 hours

25-48 hours


Northern Lincolnshire and Goole Hospitals NHS Foundation Trust (Scunthorpe General)

5-24 hours

25-48 hours

>48 hours




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Rotherham NHS Foundation Trust

5-24 hours

25-48 hours

>48 hours


Scarborough and North East Yorks Health Care NHS Trust

0-4 hours

0-4 hours

>48 hours


Sheffield Teaching Hospitals NHS Foundation Trust

5-24 hours

5-24 hours

5-24 hours


York Hospitals NHS Foundation Trust

5-24 hours

5-24 hours

5-24 hours

25-48 hours Yes Yes 21 No No Yes No

Stroke Organisational Audit Proforma 2008

National Sentinel Stroke Organisational Audit 2008 Copyright to the Royal College of Physicians 2008 1

APPENDIX ROYAL COLLEGE OF PHYSICIANS NATIONAL SENTINEL STROKE AUDIT 2008

ORGANISATIONAL AUDIT PROFORMA This proforma should describe your stroke services as at 1st April 2008. Please complete all questions. Clarification is available online against each question and also in the Help Booklet provided. In some cases you will either be directed to a later question or a response will not be apply based on answers to key questions. Data should be submitted to the Royal College of Physicians via the website.

Final Deadline 2nd May 2008.

Helpline: telephone 0207 9351174 ext 335 email [email protected]

SITE CODE:

A1 What type of service do you provide at this site? (tick all that apply) Hyperacute service

Definition

A service which is able to see and investigate stroke patients within 3 hours of stroke to assess suitability

for thrombolysis

Acute service

Definition

A service which is able to see and investigate stroke patients urgently after stroke to provide a full range

of care to patients from admission but does not offer thrombolysis

Rehabilitation service

Definition

A service which is able to see patients for rehabilitation

mailto:[email protected]



Definition of a “site” Historically some larger trusts with several disparate sites may have registered each site separately to identify the differences between them. A site may include several hospitals and some include more than one trust. The term “site” is used throughout the proforma and questions relate to services across the site as constituted by the registration form and name of the site. They will receive individualised reports indicating their trust name and the site. Where there is collaboration between trusts the name of the collaborating trust will also appear on the report.

A2 If you provide rehabilitation services only do you link with another trust? Yes No Enter the site code of link site [ ] contact RCP helpdesk for site code (give details of the main site you link with) B Do you have a stroke unit? Yes No B1 If YES, what is the total number of stroke unit beds across your site? [ ] B2 If YES which of the following types of Stroke Unit do you have? (Tick all that apply) Acute stroke unit Rehab stroke unit Combined stroke unit



SECTION 1 ACUTE PRESENTATION 1.1 Auditor Discipline: (tick all that apply) Doctor Manager Nurse Therapist Clinical Audit/Clinical Governance Other (please specify) CASELOAD Definition of a “site” Historically some larger trusts with several disparate sites may have registered each site separately to identify the differences between them. A site may include several hospitals and some include more than one trust. The term “site” is used throughout the proforma and questions relate to services across the site as constituted by the registration form and name of the site. They will receive individualised reports indicating their trust name and the site. Where there is collaboration between trusts the name of the collaborating trust will also appear on the report.

1.2) Please estimate the number of patients with stroke across the site at the time this form is completed [ ]

1.2i) Please estimate how many patients with stroke or TIA are in stroke unit beds across your site at the time this form is completed [ ] This has been re-worded to include TIA patients

1.2ii) Please estimate the number of patients with TIA there are in hospital beds across your site at the time this form is completed [ ] PRESENTATION AT HOSPITAL 1.3) Are there arrangements with the local ambulance service for emergency/rapid transfer to hospital for stroke patients with acute stroke over and above the regular system? Yes No 1.4) Do paramedics in your area have the FAST test included in bedside assessment? Yes No



1.5) Which ward is a patient with acute stroke most likely to be admitted to first? (select one option) Medical Assessment Unit/Admission ward or similar clinical decision unit General medical ward

Care of the Elderly ward Neurology ward ITU HDU

Acute stroke unit Rehabilitation Stroke unit 1.6) Do you provide thrombolysis for appropriate stroke patients at your site? Yes No If NO, go to question 1.8

1.6i) If yes, please estimate the total number of patients thrombolysed in the past year [ ]

1.6ii) If yes, what level of service do you offer Weekdays

Number of hours per day [ ] hours

Weekends

Number of hours per day [ ] hours

1.7) If yes, how many consultant level doctors do you have on your thrombolysis rota? [ ]

1.7i) If yes, which specialties are on the rota? (Tick all that apply) Stroke physician Neurologist Care of the Elderly Cardiologist General Medicine physician A& E

Other If other, please specify



1.8) IF YOU DO NOT offer thrombolysis, do you have arrangements Yes No with another acute trust for thrombolysis?

1.8i) If yes, which trust? Site code of trust [ ] 1.8ii) If yes, please give the total number of your patients thrombolysed in the past year by this trust [ ]

1.8iii) If yes, is your hospital stroke service by-passed by the local ambulance service to take stroke patients to hospital where thrombolysis services are available? Yes No

1.9) Do you use telemedicine to allow remote access for the management Yes No of acute stroke care?

1.9i) If YES, which of the following do you use: (Tick all that apply) Remote viewing for brain imaging Video enabled clinical assessment

SECTION 2 STROKE UNIT MODELS ORGANISATION OF CARE If you answered yes to question B (ie if you do have a stroke unit) TYPE OF STROKE UNIT Answer the following questions for each type of unit that is relevant to your site. Please read the definitions of each type of unit carefully to decide which questions you should answer ACUTE STROKE BEDS (ASU) Definition: Patients are accepted acutely but discharged or transferred early (usually within 7 days)

2.1) What is the total number of units for acute stroke care across your site? 1 2 3 4 5 6 Please complete questions 2.2 -2.4 for each ASU



2.2) What is the number of beds designated for acute stroke care on EACH acute stroke unit

ASU 1 ASU 2 ASU 3 ASU 4 ASU 5 ASU 6 No. of beds [ ][ ][ ][ ][ ][ ] 2.3) Which of the following features do each of these units provide? (Tick all that apply)ASU Unit

1, 2, 3, 4, 5, 6 a) continuous physiological monitoring (ECG, oximetry, blood pressure) b) access to scanning within 3 hours of admission. c) a policy for direct admission from A&E/front door d) specialist ward rounds at least 5 times a week e) acute stroke protocols/guidelines

2.4) How many of the following nursing staff are there usually on duty at 10.00 in the morning (on a normal week-day) on each of these acute stroke units?

ASU 1 ASU 2 ASU 3 ASU 4 ASU 5 ASU 6

(Enter 0 if no staff of that grade) a) Qualified nurses [ ] [ ] [ ] [ ] [ ] [ ] b) Care assistants [ ] [ ] [ ] [ ] [ ] [ ]

REHABILITATION STROKE BEDS (RSU)

Definition: accepts patients after a delay of often 2 days or more and has a focus on rehabilitation

2.5) What is the total number of units for rehabilitation stroke care across your site? 1 2 3 4 5 6

Please complete questions 2.6 -2.7 for each SRU and 2.8 if you have both acute and rehabilitation stroke units. 2.6) What is the number of beds designated for stroke rehabilitation on EACH stroke rehabilitation unit?

RSU 1 RSU 2 RSU 3 RSU 4 RSU 5 RSU 6

No. of beds [ ][ ][ ][ ][ ][ ]



2.7) How many of the following nursing staff are there usually on duty at 10.00 in the morning (on a normal week-day) on each of these rehabilitation stroke units?

(Enter 0 if no staff of that grade) RSU 1 RSU 2 RSU 3 RSU 4 RSU 5 RSU 6

a) Qualified nurses [ ][ ][ ][ ][ ][ ] b) Care assistants [ ][ ][ ][ ][ ][ ]

2.8) If you have both acute and rehabilitation stroke units are they on the same ward? Yes No COMBINED STROKE BEDS (CSU) Definition: No separation between acute and rehabilitation beds. Accepts patients acutely but also provides rehabilitation for at least several weeks if necessary. 2.9) What is the total number combined stroke units across your site? 1 2 3 4 5 6

Please complete questions 2.10 -2.12 for each CSU 2.10) What is the number of beds designated for acute stroke and rehabilitation on EACH combined stroke unit?

CSU 1 CSU 2 CSU 3 CSU 4 CSU 5 CSU 6 No. of beds [ ][ ][ ][ ][ ][ ] 2.11) Which of the following features do each of these units provide? (Tick all that apply) CSU Units

1, 2, 3, 4, 5, 6 a) continuous physiological monitoring (ECG, oximetry, blood pressure) b) access to scanning within 3 hours of admission. c) a policy for direct admission from A&E/front door d) specialist ward rounds at least 5 times a week e) acute stroke protocols/guidelines

2.12) How many of the following nursing staff are there usually on duty at 10.00 in the morning (on a normal week-day) on each of the combined stroke units?

CSU 1 CSU 2 CSU 3 CSU 4 CSU 5 CSU 6 a) Qualified nurses [ ][ ][ ][ ][ ][ ] b) Care assistants [ ][ ][ ][ ][ ][ ]



SECTION 3 ALL STROKE UNITS ALL STROKE UNITS 3.1) If you have a stroke unit / stroke units, do you have ready access Yes No to social work expertise? 3.2) For access to specialist stroke units across your site, do any of Yes No these exclusion criteria apply? If YES, 3.2i) Which of the following criteria apply:

Acute SU Rehab SU Combined SU a) Age related

b) Stroke severity c) Pre existing dementia d) No rehabilitation potential e) End of life care 3.3) What is the total establishment of whole time equivalents (WTEs) of the following professionals for all your stroke unit beds? If any of these professionals treat stroke patients in relation to stroke management at weekends on the stroke unit, tick the option of 7 day working. (Enter 0 if no establishment)

7 day working (Tick all that apply)

i) Clinical Psychology [ ] WTE ii) Dietetics [ ] WTE iii) Occupational Therapy [ ] WTE iv) Physiotherapy [ ] WTE v) Speech & Language Therapy [ ] WTE vi) Pharmacy [ ] WTE vii) Orthotics [ ] WTE viii) Foot health/Podiatry [ ] WTE



3.4) Do you provide 7-day rehabilitation on any of your stroke unit(s)? Yes No

If YES, which staff provide cover? 3.4i) Qualified therapists 3.4ii) Rehabilitation support workers

3.5) How many sessions of junior doctor time are there per week in total for all stroke unit beds? [ ] Sessions

SECTION 4 OTHER STROKE CARE MODELS EARLY SUPPORTED DISCHARGE TEAM Definition – Early supported discharge team refers to a multidisciplinary team which provides rehabilitation and support in a community setting with the aim of reducing the duration of hospital care for stroke patients. 4.1) Do you have access to a stroke specialist early supported discharge team? Yes No IF NO go to 4.2 4.1i) If yes, what percentage of your catchment area has access? [ ] 4.1ii) If yes, which of the following are regular members of the team? (Tick all that apply)

Specialist doctor Occupational therapist Specialist nurse Dietitian Social worker Psychologist Speech and language therapist Other (please specify) Physiotherapist

4.1iii) How many patients has the team treated at home in the last week? [ ] 4.2) Is there a specialist community / domiciliary rehabilitation team for longer term Yes No management in your area?

If NO go to Section 5

4.2i) If yes, is this specialist community rehabilitation team staffed by: (Tick all that apply)

Stroke rehabilitation specialist staff Neuro rehabilitation specialist staff Generic rehabilitation specialist staff



SECTION 5 IMAGING, TIA/NEUROVASCULAR SERVICE IMAGING

Are you able to obtain the following for your stroke inpatients: If yes for either of 5.1, 5.2 or 5.3 you must tick one of each of the options from a) – d) for both Weekdays and Weekends for each appropriate question 5.1) CT scanning Yes No If yes, what is the current average waiting time for both weekdays and weekends?

Weekdays Weekends a) 0-4 hours b) 5-24 hours c) 25-48 hours d) More than 48 hours

5.2) MRI scanning Yes No If yes, what is the current average waiting time for both weekdays and weekends? Weekdays Weekends a) 0-4 hours b) 5-24 hours c) 25-48 hours d) More than 48 hours 5.3) Carotid Doppler Yes No If yes, what is the current average waiting time for both weekdays and weekends? Weekdays Weekends a) 0-4 hours b) 5-24 hours c) 25-48 hours d) More than 48 hours



TIA/NEUROVASCULAR SERVICE 5.4) Do you provide any service for TIA patients at your site? Yes No If NO go straight to section 6 If YES, Yes No 5.5) Do you have a neurovascular clinic?

If YES, i) How many clinics within a 4 week period? [ ] ii) How many new patients were seen during the past 4 weeks? [ ] iii) What is the current average waiting time for an appointment? [ ] days

Definition of High risk TIA patient Risk will be assessed using a validated tool (e.g. ABCD2 where high risk is defined as a score of 4 or more)

5.6) Do you have a system which enables you to see, investigate and Yes No initiate treatment for ALL your HIGH risk TIA patients within 24 hours of referral?

5.6a) If YES, is this as an: inpatient (tick all that apply) outpatient

5.6b) If NO, within what timescale can you see, investigate and initiate treatment for ALL your HIGH risk TIA patients? (Tick only 1 option)

less than one week after referral 1-2 weeks after referral 2-4 weeks after referral More than 4 weeks after referral

Definition of Low risk TIA patient Risk will be assessed using a validated tool (e.g. ABCD2 where low risk is defined as a score of less than 4)

5.7) Do you have a system which enables you to see, investigate and Yes No initiate treatment for ALL your LOW risk TIA patients within one week of referral?

5.7a) If YES, is this as an: inpatient (tick all that apply) outpatient



5.7b) If NO, within what timescale can you see, investigate and initiate treatment for ALL your LOW risk TIA patients? (Tick only 1 option)

1-2 weeks after referral 2-4 weeks after referral More than 4 weeks after referral

5.8) Specify the average timing between diagnosis and carotid surgery for patients requiring carotid endarterectomy? (Tick only 1 option)

< 1 week 1-2 weeks 2 – 4 weeks > 4 weeks Not applicable

5.8a What are the major rate limiting factors in delaying access to carotid endarterectomy? Rank in order of priority (1 is the most important cause of delay 6 is the least important cause of delay) Not known [ ] Access to surgical outpatients [ ] Access to scanning (brain) [ ] Access to scanning (carotid) [ ] Access to theatre/anaesthesia [ ] Access to surgeons [ ] Access to HDU/ICT [ ] 5.9) Are there direct referral pathways set up between your local ambulance service and your TIA services to allow Paramedic/Technician referrals of TIA patients? Yes No



SECTION 6 SPECIALIST ROLES MEDICAL STAFF 6.1) Is there a consultant physician with specialist knowledge of stroke who is formally Yes No recognised as having principal responsibility for stroke services? 6.2) Do you have an accredited specialist registrar in post registered for Yes No stroke specialist training? 6.3) How many formal sessions are there per week of senior doctor time for the management of stroke (including Outpatient Clinics) a) Consultant [ ] sessions per week b) Associate specialist [ ] sessions per week c) Non consultant career grade [ ] sessions per week d) Staff grade [ ] sessions per week e) Clinical Assistant [ ] sessions per week OTHER STROKE SPECIALIST ROLES 6.4) How many whole time equivalents of each of the following stroke specialists do you have? (enter 0 if you do not have one) No. of whole time

equivalents 6.4i) Stroke Co-ordinator [ ] 6.4ii) Stroke Specialist Nurse [ ] 6.4iii) Stroke Clinical Specialist Therapist [ ] 6.4iv) Stroke Consultant Nurse [ ] 6.4v) Stroke Consultant Therapist [ ] Vocational Training and Support 6.5) Is there access to vocational training/employment support for Yes No stroke patients?



SECTION 7 CONTINUING EDUCATION & RESEARCH For question 7.1 please answer yes for “Stroke Unit” if a programme exists in ANY of your stroke unit(s) (ie acute, rehabilitation or combined). “Other wards” refers to having a programme for ALL other wards in the hospital which treat stroke patients.

CONTINUING EDUCATION & RESEARCH CAPACITY

Stroke Unit Other Wards where patients are admitted in

the Trust 7.1) Is there a programme for the continuing education Yes No Yes No of staff in management of stroke? 7.2) How many clinical stroke related research studies with formal research ethics committee approval and patient consent (or relative assent) are registered with your Research & Development Department (on the day you complete this form)? Please give as a total and then estimate by type of study.

Total [ ] a) Acute [ ] b) Rehabilitation [ ] c) Prevention [ ] d) Other [ ] 7.3) How much time (in whole time equivalents, WTE, and however funded) is spent on clinical stroke related research studies with formal research ethics committee approval and where patient consent (or relative assent) is required? Please give as a total and then estimate by type of profession.

Total [ ] WTE

a) Doctor [ ] WTE b) Nurse [ ] WTE c) Occupational Therapy [ ] WTE d) Physiotherapy [ ] WTE e) Speech & Language Therapy [ ] WTE f) Psychologist [ ] WTE g) Dietitian [ ] WTE h) Other [ ] WTE



7.4) Does your site receive research staff support from the Stroke Research Network? Yes No

7.4a) If Yes specify research nurse/coordinator WTE support provided [ ] WTE

SECTION 8 TEAM MEETINGS TEAM MEETINGS For the following questions please answer YES for “Stroke Unit” if the answer is YES for ANY of your stroke units (acute, rehabilitation or combined). Please answer YES to “Other wards.” if the answer is YES for ALL other wards in the hospital which treat stroke patients. Stroke Unit Other Wards

where patients are admitted in

the Trust 8.1) Are there team meetings at least once a week for the Yes No Yes No interchange of information about individual patients? 8.2) Which of the following disciplines regularly attend the team meetings?(please mark all that apply)

Stroke Unit Other Wards where patients are admitted in

the Trust a) Clinical Psychology b) Dietetics c) Medicine (senior doctor) d) Nursing e) Occupational Therapy f) Physiotherapy g) Social Work h) Speech and Language Therapy



SECTION 9 PATIENT/CARER COMMUNICATION For the following questions please answer YES for “Stroke Unit” if the answer is YES for ANY of your stroke units (acute, rehabilitation or combined). Please answer YES to “Other wards..” if the answer is YES for ALL other wards in the hospital which treat stroke patients.

Stroke Unit Other Wards

where patients are admitted in

the Trust 9.1) Does the organisation of the ward/unit enable patients Yes No Yes No to have access to their management plan? 9.2) Is there patient information literature displayed in unit/ward on the following?

9.2a) Patient versions of national or local guidelines/standards 9.2b) Social Services local Community Care arrangements 9.2c) The Benefits Agency 9.2d) Secondary prevention advice DISCHARGE PLANNING 9.3) Do you have a standard minimum dataset for discharge summaries to primary care? Yes No 9.3a) If yes, which of the following are included? (Tick all that apply)

Diagnosis Significant events during admission Investigations Medication Follow up arrangements Referrals to other agencies

9.4 This question has been removed 9.5) Are patients given copies of their discharge summary/letters? Yes No

9.6) Does the Stroke service have formal links with patients and Yes No carers organisations for communication on service provision, audit and future plans?



9.7) Is there a community user group for stroke? Yes No

9.8) Is there a policy to give patients a named contact Yes No on transfer from hospital to community?

9.9) Are Patient/Carer groups involved in formulating policy to Yes No deliver care?

9.10) Are Patient/Carer views sought on stroke services? Yes No

9.11) Has a report been produced within the past 12 months which Yes No analysed the views of patients?

Notes:

This section is for you to clarify your answers to any questions. Identify the question number(s) which apply to each comment. (Online version allows you to enter comments next to each individual question)

Summary report on the National Sentinel Stroke Audit 2001/02

Documents

Transcript of Summary report on the National Sentinel Stroke Audit 2001/02