A range of services for the diagnosis of stroke, acute treatment, rehabilitation and follow-up after discharge from hospital. Currently these services are delivered at Lincoln and Pilgrim Hospitals. Diagnostic services start in our emergency departments and then patients have treatment on the acute stroke units in these two hospitals. There is also a stroke rehabilitation service in the community that cares for people after they have been discharged from hospital.
Why we need to change?
Current hospital services are delivered by two separate teams, one at each hospital and are heavily dependent on temporary staff. Our hospital stroke services are not achieving all performance standards and we have significant staffing vacancies.
The number of patients we treat at Lincoln and Pilgrim Hospitals is relatively low and as a result staff at each hospital are only just seeing enough patients to maintain their expertise.
The service currently only achieves six out of the ten domains in the Sentinel Stroke National Audit Programme and only two out of the four priority standards for seven-day services. This means that the service is not achieving national care standards.
In the current service model, Lincoln and Pilgrim Hospitals should each have eight permanent consultants, but each only currently has one and we have been unable to recruit to these posts over the last three years. There is a serious shortage of stroke consultants nationally, with over 40% of posts remaining unfilled.
Clinical evidence is clear that concentrating services in a specialist unit will reduce the number of deaths from stroke, improve rehabilitation, will get patients home more quickly and increases our ability to recruit staff.
There is clear evidence that concentrating such expertise saves lives; the Lincolnshire Heart Centre is a good example of this.
What are the ‘emerging options’?
Our first emerging option, similar to that for breast services, is to take a centre of excellence approach, providing acute stroke care from the Lincoln Hospital site. This is the NHS’s current preferred emerging option because it will provide the best model to meet national care standards for patients, and to recruit and retain staff.
The second emerging option is to retain the current service at Lincoln and Pilgrim Hospitals but with an out of hours combined on-call rota being based at Lincoln.
In both emerging options, our intention would be to enhance rehabilitation in the community across Lincolnshire to reduce the length of stay in hospital from 14 days to 7 days in line with national best practice.
The benefits of the NHS’s preferred emerging option could include:
- Ability to meet national standards of care
- Reduction in the number of deaths from strokes
- Reduction in the number of people living with continued disability
- Improved staff recruitment and retention