The case for change

Significant improvements have been made to stroke services in County Durham and Darlington recently. As of December 2010, life-saving, clot-busting thrombolysis treatment has been available 24 hours a day, seven days a week for the first time.

This round the clock availability represented a great step forward in the drive to get high quality, effective treatments to patients suffering a stroke within the nationally recommended timeframe. However, NHS County Durham and Darlington recognises that more needs to be done to ensure that quality standards are fulfilled for the benefit of local people.

Following a review of all stroke services, from emergency care through to rehabilitation, it has become clear that hyperacute services are where the fastest improvements can be made. Hyperacute services are one of the most critical components of stroke care that patients need when they are at their most seriously ill.

National standards say that these should be available around the clock with patients being directly admitted to a stroke unit where specialist stroke consultants and quick access to essential tests such as brain scans are available.

In County Durham and Darlington, hyperacute stroke services are provided from the University Hospital of North Durham and Darlington Memorial Hospital by County Durham and Darlington NHS Foundation Trust. Unfortunately, services are still not achieving key quality standards, with patients experiencing varying quality of services. Not enough patients are being directly admitted to a specialist stroke unit, leading to unnecessary delays in diagnosis and treatment.

During normal working hours, hyperacute stroke services are currently available at two sites, however, staff alternate between sites to provide out of hours provision. Currently thrombolysis is only available 24 hours a day, seven days a week, on alternate hospital sites, i.e. one week at Darlington and the next at Durham.

So for example if someone had a suspected stroke at 3pm on a Wednesday they would currently go to either site, whichever was closer. However, if the stroke occurred at 9pm the patient would be transported to the designated hospital on the rota that particular week i.e. Durham OR Darlington. 
Limited availability of staff skilled in stroke care also threatens the ability to continue to provide such services over two hospital sites in the medium to long term.

Ultimately specialist stroke services have improved over recent years but the current model is unsustainable for the future. By providing 24 hours a day, seven days a week coverage, the population of County Durham and Darlington has already benefitted.

As health commissioners we now need to make sure that this can be continued and improved upon in the coming years for our local population.

DOING NOTHING IS NOT AN OPTION.