The options appraisal process

During January, 2011, a sub-group of the Stroke Strategy Implementation Group (SSIG) was tasked with carrying out an options appraisal on potentially different configurations of stroke hyperacute services. The sub-group, consisting of County Durham and Darlington Foundation Trust’s lead stroke consultant and their clinical stroke service manager together with NHS County Durham and Darlington’s clinical public health lead and stroke service commissioning manager, developed criteria and weighting for each option.

The criteria below were chosen to help ensure a high quality, long term stroke hyperacute service for County Durham and Darlington remained the main goal. Each criterion was weighted according to its significance, with clinical quality ranked the most important and cost effectiveness the least.

• Clinical Quality - Maintains or improves clinical outcomes; timely and appropriate services; minimises clinical risk
• Sustainability/flexibility Ability to meet current and future demands in activity; ability to respond to local, regional, national service changes
  
• Equity of access Reasonable access for urban and rural populations
  
• Efficiency Delivers patient pathways that are evidence based; supports the delivery through access to resources
• Workforce Provides environments which support the recruitment/retention of staff; supports clinical staffing arrangements
• Functional suitability Provides environments suitable for delivery of care; clinical adjacencies with other relevant services/depts e.g. imaging
• Acceptability Acceptable to service users, carers, relatives, other significant partners
• Cost effectiveness Provides value for money

The criteria were applied to 11 different options, each a different proposed model for hyperacute stroke services for patients in County Durham and Darlington. The options evaluated included a range of two-site and single-site hyperacute service configurations including:

• the current hyperacute stroke service provision at two hospital sites
• the provision of a single-site hyperacute stroke service at each of the three County Durham and Darlington hospitals
• options for regional hyperacute stroke services based in Newcastle and on Teesside

Each of the 11 options was awarded a score. The sub-group presented the criteria, weighting and findings of the options appraisal process to the Stroke Strategy Implementation Group (SSIG) which endorsed the process and the findings.

The 11 options evaluated against the criteria, ranked in order of their scores, are as follows:

1. Single site 24/7 hyperacute model at University Hospital of North Durham (+ rehabilitation at BAH) Overall SSIG score 841

2. Single site 24/7 hyperacute model at Darlington Memorial Hospital
   (+ rehabilitation at BAH) Overall SSIG score 815

3. Single site 24/7 hyperacute model at University Hospital of North Durham
   (+ drip and ship to hospitals in Newcastle or Teesside + rehabilitation at BAH)
   Overall SSIG score 771

4. Single site 24/7 hyperacute model at Darlington Memorial Hospital
   (+ drip & ship with neighbouring Trusts + Rehab at BAH ) Overall SSIG score 756 
    
5. Regional hyperacute stroke service in Newcastle or Teesside, outside of County Durham and Darlington Overall SSIG score 742

6. Single site 24/7 hyperacute and rehabilitation model at Bishop Auckland Hospital
   Overall SSIG score 709

7. Continuation of current two site 24/7 hyperacute model at UHND and DMH
   (+ rehabilitation at BAH) Overall SSIG score 590

8. Two site 24/7 hyperacute model - UHND and DMH
   (+ out of hours diversion to single site at University Hospital of North Durham + rehabilitation at BAH) Overall SSIG score 549

9. Two site 24/7 Hyper Acute model - UHND and DMH (+ out of hours diversion to single site at Darlington Memorial Hospital + rehabilitation at BAH) Overall SSIG score 538

10. Drip and ship including telemedicine + single site 24/7 hyperacute model at UHND
    (+ rehabilitation at BAH) Overall SSIG score 532

11. Drip and ship including telemedicine + single site 24/7 hyperacute model - DMH
    (+ rehabilitation at BAH) Overall SSIG score 506

Key abbreviations

University Hospital of North Durham: UHND
Darlington Memorial Hospital: DMH
Bishop Auckland Hospital: BAH
Stroke Strategy Implementation Group: SSIG

Full details of the options appraisal process can be found in the main consultation document.