How many people will this affect?
Barnsley Hospital’s hyper acute stroke service treats around 550 stroke patients every year which is 16% of all stroke patients across South Yorkshire, Bassetlaw and North Derbyshire.
Rotherham’s hyper acute stroke service treats around 480 stroke patients every year which is 14% of all stroke patients across South Yorkshire, Bassetlaw and North Derbyshire.
Will this mean extra patients going to the other hospitals – and if so, how will they cope?
Discussions are taking place with the hospitals now around possible future changes and this includes managing any increases in numbers of patients in a careful and planned way. Although the increase in numbers is relatively small overall, changes would only be made if all the right measures were in place, including numbers of staff, speed of tests and standards being met. – making the services safe and sustainable in the future.
What is the spend per head?
The NHS spend for stroke is calculated on the costs of inpatient care and in 2015/16 we know that this was approximately £10.2 million across the five CCGs in South Yorkshire and Bassetlaw. This breaks down as £1.6 million in Barnsley, £0.7 million in Bassetlaw, £1.5 million in Doncaster, £1.9 million in Rotherham and £4.5 million in Sheffield.
The average spend per head in 2015/16 across South Yorkshire and Bassetlaw was £3409 for inpatient care and treatment.
There are other costs associated with stroke care, such as those within emergency departments, but these are difficult to assign directly to stroke care and treatment. There are also variations in how people are admitted. In Sheffield, patients go straight to the hyper acute stroke unit but in other hospitals, they go via A&E. In addition, some patients present with ‘mimics’ (the term used by doctors when a patient’s symptoms could be a stroke but after tests show they are not).
Is 45 minutes to the hospital fast enough?
Yes. The 45 minute travel time has been set as a reasonable period to ensure that there is no excessive delay in getting people to hospital.
When a person has a stroke we know that the first few hours after the stroke are critical. If the right treatment can be given to the person during these first few hours they will have a much better chance of surviving the stroke and recovering from it. There are two critical time periods after having a stroke:
- The first four hours after a stroke are important - during this time some patients may benefit from being given a powerful clot-busting medication that can dissolve the clot that caused the stroke - this is called thrombolysis treatment.
- The first 72 hours after a stroke are important - evidence shows that if patients receive the right medication, are monitored very closely and start having therapy treatments they are much more likely to make a better recovery and be less disabled by the stroke in the long term.
The treatment that should be given during this first 72 hours is called hyper acute stroke services. This is the recommendation of national organisations like the Royal College of Physicians (RCP) and the National Institute for Health and Care Excellence (NICE), as well as the Government. We want anyone living in our area that has a stroke to be able to get the right treatment as quickly as possible, any time of the day or night.
Are people in primary care trained to spot strokes?
Yes. GPs are trained to identify the symptoms of stroke.
They also work with patients who are at risk of a stroke to help them manage their health and reduce the chances of having one. This includes looking at lifestyle factors – such as a healthy diet, exercise, maintaining a healthy weight, stopping smoking and reducing or stopping alcohol. They are also increasingly starting to identify and support people with atrial fibrillation (AF) – a common heart condition that causes an irregular heartbeat and increases the risk of stroke.
Are there enough staff to support rehabilitation services?
Rehabilitation services for people who have had a stroke aren’t part of the proposals. The proposals are only for the first 72 hours of care after someone has had a stroke. All local rehabilitation services will stay the same.
Is it dangerous to travel further?
No. Changes like the ones being proposed in our region have already been made in London and Manchester.
Evidence from these changes has shown that a centralised model of hyper acute stroke care, in which hyper acute care is provided to all patients with stroke across an entire geographical area, can reduce death rates and length of stay.
I live in Barnsley/Rotherham where will I go if I have a stroke?
In the future, if you have a stroke, you would be taken to a hyper acute stroke unit in Doncaster or Sheffield for the first 72 hours of your care. If you live in the north of Barnsley, you may also be taken to Wakefield for these few days. At the moment though, nothing will change and you will be taken to and treated in Barnsley and Rotherham.
For Barnsley patients needing thrombolysis changes to care has already started due to a sudden unexpected change to medical staffing availability. This treatment is just one aspect of hyper acute stroke services, so if this wasn’t needed for the patient, they would continue to be cared for in Barnsley.
Is this about cutting costs?
No, the proposals are not about cutting services or saving money. The review of hyper acute stroke services took place because the quality of care and outcomes and experience for people was not the same in all hospitals. We want to improve quality, outcomes and experiences – which save lives and means every stroke patient in our region has the best possible care, helping them to get better quicker and have less chance of living with a disability when they go home.
How much money will you save?
We are still working on the financial business case but our projections suggest the proposals would be either cost neutral or cost slightly more. We would also need to invest some money to make the changes.
Why can’t you just improve services locally?
The review into hyper acute stroke services showed us that there is a shortage of clinical staff and that care and treatment was variable, with some people having better experiences, better outcomes and better access than others. The commissioners agreed that everyone in our region should experience the highest quality and safest service possible and have been looking at options to make improvements.
We therefore need to look beyond our current boundaries for solutions.
Who will pay for me to travel?
Stroke patients would be transferred by ambulance to the best place to meet their needs. For relatives, some people qualify for help with travel costs under the healthcare travel scheme. This would be assessed by staff at the hospital and if eligible, costs would be paid.
If people were taken to specialist stroke centres, they would be treated there for up to the first 72 hours. After this time, or as soon as they are well enough, they would be transferred back to their local hospital.
How will my relatives get to see me? Where can they stay?
Relatives would need to make their own way to the hospital, at the time of the stroke and also when visiting you. Unfortunately there are no overnight facilities for visitors in any of the hospitals in our proposals.
You’re closing stroke services, what’s next?
We are not closing local stroke services, it is just the first 72 hours of care that we are proposing to change. The acute stroke units in Barnsley and Rotherham would continue to operate as they do now.
We are also proposing to change the way children’s surgery is provided across the same geography.
This means we would no longer carry out operations on children for some conditions on a night, at weekends or where there is an overnight stay. Each hospital would still have children’s services and provide day case surgery. You can read more about these proposals here.
There are no plans to close other services.
Is this the first step to closing local hospitals?
There are no plans to close any hospitals.
The changes proposed are entirely about ensuring everyone in our region has the best experience and outcomes, faster treatment and better access to services.
During the public consultation period, we are responding to your questions. Please email us firstname.lastname@example.org with your questions.