What do you think? Tell us what you think of our ideas by 5pm, 1 April 2016

Consultation on Local Stroke Services

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Contents

About the consultation...........................................................................

Introduction............................................................................................

Foreword................................................................................................

Why we are doing this consultation?.....................................................

What is a stroke?...................................................................................

Recovering from a stroke.......................................................................

Types of stroke rehabilitation.................................................................

1. Early Supported Discharge.......................................................... 2. Community Rehabilitation Service............................................... 3. Hospital rehabilitation...................................................................

Grays Court and Beech Ward................................................................

Stroke services now...............................................................................

Making stroke rehabilitation services better...........................................

The options............................................................................................

Where the new stroke beds should be...................................................

Why stroke services should change......................................................

Questions and answers..........................................................................

What happens next?..............................................................................

Equality impact assessment...................................................................

Questionnaire.........................................................................................

Monitoring..............................................................................................

How to find out more..............................................................................

Word list.................................................................................................

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Important!

In this easy read document when a tricky word is first used it will be in bold blue text, shortly followed by a blue box giving the meaning. For example, “Consultation” is mentioned on the front cover and here is the meaning:

Consultation: A way of asking people for their thoughts and ideas All of the tricky words can also be found in the Word List on page 24 so you can look them up if you need to. About this consultation

The consultation closes at 5pm, 1 April 2016. This consultation document explains why and how we want to make changes to stroke rehabilitation services across Barking and Dagenham, Havering and Redbridge. Please read it and let us know what you think by filling in the questionnaire at the back and sending it back to FREEPOST BHR CCGS (no stamp needed). This consultation is about making changes to stroke rehabilitation services for adults, not children.

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Introduction In this document we talk about rehabilitation.

Rehabilitation: The different types of help you need after a stroke After having a stroke you recover by building your strength, relearning skills or finding new ways of doing things. This is what we mean by rehabilitation. Rehabilitation often looks at different types of therapy:

Physical to help rebuild weak muscles

Occupational to help with daily activities like getting washed, getting dressed and cooking

Speech and language therapy to help with speaking, understanding and swallowing

Treatment of pain

Help with emotional problems

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Foreword

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As doctors we know that people don’t always get the right care after a stroke and we want this to change. What matters with a stroke is getting the right treatment, in the right place, at the right time.

If you live in London and might of had a stroke you will now be taken to one of the eight specialist stroke centres; known as hyper acute stroke units (HASUs). Here patients get quick, expert care from specialised staff, 24 hours a day, 7 days a week.

HASU (Hyper Acute Stroke Unit) Medical centres set up to focus on the needs of stroke patients

Stroke patients are assessed, have a brain scan, are diagnosed and given life-saving medicine within 30 minutes of getting to the hospital. This is saving lots of lives and making people’s chances of a faster and lasting recovery much better.

Diagnosed: To be told the medical condition you have such as a stroke

What’s important now is to build on this by looking at rehabilitation services and longer term recovery. We need to make sure that wherever you live, you get the same excellent care, whether at home or in a hospital.

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Locally, the demand for stroke services is going to grow in the next 20 years as the number of older people increases. We want to make changes to services now, to make sure people recover and live the fullest life possible.

These changes are all about making our health service the best it can be – thank you for helping us to do this by reading this document and telling us what you think of our ideas.

GP stroke leads:

Dr RavaliGoriparthi, Barking and Dagenham CCG

Dr Alex Tran, Havering CCG

Dr Sarah Heyes, Redbridge CCG

CCG (Clinical Commissioning Group): A group of medical professionals who work together to plan local health services Hospital stroke lead:

Dr Sreeman Andole Divisional Director and Clinical Lead in Stroke Barking, Havering and Redbridge University Hospitals NHS Trust

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Why are we doing this consultation?

We want to make stroke services work with each other and focused on what people need. It shouldn’t matter where people live. If we do this it will help people recover better and more quickly. Around 9,000 people living in our area have had a stroke and this will increase. We need a stroke rehabilitation system that will give good quality care for people now and can also care for more people in the future In this document we have given different options and explained what we think is the best option and why. We want to know what you think, do you agree or disagree, and if there is anything else you want us to consider. We’d like to hear from as many local people as possible especially if you have had a stroke, or have been a carer/family member/friend of someone who has.

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What is a stroke?

A stroke is a serious, life-threatening medical condition that happens when the blood supply to part of the brain is cut off. If this happens then brain cells begin to die. This can lead to brain injury, disability and sometimes death. Strokes are a medical emergency. The sooner you receive treatment for a stroke, the better your chances of recovery. If you think you or someone else is having a stroke, call 999 immediately and ask for an ambulance. You are more likely to have a stroke if you are over 65, smoke, have high blood pressure, diabetes, high cholesterol, irregular heart rate or from South Asia, Africa or the Caribbean. When you have a stroke, the first stage of care (known as acute care) focuses on providing life-saving treatment and then stabilising you. This takes place in a hyper-acute stroke unit (HASU).

There is a HASU at Queen’s Hospital in Romford and some people go to the HASU at the Royal London Hospital in Whitechapel.

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After one or two days of intensive treatment at the HASU, some people go home to recover. Most patients will then be transferred to an acute stroke unit (ASU). ASUs have different sorts of rehabilitation depending on what’s needed and people stay there while they recover. Most people are ready to move on from the ASU after two to three days.

There are ASUs at Queen’s Hospital in Romford and Whipps Cross Hospital in Leytonstone.

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Recovering from a stroke

What happens after you have a stroke will depend on how serious it is. Once you’ve been stabilised, the next step is rehabilitation. A stroke can result in arm/leg weakness, visual problems, facial weakness, slurred speech, bladder control issues, difficulty swallowing and problems using language correctly so your rehabilitation will depend on what you need to get better.

Types of stroke rehabilitation Locally, there are three types of stroke rehabilitation services: 1. Early Supported Discharge (ESD)

This is regular intensive rehabilitation in your own home, five days a week for up to six weeks, depending on your needs. It is similar to rehabilitation in hospital and is for people expected to make a good recovery from their stroke. It helps you recover by practicing everyday tasks like dressing, washing, cooking, shopping and walking. 40% of all stroke rehabilitation should be delivered through in this way but at the moment it is only around 20%.

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2. Community Rehabilitation Service (CRS)

The Community Rehabilitation Service is for people who don’t need to be in hospital but who are not likely to make a full recovery. CRS is less intensive and less frequent and works to help people regain confidence by providing treatment, advice and support. The CRS team includes occupational therapists, physiotherapists, rehabilitation nurses and therapy assistants.

3. Hospital rehabilitation

Some patients need more care after their stroke so need to spend more time in hospital. They will stay in a hospital rehabilitation unit. People should spend around 20 days here but at the moment they often spend longer. This is partly because the rehabilitation they get isn’t right or isn’t available. There are two stroke rehabilitation inpatient units locally: Grays Court and Beech Ward. People do not get home-based services unless doctors are sure that they are well enough to go home and it is safe for them to do so. If a patient is not ready to go home they will go to a stroke inpatient unit and we expect this to continue.

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Grays Court, John Parker Close, Dagenham

Beech Ward at King George Hospital, Barley Lane, Goodmayes

Mostly used by patients who live in Barking and Dagenham and Havering. Capacity and facilities: 17 beds; 13 single en-suite rooms (which make it harder to watch patients and for patients to talk to each other) and one room with four beds for high risk patients. Has a physiotherapy gym, day room/ dining area and consultation rooms. It does not have 24/7 medical cover so in an emergency, an ambulance is called to take patients to hospital. Public transport: No regular buses and the nearest underground station is 15 minutes’ walk away. Parking: Free parking on site, used by staff and visitors so it is often full. Some parking on nearby streets.

Mostly used by patients who live in Redbridge. Capacity and facilities: 15 stroke beds in one ward, with separate bays for men and women and three single rooms. Has a day room, physiotherapy gym and access to a larger hospital gym. Being at King George Hospital means easy access to other hospital services and facilities. There is 24/7 medical cover and in an emergency doctors on site can act quickly. Public transport: Four bus routes stop in the King George grounds. Nearest train station is 20 minutes’ walk (or a short bus ride) away. Parking: Large on-site car park for staff and visitors, charges apply.

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Stroke services now

If you have a stroke at the moment: You’ll spend more time in hospital than you need to, even when it’s better for you to be at home, you won’t always have specialist stroke staff taking care of you and your recovery will take longer. The hospital, services and care all depend on where you live.

If you live in Redbridge: Hospital rehabilitation will be in Beech Ward at Kind George Hospital If you live in Wanstead area your only option is hospital recovery If you can have EDS you can’t have all the therapies that should be on offer

to you

If you live in Barking and Dagenham: Hospital rehabilitation will be at Grays Court You’ll spent longer in an ASU because it takes longer to be admitted to

Grays Court If you can have EDS you can’t have all the therapies that should be on offer

to you

If you live in Havering: Hospital rehabilitation will be at Grays Court

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Making stroke rehabilitation services better

Over the past year, we have been looking at how to make our local stroke rehabilitation services better. To read more about the different options we thought about please visit our website. We held a workshop to talk about the different options. More information about this is also on our website. The workshop involved doctors, council representatives, patient representatives, Healthwatch representatives, carer organisation representatives, stroke specialists and local NHS managers. The group discussed each option, thinking about lots of different points.

The options

Option 1: Do nothing – services stay the same as they are now. The group decided that current services are unfair and so this option should not happen. Option 2: A single separate ESD service and a single separate CRS service, covering all three boroughs. The group thought that this would take away some of the unfairness but add to waiting times as patients are handed back and forward. Option 3: A combined ESD and CRS service covering all three boroughs, offered by one provider, with one inpatient unit. Everybody agreed this to be the best option

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Where the new stroke beds should be

The group then looked at where the inpatient stroke rehabilitation service should be. Option A: King George Hospital, Goodmayes

Option B: Grays Court, Dagenham

• Patients would have 24/7 emergency medical cover on site

• There are other services on the that stroke patients can use

• Good transport links

• Patients would not have 24/7 medical cover and would have to go to hospital by ambulance in an emergency

• Public transport not as good • Limited car parking

The group agreed that King George Hospital would be the best place for the new service. The group only thought about what was best for patients – they did not talk about money or how much any changes might cost. A different group was set up to look at how much each option would cost. It was agreed that any stroke rehabilitation service should not cost any more than the current service, but if money was spent differently it would help people recover more quickly and fully.

No talk about

money!

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Why stroke services should change

We want stroke services to change to: • help people to recover better • give everybody a fair opportunity to care no matter

where they live • give more rehabilitation in patient’s own homes • allow people to leave hospital quicker with the right

support • make services and systems work better together • avoid transfers and care delays where possible • help prepare for more older people and stroke

patients in the future • keep getting better at what we are doing

We want to make sure all stroke survivors:

• get regular health checks to see how they are living with the effects of stroke and what support they need

• helped if they want to go back to work • given the emotional support they need • get 6 and 12 monthly health and social care needs

reviews • get ongoing recovery support

Making these changes will mean stroke survivors receive the support they need from specialist staff.

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Question and answers

Does everybody support these changes? Partners were involved in the workshops and we are asking everybody to reply to this consultation. When would the changes happen? We need to take the time to make sure we get things right and don’t cause any disruption for patients so it won’t be straight away. Is this just about saving money? No. These changes don’t save us any money, but people will receive better care – which is more important to us. Why just one stroke rehabilitation ward? This is the safest way of providing high quality care. What would happen to Grays Court? We do not own Grays Court – it belongs to Barking and Dagenham Council, so they would need to decide what to do with it. We would work with the council and other partners to help decide what to do. Does King George Hospital have space for a stroke rehabilitation unit? Yes. We would need to talk to BHRUT (as owner of King George Hospital) about where this would be.

Care

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What about having the new unit at the St George’s Hospital site in Hornchurch? We are still working with the site’s owners and NHS England to develop a new health centre on the site. That is still in the planning stage and so any new centre is some way off, but plans don’t involve having overnight stays there, or 24/7 emergency cover. How does social care fit into this? We are asking social care teams what they think of the ideas in this consultation document. The changes would mean social care is able to be arranged more quickly. There would only be one unit/team for social care to work with, and care would be the same wherever the patient lived. The relationship between the teams and ways of working together would be better. How many beds would there be at King George Hospital’s stroke rehabilitation? We don’t know this yet. We have 32 stroke beds over two sites now and there is space for all of these at King George Hospital. We would expect that the number of beds needed would reduce as more people use home-based services such as ESD. To find out more about our work on stroke rehabilitation services visit our websites.

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What happens next?

When the consultation closes, we will read and think about all the comments we have got.

We will use what you tell us to write a report so that the people who have to make the final decisions have everything they need.

We will put the dates of the decision-making meetings on our websites. These are public meetings, so you are welcome to come along.

All the reports that the decision makers read will be on our websites so you can read them too.

If you are commenting as part of an organisation or you are representing the public (as an MP or councillor for example) your comments may be made available for the public to look at.

If you are commenting for yourself, we will not put your name or answer in full but we may use some of what you’ve said to show particular points of view.

If you let us know your contact details (on the questionnaire), we can keep you up to date about any decisions we make.

Equality impact assessment

We use equality impact assessments (EIAs) to find the good and bad impacts of a particular piece of work on equality. This helps us to see if we need to make any changes. More information about this is on our website.

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Questionnaire

Are you… (tick as many as apply)

?

Someone who has had a stroke

Someone who know someone who’s had a stroke

Someone who works for the NHS

A carer

A local person

Someone else

Don’t want to say

What is the first half of your postcode?

Are you representing a group?

Yes – what is the group’s name?

No

Have you or someone you know used or worked in stroke rehabilitation services in Barking and Dagenham, Havering or Redbridge?

Yes

No

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Now we want to know what you think about our ideas to change stroke rehabilitation services…

What do you agree with?

What don’t you agree with?

Have you any other comments or ideas?

Thank you for helping us.

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Monitoring We would find it useful if you could tell us a bit about yourself. We ask for this so that we can see what sorts of people are helping us and whether they think differently from other groups. Monitoring: A way of making sure we are being fair to everybody

Name (you don’t have to give this if you don’t want to)

Would you like to be kept up to date about the NHS (including this consultation?)

Yes (please tell us your email or postal address)

No

Are you?

Male

Female

Don’t want to say

Do you have a disability?

Yes

No

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Don’t want to say How old are you?

Under 16 16-25 26-40 41-65 66-74 75-79 80 or over Don’t want to say

What is your background?

Any White background Any mixed background Any Asian background Any Black background Any other group (please tell us what)

Don’t want to say What is your belief or religion?

Agnosticism Islam Atheism Judaism Buddhism Sikhism Christianity Hinduism Other Don’t want to say

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How to find out more

To get more information about our work to change stroke rehabilitation services you can:

• Look on our websites: www.www.barkingdagenhamccg.nhs.uk/stroke www.haveringccg.nhs.uk/stroke www.redbridgeccg.nhs.uk/stroke www.barkingdagenhamccg.nhs.uk/stroke www.havenhs.uk/stroke

• Come and see us – visit our websites or give us a call to find out when we will be near you

• Ask us to come and see you - if you would like someone to come and talk to your group, email haveyoursay@onel.nhs.uk or call 020 3688 1615

Word list

ASU Acute Stroke Unit BHR Barking and Dagenham, Havering and Redbridge

boroughs BHRUT Barking, Havering and Redbridge University Hospitals

NHS Trust CCG (Clinical Commissioning Group) A group of medical

professionals who work together to plan local health services

Consultation A way of asking people for their thoughts and ideas CRS Community Rehabilitation Service Diagnosed To be told the medical condition you have such as a stroke ESD Early Supported Discharge HASU (Hyper Acute Stroke Unit) Medical centres set up to focus

on the needs of stroke patients Monitoring A way of making sure we are being fair to everybody NELFT North East London NHS Foundation Trust Rehabilitation The different types of help you need after a stroke