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Centralisation of stroke services in Greater Manchester to be extended

The centralisation of stroke services in Greater Manchester is to be extended with £2m of investment allowing the specialist centres to remain open for longer.

Since 2010, anyone in Greater Manchester calling 999 within four hours of a stroke has been taken to one of the hyperacute stroke centres at Salford, Stockport or Bury. After that four-hour limit, people are admitted to district stroke centres at their local hospital.

This has resulted in only 30% of strokes being treated at the ‘hyperacute centres’ – where patients can get access to emergency ‘clot-busting’ thrombolysis and immediate brain scans.

Last year a study led by University College London found that London, which also centralised stroke services at the same time as Greater Manchester, saved around 96 stroke patients every year who would likely have died under a non-centralised system.

However the authors said there was no reduction in mortality in Greater Manchester, due to less compliance with the new system. The figures show that in its first year, 36% of the patients who presented with stroke within four hours were not taken to a comprehensive stroke centre or primary stroke centre.

Under the new plans the four-hour time limit in Greater Manchester will be removed so that the area can achieve centralisation of stroke services which is more comparable with what has been achieved in London.

The same study estimated that, if Greater Manchester fully complied it could reduce annual stroke deaths by 50.

Dr Khalil Kawafi of Fairfield Hospital in Bury, said: “There is strong evidence that these changes will lead to better outcomes for stroke patients in Greater Manchester. We believe they will give people a greater chance of survival and will aid people’s recovery from stroke.”

From the end of March hours at the hyperacute stroke centres at Fairfield Hospital and Stepping Hill Hospital in Stockport are to be extended to 7am-11pm seven days a week (they currently open 7am-7pm, Monday-Friday), while the centre at Salford Royal will continue to operate on a 24/7 basis.

Every new onset suspected stroke case in Greater Manchester will be immediately taken to one of these centres – irrespective of where their stroke happens.

However there will be a small number of patients who, for clinical reasons, may not be taken to one of the centres for treatment. This could be because they present with symptoms a considerable time after they have had their stroke and therefore are not classed as a 'new onset of stroke’, or because they have other, more pressing, medical needs that require treatment at an A&E department.

If a patient presents to a district stroke centre with symptoms that are not new, clinicians will consult with the hyperacute centre and transfer the patient if it is appropriate.

A spokesman for NHS Greater Manchester CSU told NHE that based on the study of stroke centralisation in London around 97% of patients are expected to need treatment at one of the hyperacute centres.

All district stroke units at local hospitals will remain open under the plans but will shift their focus to patient rehabilitation and recovery.

The additional £2m being invested to implement the changes is partly being used to extend the operating hours at Bury and Stockport.

Alan Campbell, senior responsible officer at Salford CCG which is implementing the Greater Manchester-wide service change, said: “From the end of March this year everyone in Greater Manchester will have access to the same high quality, emergency care if they have a new onset of stroke. It means everyone who has a stroke will be able to access the best practice care processes which are crucial in the first days after a stroke.

“Every year in Greater Manchester approximately 4,000 people have a stroke, and one in eight of these people die within 30 days. Ensuring world-class emergency healthcare for all stroke patients in Greater Manchester is one of our top priorities. And with this change we will make sure everyone has equal access to these critical treatments.”

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