Southmead Hospital to become centre of excellence in huge revamp of stroke services

Southmead Hospital is set to become a centre of excellence for treating stroke patients in a massive shake-up of services.

Sufferers would be rushed to the north Bristol site instead of their nearest hospital under proposals health chiefs say will save between 12 and 15 lives a year and prevent dozens from becoming disabled or needing long-term care.

Survival rates and the level of treatment residents currently receive varies greatly across the region and “depends very much on where you live and what time of day it is”, a meeting of Bristol, North Somerset and South Gloucestershire CCG governing body was told.

The plans, drawn up by senior clinicians, staff and stroke survivors, are going out to a 13-week public consultation after being approved at the meeting on Tuesday, June 13.

At the forefront of the new set-up, Southmead would become a “hyper-acute stroke unit” with the region’s stroke experts under one roof, similar to how heart care and major trauma is organised.

Beneath that, the preferred option for changes to ongoing hospital care following emergency treatment is for a single specialist stroke unit at Southmead, although residents are also being given a second choice of an additional smaller unit at the Bristol Royal Infirmary.

The final major change would see inpatient rehabilitation, for those who are well enough to leave hospital but not yet fit enough to live independently at home, at two specialist units – Weston General Hospital and another location in either Bristol or South Gloucestershire.

Phil Clatworthy, consultant stroke neurologist at North Bristol NHS Trust, which runs Southmead, told the CCG governing body there was strong evidence that emergency care by specialists at centralised, 24/7 hyper-acute stroke units, which focus on patients’ survival and minimising brain damage, substantially reduced the risk of dying or being left disabled.

He said: “Unfortunately we know the care and treatment you receive after a stroke depends very much on where you live and what time of day it is, so the chances of surviving and maintaining your independence after a stroke will vary across the region.

“We estimate that in comparison with our current services the changes should save 15 lives a year, allow 60 to 70 people to live fully independently at home after their stroke and 60 to 70 people to avoid needing a new, permanent care-home placement.”

Southmead Hospital is to become a centre of excellence. Photo: James Koch

Asked whether clinicians at University Hospitals Bristol and Weston NHS Trust (UHBW), which runs the BRI, were assured of future clinical quality and safety by no longer having a stroke unit there, Dr Clatworthy said: “There has been extensive discussion about the model at the BRI, and UHBW is very well represented on the project board and has signed off the models.

“It will be a process of disaggregating a current way of working and that, unsurprisingly, results in some concern, not so much about the stroke pathway but patients who might be looked after by stroke physicians because they happen to be in the BRI would need a new model.

“So the description of a single stroke workforce responsible for people wherever they are is the means of mitigating that.

“There will be stroke physicians visiting the BRI daily, so we are very confident the support will be there.

“The reason we have accepted the second acute stroke unit as a possible option for the consultation is to get to the bottom of that discussion and flush out any concerns and anxieties.

“So we haven’t ruled it out at this stage, it’s something we will have a further conversation about.”

Kevin Haggerty, CCG North Somerset representative for Weston-super-Mare, where he is a GP, and Worle said: “We would certainly like to see a levelling-up from a Weston perspective

“Your audit showed that our outcomes are not as good as everyone else’s so we have the most to gain.”

Claire Angell, who had a stroke seven years ago, told the meeting: “When I started volunteering for the stroke programme over five years ago I was pretty disillusioned at how stroke survivors’ experiences differed so greatly.

“It was quite upsetting and had a real impact on their recovery and their ability to live well afterwards.

“By having the opportunity to contribute fully to the clinical design, as service users we are optimistic that these changes will really improve care for future patients and support their carers.

“Having a stroke is traumatic for the patient, the family and their friends.

“Your whole world changes in a second and anything that can be done to help people through that experience in as smooth a way as possible and help make life worth living has to be worth it.”

It follows a shakeup of services. Photo: James Koch

CCG deputy finance director Jon Lund said the preferred option would cost £2.9m and the second option including the BRI unit £3.4m.

Programme clinical lead Chris Burton said: “We want everyone to have the best possible opportunity to survive and thrive after stroke, which is why we’re excited to test these proposals with the public.

“Clinical evidence and service change examples from across the country show that when you bring specialist staff, equipment and resources together into a single centre like this, deaths are prevented and people’s long-term outcomes are improved.”

Burton said the final decision would be made by the CCG governing body later this year or early 2022 following the feedback and further analysis.

The consultation opens at 9am on Monday, June 7, and closes at midday on Friday, September 3.

All the information will be at www.bnssghealthiertogether.org.uk/stroke-services

Adam Postans is a local democracy reporter for Bristol.

Main photo: Barbara Evripidou

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