Chief Medical Officer Dr Michael McBride sets out the thinking behind the Department of Health’s public consultation on reforming stroke services

Imagine that the future of stroke services was in your hands.

What questions would you ask?

Does the expert evidence indicate reform is vitally needed? Yes – and such reform will save lives and significantly reduce disability.

Does everyone across NI have access to the best care when they need it? No.

Are stroke charities urging us to make changes? Yes, and strongly so.

Are current standards of care consistently meeting national standards? Sadly, they are not.

These answers are very sobering, and clearly indicate that change is needed. It is for this reason that the Department of Health has issued the “Reshaping Stroke Care” proposals for public consultation.

These proposals are about improving services, and most importantly, significantly improving outcomes for patients.

Ultimately, they are about securing better futures for stroke patients and their families.

But what precisely will the proposed changes mean for the service we provide?

Firstly, we need to make sure the necessary expertise and interventions are available for everyone, 24 hours a day – we can only do this by creating new Hyperacute Stroke Units, and consolidating hospital care. Establishing Hyperacute Units will mean better and faster diagnosis, ensuring patients get the right care at the right time and in the right place. That will allow for increased use of the clot busting Thrombolysis.

We also plan to expand our Thrombectomy service. This is a revolutionary specialist procedure that removes a clot from the blood vessels in the brain.

It’s a truly life changing intervention, that can reduce disability and mean more people living independently after stroke.

This service is provided in Belfast for the whole of NI, and is suitable for around 10 per cent of stroke patients - but it is currently only available during the daytime on week days. As part of our proposals we will move to 24/7 service, meaning in the region of 150 more people a year will benefit from it.

A network of Hyperacute Stroke Units is essential to make this happen - only these units would have the necessary around the clock expertise and diagnostic tests to identify patients who need immediate transfer to Belfast for the procedure. It is vitally important that Thrombectomy is not denied or delayed because of lack of specialist imaging or expertise at a localised stroke centre.

Finally, we also need to invest in improvements to early supported discharge, community-based rehabilitation and long-term care to help stroke survivors after the short period of improved acute care.

I sincerely believe that the case for change is simply overwhelming. However, we simply can’t move to the new Hyperacute future without making changes to existing provision; concentrating hospital care on fewer sites. Currently, skilled staff and other resources are spread too thinly across too many locations.

The ‘Reshaping Stroke Care’ consultation is about striking the right balance between accessibility and guaranteed standards of care when patients reach hospital: standards which can make all the difference in terms of saving lives and reducing disability.

The proposals do mean some travel times may be longer than is currently the case. But while travel times are important, what matters above all else is the level of expert care you receive.

What good is a shorter journey time if you end up waiting too long in the wrong hospital setting, with no stroke specialist there to assess, diagnose and treat you?

We’re not overlooking the importance of travel times, or the entirely understandable concerns around this issue in local communities.

Planned changes to the ambulance service’s response system will help ensure stroke patients are taken to specialist centres as soon as possible.

The consultation also proposes extending the HEMS air ambulance service to coordinate with emergency road transport for stroke patients in remote rural areas, to help ensure they arrive at hospital for treatment as quickly as possible.

Consolidating some specialist hospital services is nothing new in our health service. Many trauma cases – for instance from serious road traffic accidents – are taken directly to Belfast. A significant proportion of serious heart attack patients are now transported directly to just two centres – in the RVH and Altnagelvin Hospital. The benefits from that service are as good, if not better, than for anywhere else in these islands. And that success comes from concentrating expertise in centres of excellence to provide the best possible care.

That is the standard we must aspire to for stroke services.

The public consultation on “Reshaping Stroke Care” will run for 12 weeks.

The Department encourages everyone to take part.

We want a healthy, informed and respectful debate on the best way forward.