Welcome to our regular online bulletin bringing you news about the network and the wider world of stroke and neurorehabilitation

Network news

We have successfully appointed two Clinical Leads to the team, both from Salford Royal stroke services. Rachael Collins (left) started in early November as our new Clinical Lead for Inpatient Rehabilitation. She is an Advanced Clinical Practitioner in stroke and a senior Occupational Therapist with significant experience and expertise.

Dr Jungim Kwon (right) commenced in early December as our Acute Stroke Clinical Lead. She is a Specialist Stroke Physician and lead for mechanical thrombectomy. She too brings a wealth of experience and will be focused on projects involving CVD prevention in hospital, as well as pre-hospital, hyper acute and acute stroke pathways of care.

We are delighted to welcome Stroke Association Associate Director - NW Jen Gardner (pictured on the right with our Manager) as a new Co-Chair of our Board. She will share the role with Jackie McShane, Chief Operating Officer at Stockport NHS FT.  

Our Facilitator Amanda Fish leaves us on 31st December to return to Trafford INRU after a year's secondment. We thank her for her contribution and look forward to working with her when she gets back to base.

The team support a wide portfolio of projects which you can view on our Projects and impacts webpages.

Pathway updates

Stroke pre-hospital

On 4th November, an updated pathway was launched across the three North West sub-regions within the North West Ambulance Service (NWAS) footprint. The amendments followed a review of the previous exclusions and will help ensure patients are taken to the right hospital first time. Paramedics and Ambulance Technicians are now able to use extended judgement and the NWAS clinical support hub where stroke is suspected for non-textbook FAST positive patients. The pre alert window has also been extended from 6 to 9 hours across the North West to maximise access for patients who may be eligible for intervention.

A new fantastic interactive stroke recognition website is now live for clinicians. It has been designed by Boehringer Ingelheim, supported by local stroke Advanced Clinical Practitioner Joe Dent. The educational platform is also beneficial to professionals working in the community. 

Motor Neurone Disease (MND) emotional support

Following the success of our MND pathway development project, we have started a follow-on initiative, again funded by the MND Association. It will focus on emotional support pathways for people affected by MND. An Assistant Psychologist has been appointed who will work under the supervision of a senior Psychologist, supported by the network team for project management and patient involvement. We anticipate the project will also benefit other neurological conditions.

Multiple Sclerosis (MS)

The MS Pathway Development Steering Group is now established with excellent stakeholder engagement, including representation from the Manchester Centre for Clinical Sciences MS and Neurorehabilitation Medicine teams, Community Neurorehabilitation Teams, charities, and also those with lived experience.

So far, the group has reviewed national guidelines to map current MS service provision across the region, identifying key stages in the pathway for potential enhancement. Areas such as support for newly diagnosed patients and palliative care have been highlighted as opportunities for further development.

FACETS Digital Toolkit

A research team at Bournemouth University is developing a digital toolkit to help people manage and track their fatigue. The toolkit is nearing completion, and a revised version is now available for testing. The MS Society is inviting healthcare professionals and charity/ community workers to help refine and test the tool. Interested in taking part or learning more? Sign up for testing or email the team.

Bladder and bowel

For the past few years, there has been a collaboration between NHS clinicians (inpatient and community), the voluntary sector and Coloplast to improve the care of patients suffering from neurogenic bladder and bowel. 

The company have now appointed a new specialist nurse in Greater Manchester. The role will support a caseload of patients and work with local clinical teams to help them enhance the support they provide. The new service will initially focus on MS and spinal injury patients and with new clinics starting in the New Year. More details will follow on how to refer patients. 

Quality improvement news

We have gone a bit toolkit mad! The new documents are a culmination of collaborative work with stakeholders and aim to help professionals improve services using what we have learned.

You can download the following now:

• Functional Neurological Disorder (register for access)
• Patient and Carer Involvement

Toolkits for MND, spasticity, longer term support and stroke/TIA for GPs will be launched in the coming months - keep an eye on X (Twitter) for details.

We have also been delighted to support several QI initiatives across the region. Bolton community services hosted an event in early November in association with the University of Keele.  The day was based around the SQuIRe pilot of a health improvement practitioner in stroke but quickly expanded into other areas where collaboration between NHS and other local services may be beneficial. More work is planned with a commitment to bring teams together to maximise opportunities for patients and use of resources.

The initiative overlaps with the Bolton Community Neurorehabilitation Team (CNRT) pilot of our model for neurological longer term support developed by a steering group of clinicians, patients, carers and third sector organisations. The outcomes will be shared next year.

On 9th December, the Northern Care Alliance NHS FT brought its four Community Neurorehabilitation Teams together to explore closer working and collaboration. There was detailed discussion on patient cohorts accepted by teams with a focus on working towards greater equity of access across the different geographically based services. Again, further meetings are planned.

Training and education

There has been a whirlwind of educational activity since the last bulletin and we are currently planning next year's programme for experienced staff.

On 16th October, we hosted a webinar on sex and relationships and have subsequently incorporated the online training into a new webpage full of resources. This topic was raised at our Patient & Carer Group, with members fully involved in developing and delivering the workshop. Further advanced training is planned for next year.

On the 31st October, we co-hosted a workshop for NHS staff from our inpatient and community teams, partnering with GM Active who provide health and wellbeing facilities across Greater Manchester. This initiative was born out of the need to address new recommendations in the National Clinical Guideline for Stroke (2023) and to support cardiovascular disease prevention work across the region.

The event brought teams together to network and review guideline recommendations to build awareness of the need for aerobic training patients with other neurological conditions including stroke. The event also sought to develop a set of priorities for the future.  The day was a huge success and provoked thoughts on the next steps and how can we continue to work collaboratively across the region.

In November, the latest introductory stroke study day was hosted by Manchester University NHS FT stroke services supported by the network team. Dates for 2025 are now being finalised and are listed below.

A number of local clinicians and network staff attended the UK Acquired Brain Injury (UKABIF) conference held in Manchester. Our Facilitator Cillian O'Briain (pictured right) shared a poster on behalf of the network of our driving pathway for neurological conditions other than stroke.

Stroke and neurological Occupational Therapists from across Manchester University NHS FT came together in November to enhance their clinical reasoning and therapeutic handling skills in assessing and treating patients with upper limb difficulties.

The training was led by Physiotherapist and British Bobath tutor, Tim Walton, and reflected current evidence and best practice. The weekend offered plenty of opportunity to acquire and practice knowledge and skills and to network with colleagues.

Some of the network team attended the UK Stroke Forum in Liverpool in early December. Our Facilitator Chris Ashton spoke on his work with the Sentinel Stroke National Audit Programme (SSNAP) team on determinants of pre-hospital timings for acute stroke patients treated in this setting. His input has also been invaluable in developing and rolling out of the first national pre-hospital dataset - due early 2025. The conference also featured a number of other speakers and posters from clinicians across the network.

Introductory study days (stroke)

Introductory Stroke Study Day – 5th February – Salford Royal ( Mayo Building)

Introductory Stroke Study Day – May (Date TBC) – Fairfield Education Centre

Introductory Stroke Study Day – 16th September – Wrightington (provisional date)

Introductory Stroke Study Day – November (Date TBC) – Trafford General

You can view all our previously recorded webinars on our YouTube channel, with details of how to access restricted content at the bottom in the archive section. Our training website pages are also a useful source of information and include our events, Elearning packages, online resources and course information.

Taking PPI to the next level

The network created a new Co-ordinator role to provide a step change in our Patient and Public Involvement (PPI). Since January 2023, Abi Bisset has been working in the role which has focused on:

• Empowering our existing Patient and Carer Group
• Equipping the network to involve patients and carers in the right way at the right time
• Building capacity so that network can sustain and grow its PPI offer

We have been much more proactive over the past year in providing the group with feedback on the projects they are involved with, as well as educating members about what good PPI looks like. As a result, they are more empowered to work in equal partnership with us, holding us to account with our PPI practices.

PPI now is also embedded within more of our projects.  Over the last year we have pulled together step by step guidance and resources within a newly launched PPI Toolkit to encourage greater use of PPI in the improvement of our services. We’re also working to increase diversity in the patients and carers we work with, and to hear new voices all the time.

Unfortunately, due to funding, Abi will be leaving the network at the end of January 2025. She has been a hugely beneficial addition to the team and we are extremely sad to see her go. However, she leaves us with a fantastic legacy that will ensure PPI will be better embedded in our work in the future. 

National Clinical Guideline for Stroke regional audit

An updated guideline was published last year and it was agreed we would audit the compliance of all stroke inpatient and community teams with applicable recommendations. A huge thank you to everyone who responded to our call for data - it was a mammoth task to enter and also collate the information. However, as a result of everyone's Herculean efforts we have a full dataset and have now reported the findings - no other region has undertaken such a comprehensive review.  You can download a redacted version of the report here.

The information helps us benchmark the our stroke services across the care pathway. It also identifies recommendations with poor compliance by teams and highlights where work needs to be focused to collectively improve the consistency and quality of services. Teams are also able to review their own compliance to inform local improvement plans.

Overall, 19% of all 21 teams (8 stroke units; 13 Community Stroke Teams (CST)) fully complied with at least 85% of applicable recommendations. 29% were able to comply 75-84% of recommendations, with just over half of teams complying fully with 74% or less. Stroke units fared better than CSTs, and Hyper Acute Stroke Units (HASU) did better than District Stroke Centres (DSC). Compliance can depend on a range of factors, with lack of equity in funding across CSTs a significant issue. All of our teams fully or partially meet the vast majority of applicable recommendations.

Key findings were:

• Stroke units have greater full compliance than CSTs in Section 2: Organisation of stroke services – average 75% vs 46%
• Ditto Section 5: Long term support and secondary prevention - average 86% vs 68%
• Similar full compliance levels between inpatient and community services for Section 4: Rehabilitation and recovery - around 74%
• HASUs have greater compliance than DSCs for Section 3: Acute care - average 93% vs 81%

We will be discussing the findings in appropriate forums coming up to identify areas of poorer compliance we can focus on. We have also shared at meetings within the Integrated Care Board to ensure the system is aware of the strength of our stroke services, and where we may need support to improve.

MND nutrition project

We have previously updated on service improvements supported by the network and funded by the MND Association. Within the wider project was a review of current nutritional pathways via audits and focus groups. Staff surveys were also undertaken to establish confidence and competency levels in delivering nutritional care to people with MND. This work was led by senior specialist Dietitian Christina Federico (pictured below) who is based at the Manchester Centre for Clinical Neurosciences at Salford Royal.

Her work has resulted in the development of a nutrition specific education package which she delivered to dietetic teams across the region. She has also supported nutritional education to the wider multi-disciplinary team at our now regular MND training events. Feedback has been very positive with all Dietitians stating they felt more confident in managing nutritional care in MND.

The project has enabled the MND specific gastrostomy pathway at Salford Royal to be reviewed and updated. Details of the education programme were recently shared as a poster presentation at a national nutrition conference (BAPEN). The work has provided helpful data and learning around nutritional management of people with neurological conditions which will now be applied to other patient groups.

Team success in Tameside

In November, there was success at the Tameside & Glossop Integrated Care NHS Trust's annual 'Everyone Matters Awards'. The stroke team - comprising of the Community Neurorehabilitation Team, Stroke Therapy Team and Ward 45 (Stroke Rehabilitation Unit) won Clinical Team of the Year! This is fantastic recognition of the amazing work by everyone for their patients and is very much deserved.

Images of stroke selected by university

The University of Manchester asked its Postgraduate Researchers to highlight their Research Culture themes as part of the ‘Images of Research’ competition, which forms part of their annual Postgraduate Researchers Showcase.

Dr Shahd Benafif's image ‘Facing Stroke-blues Together’ was selected for the ‘building collaboration and interdisciplinary’ theme. Shahd’s image of a handshake mosaic neatly captures the essence of collaboration, and the union of art and science. 

The image was taken in the stroke unit at Stepping Hill Hospital, the top site for recruiting stroke survivors for the Speech after Stroke Recovery Study (SAYS). The study aims to understand the speech recovery journey of stroke survivors by exploring the impact of dysarthria.

New role to tackle staff shortages

The North Manchester CNRT has embarked on recruitment and training of a newly qualified band 5 Speech and Language Therapy (SLT) role - a first for the service. Similar to other Allied Health Professions, the SLT workforce has experienced significant recruitment challenges in recent years. As a result, the Royal College of SLT recommends the creation of lower banded or development posts with structured support and competency frameworks.

The CNRT had been unsuccessful in recruitment to band 6 posts and it was decided to trial a new band 5 position, with leadership support from a senior therapist. Within community, newly qualified posts will often be able to take on focused work with patients for weeks or months, develop and carry their own caseload, and can build in time for consolidation of skills.

The team identified resources to support the role into practice, such as Preceptorship programmes and the Royal College of SLT professional development framework. There were also opportunities to shadow across a range of professions and community teams in the local care organisation.

The CNRT has now successfully recruited to the new post. Candidates reported they were attracted to building a varied caseload working in community specifically. Key learning is that these types of roles can be considered for posts traditionally thought of as complex.

Stroke Association news

NHS 10 year health plan - influencing for stroke to be a priority

The charity knows that the work they do every day truly makes a difference to their lives. They also believe there is opportunity for us collectively to influence the NHS Plan to make sure it meets the needs of stroke survivors and carers. Their CEO Juliet Bouverie is on national groups that have been tasked with writing key recommendations. They have also submitted an organisational response to the Government’s plan setting out what they think are the important priorities for stroke (the network has also responded). They are encouraging those with lived experience and their local teams to have their say by visiting the Change NHS website. The charity are are also hosting feedback utilising "Workshop in a Box" to directly feed in stroke survivor insight.

Stroke Choir news

You may remember the North West stroke choir, who sang so vibrantly at our annual stroke conference in March. What else have they been up to since then? 

They had a busy stroke awareness month in May including a visit to the Bridgewater Hall for an amazing day of music. The group also had the privilege of singing at Salford Royal Hospital, performing in the main entrance and then afterwards entertaining the stroke wards. July saw their 10^th birthday, celebrated with cakes, conversation and of course a little sing song. They also performed with other choirs in the city centre for Manchester day.  In October they were delighted to share how they find strength through support - watch them here. And did you see them singing recently at the Cheadle Christmas lights switch on? 

The choir is made up of stroke survivors, families, volunteers and people who work with, or who have been affected by, stroke.  You can find out how to join here.