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

Network news

At the end of March, we said goodbye to our Community Clinical Director Tracy Walker after 8 years of sterling service. Our Inpatient Rehabilitation Clinical Lead Jenny Harrison also completed her tenure, with Fatema Mullamitha, our Community Stroke Lead finishing at the end of May. We would like to thank each of them for their enormous contribution, as well as passion and commitment to service improvement during their involvement with us. We will advertise for leadership roles in the coming months.

Network strategy launched

In May we launched our strategy for 2024-2026 which reflects national requirements (mostly for stroke), regional objectives including the transformation of inpatient neurorehabilitation services, and crucially what our patients and carers told us were important to them.

We have a large programme of quality improvement projects that will ensure we collaboratively deliver on these key areas, and we look forward to work closely with our stakeholders for the benefit of our patients, their families and carers. You can view the strategy here - it is interactive for easier navigation.

Health inequalities in MS research

Dr David Rog and members of Multiple Sclerosis (MS) team at the Manchester Centre for Clinical Neurosciences based at Salford Royal Hospital have just published some important research highlighting the variation in uptake of Disease Modifying Treatments (DMT) in our local population.  

The study used data from patients treated at the neuroscience centre between 2010-2020 and found that those who were non white or more deprived, were less likely to access DMTs. We will be picking this important finding up in our planned work to improve the MS care pathway later in the year. You can read the paper published in the British Medical Journal here.

NHS England thrombectomy service visit

On 14th June, the region was delighted to host NHS England National Medical Director Professor Stephen Powis and National Stroke Clinical Director Dr David Hargroves to hear more about our mechanical thrombectomy service. The visits are part of a series to support the national ambition of ensuring all patients have access to 24/7 services, and intervention rates increase to around 10% of all strokes (currently ~4% nationally).

The visit took place at Salford Royal Hospital, with the NHS England team joining the network and members of the Trust’s executive plus stroke, radiology, critical care and anaesthetic services as well as local leaders from the Integrated Care Partnership and the Stroke Association.

The delegation were treated to a presentation from our Clinical Director and Salford clinicians about the regions high performing stroke pathway. They also heard about how our thrombectomy service was established and developed so that it now operates 24/7.

Our visitors were taken round key clinical areas including the new stroke facilities in the Major Trauma Centre recently opened at the hospital. Stephen Powis was evidently impressed by the tour as he declared they were was the best facilities they had seen on the 12 visits they have completed so far. The NHS England team were very complimentary about what we have achieved in Greater Manchester and discussions focused on how the service can increase procedure rates to 10% (currently on 5.5% but with an upward trajectory). The day really was a team effort and highlighted how closely everyone works within the network to deliver this amazing, life changing service.

Pathway updates

Discharge

During the pandemic, Social Workers were withdrawn from hospitals and a new process called discharge to assess introduced. These changes have sometimes led to poor patient experience (especially for more complex patients) and inefficient working between teams. 

The network attended the Greater Manchester Directors of Adult Social Services meeting at the end of last year and was able to establish links with key localities where there are particular issues. Extremely positive collaborative meetings between social care management, inpatient teams and the regional complex discharge service have now taken place in Bury, Stockport and Wigan, with clear plans for action agreed in all. Work will focus on establishing effective MDTs, communication and processes. In many Trusts, social care staff are now returning to wards which will also be of benefit.

Vestibular rehabilitation

We are working with colleagues across neurorehabilitation, stroke, falls, audiology and vestibular physiotherapy to map current pathways for vestibular assessment and rehabilitation across the region. The hope is that we will be able to share a comprehensive picture of the current pathways in place to increase awareness and appropriateness of referrals. We are also in the process of developing a model for vestibular assessment and treatment within stroke and neurorehabilitation services, alongside standardised assessment and screening tools.

Slow stream rehabilitation

We are working with our Integrated Care Board and NHS England to develop a case management structure for patients needing to access slow stream rehabilitation in the independent sector.

Individual Funding Requests (IFR) and Permissible Activity

The Integrated Care Board have started a review of their Effective Use of Resource (EUR) policies, of which six apply to our services: Functional Electrical Stimulation (FES), Trophic Electrical Stimulation (TES) for Facial Palsy, Lycra, Communication Aids, Orthoses & 24hour Postural Management, and Cough Assist. These are currently managed under ‘Permissible Activity’ but there is question as to whether this is the appropriate commissioning arrangement. The FES and TES policies are currently under consideration and have had independent evidence reviews completed by public health commissioners. We have engaged with clinicians in our teams and submitted responses to these reviews and will be attending board meetings to discuss further with key clinical colleagues. The date for the FES review meeting is in mid July, with the date for the next TES meeting not yet set. The other policies will be reviewed during 2025 and 2026.

Neurological longer term support

Our steering group have developed a model which will be piloted in the Bolton locality to test its feasibility. The purpose of the model is to identify the support required for an individual to ‘live well’ with a neurological diagnosis, and the pilot will test how this can be delivered in practice. The results of will inform the direction of the project moving forward and tie in with similar life after stroke pilot work now completed.

Spasticity

A successful advanced spasticity workshop was delivered by Tim Walton and Lynn Fletcher over the course of 1.5 days at Bolton University. This was accessed by specialist physiotherapy and occupational therapists from across the region and focused on therapeutic handling of spasticity. This will form part of an ongoing training programme overseen by the steering group.

Vocational rehabilitation

We continue to facilitate a Community of Practice and recently asked members to complete a confidence rating scale. An average improvement of 13% was found when compared with the same exercise in January 2023, highlighting the benefits for clinicians of meeting and discussing complex interventions. A national forum is being established and our Facilitator, Cillian O'Briain is involved in a steering group to support its development.

Driving guidelines (Neuro)

Last year, we updated our stroke driving guidelines for professionals and this year we set up a task and finish group to develop similar guidelines for other neurological conditions. In May, we presented the guidelines at our Patient & Carer Group. Members offered invaluable feedback and shared personal experiences of returning to drive with a neurological condition. Some changes have been made to the guidelines and the final draft will go to our Clinical Effectiveness Group in the coming months for approval.

Motor Neurone Disease (MND)

The MND project is reaching its final stages with completion planned for July. The network will ensure the project’s progress and legacy continue, for example, the biannual MND Steering Group is now ‘business as usual’, a library of resources collated through the project is available in our MND Toolkit and plans are in place to ensure MND professionals have access to relevant training.

The project has highlighted the need for further focus on emotional support services and we are currently working with others on a grant for further MND Association funding. The collaborative nature of this project has proved to be an exemplar approach to (mostly cost neutral/saving) pathway development which we will employ to explore development opportunities in MS later in the year.

Training and education

A number of face to face events were held in April and May as part of our blended programme including online webinars. A spasticity management event in Bolton was well attended (pictured right), as was our follow on training in MND in May.

We are also scoping how teams are currently able to access funding for training courses, as we are aware that many Trusts are now reducing or stopping monies previously available. Most of our courses are free, however, where we have to pay for a trainer or venue costs then we have to pass this onto delegates.

We offer a wide programme of face to face and online events, those hyper linked are open for bookings. 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.

Introductory level

2024

Introductory Stroke Study Day – 28th June  – Fairfield General

Introductory Stroke Study Day – 9th September – Wrightington Hospital, Wigan

Introductory Stroke Study Day – 27th November – Trafford General

Experienced/advanced level

2024

The North West Neuro and Stroke Psychology Workshop – 26th June

UKABIF and GMNISDN Webinar –  Improving outcomes in people with neurological conditions experiencing homelessness – cancelled on 26th June and likely new date in September

Stroke Ed Balance Workshop  24th & 25th September

Stroke Ed Lower Limb Workshop- 27th – 29th September

Unconscious bias workshop – October  (date to be confirmed)

Sensory Rehabilitation –  November (date to be confirmed)

2025

OCE Postural Seating Training – 14th-17th February

GMNISDN Annual Conference – 26th March

Patient & Carer Group

In January, we merged our stroke and neurorehabilitation groups which has proven hugely successful. Following an initial session of getting to know each other and how different conditions can impact lives, the next meeting in May (at a new venue) focused on some key areas including driving and longer term support. Our Co-ordinator Abi Bisset is now helping to develop induction materials and will be working with the group to develop ways teams can integrate involvement into the service improvement.

Bolton Neuro Voices has new Trustee

Marie Oxtoby has now retired from her role as chair and hydro co-ordinator. Following an appeal in our last newsletter, Bury Occupational Therapist Shelley Radcliffe has joined the committee although they still have no overall co-ordinator. Shelley said of her appointment "I have always been aware of the wonderful, affordable hydrotherapy service that Bolton Neuro Voices brings to the Stroke/Neuro community across Greater Manchester and the value of this service to our client group. I am also a distance open water swimmer and when Marie advertised for support, personally understanding the value of water therapy motivated me to contact her. I am very excited for this new opportunity and looking forward to working alongside the physiotherapists when a new assessment group runs. As a trustee with Bolton Neuro Voices I am well placed as a clinician and swimmer to support any queries arising throughout the network and look forward to hearing from you via email shelley.radcliffe@nca.nhs.uk".  

The charity has helped many people including Dan pictured right who started at Neuro Voices, progressed onto swimming and was introduced to Adapt E who lent him a trike and he signed up for his first Triathlon!

Research study seeking children to participate

We have been asked by Professor Audrey Bowen (pictured right) and her researcher Trainee Psychologist Daisy Gibson to raise awareness of their study now open to recruitment:

“How does life change when your parent or caregiver has a stroke?”

This study is part of a thesis for Daisy's Doctorate in Clinical Psychology. They want to hear the experiences of children, young people and adults who have a parent or caregiver who had a stroke when they were aged 8-18 years old. By learning about children’s experiences, they hope to better understand the impact stroke can have on the whole family and build recommendations for supporting children and families after stroke in the future. The study has approval from the University of Manchester Research Ethics Committee.

They need help sending out the invitation and have an advert that can be used. If you want to get involved or to find out more please contact Daisy directly by email at daisy.gibson@postgrad.manchester.ac.uk.

Stroke Association news

Manchester services workshop

On 5^th June, Stroke Association staff, stroke survivors, carers and community stroke team therapists from throughout North, Central and South Manchester came together. The meeting was to hear what is important to stroke survivors and clinicians in the Manchester locality when it comes to the provision of Life After Stroke services and the difference that support makes. 

Currently, the organisation are not funded to provide a service in South Manchester. The information gathered during the workshop will be used to answer the question of how to provide the most impactful service to stroke survivors across the Manchester Locality within existing funding parameters, of North and Central – but also to include South Manchester residents

Chelsea Flower Show – Garden for Recovery

Miria Harris, landscape designer, had a stroke 5 years ago.  The Stroke Association were highly honoured this year as she represented the charity at the RHS Chelsea Flower Show. Her recovery from stroke inspired her to design ‘Garden for Recovery’.  

Marie Griffiths, a Stockport Stroke Recovery Coordinator attended and shared her reflections;

"I spent a day as a garden host greeting the show-goers! We chatted about the garden, it’s design and inspiration, about stroke and the Stroke Association’s work. As I sat on the train on the way home I thought about the sheer number of people I had spoken to throughout the day, the breadth and variety of the conversations. A common theme was how wonderful the garden was, avid gardeners who loved the design and planting, and vison and meaning behind the garden. I spoke to many stroke survivors, family and friends who came to seek out the garden specifically, who were full of admiration for Miria Harris, her own experience of stroke and what she had achieved. I heard many extremely positive stories of support, stroke survivors had received from the Stroke Association in their own recovery, from around the country."

Reading to patients on wards

Just a reminder of a service that may be of interest to teams. InterAct is an award winning charity dedicated to supporting stroke recovery through reading and storytelling. The organisation employs a team of professional actors to deliver a rich variety of reading material that is selected to suit the needs of each stroke patient. Their approach can help stimulate memory, engage language, and lift spirits - ultimately alleviating symptoms of post stroke depression which can slow or even arrest recovery. The charity provide people to read to stroke patients on the stroke ward at Trafford General and offer an 'at home' service to outpatients. They are particularly keen to promote this to clinical staff so that they might signpost patients to the service on / after discharge. You can find out more here.

HEADS UP research study publish results

Some of our teams were involved in this project led by Dr Maggie Lawrence in Scotland. The HEADS: UP research programme, funded by the Stroke Association, came to an end last Spring. You can download the final report here.

Maggie notes: "I would like to take this opportunity to say 'thank you' for your interest in the study and for helping us to recruit so successfully to the study. It would not have been possible without help from organisations such as yourselves, people affected by stroke, and members of the public."  

If you want to speak to Maggie about the study you can email her directly at Maggie.Lawrence@gcu.ac.uk