Written question WQ89266

Guided by our Stroke Quality Statement, work is being undertaken across Wales to improve access to stroke services and outcomes for people affected by stroke. A national stroke programme team ,led by the National Clinical Lead for Stroke, is supporting health boards to drive improvement in outcomes for people affected by stroke through regional operational delivery networks (ODN). The North Wales ODN is fully engaged with the national stroke programme team.

The comprehensive stroke centre (CRSC) model is the optimal model for stroke care in Wales. Newly-launched stroke guidelines from the Royal College of Physicians call for stroke care to be organised in this regional way, and this is strongly supported by Welsh Government, Welsh clinicians, and the Stroke Association in Wales. Where this model has been adopted in other areas of the UK, significant improvement in outcomes across the stroke pathway have been achieved.

Each CRSC will become the focal point for clinical expertise, and for the delivery of interventions, such as mechanical thrombectomy and intensive rehabilitation in the first critical 72-hour hyper-acute phase following a stroke. Following this phase of care, people will be transferred to local hospital and community stroke services to continue their ongoing recovery and rehabilitation closer to home.

To ensure equitable access to thrombectomy, the Welsh Health Specialist Services Committee commissions access to thrombectomy from two English NHS Trusts; The Walton Centre in Liverpool and North Bristol NHS Trust.

A national thrombectomy oversight group meets every two to three months, seeking opportunities for improvement, and supports new innovations to improve the existing thrombectomy pathway, including:

• The deployment of artificial intelligence in radiology departments to accelerate diagnosis of stroke, enhance clinical decision making and reduce onward pathway delays.

• Pre-hospital virtual triage is being piloted in Cardiff and Vale University Health Board which will enable patients to be taken straight from the ambulance to a CT scan. Early indications are that this is demonstrating promising outcomes and the national stroke programme team is exploring opportunities to spread this.

• Since March 2022, inter-hospital transfers for thrombectomy are classified as a ‘category red transfer’ – the most urgent response. Wales is the first nation to have a ‘red’ inter-hospital transfer arrangement.

All health boards provide rehabilitation as an integral part of their stroke services, and continue to develop early supported discharge, which provides essential rehabilitation to enable people to recover at home. We make £1.4m available for community-based multi-professional rehabilitation support workers for all, including those at risk of losing their independence. This is supported by our Allied Health Professions Framework Programme and the All Wales Rehabilitation Framework. Health boards, local authority and third sector partners are using the Framework to plan rehabilitation services to respond to the needs of their populations.

Moving forward, stroke will form part of the Cardiovascular Strategic Network, and a Stroke Improvement Network (SIN) will be established to focus on the stroke specific agenda; the SIN will support the regional ODNs. This will provide a robust forum for sharing best and promising practice across the whole stroke pathway, from prevention through rehabilitation and recovery, and life after a stroke. As part of the national stroke programme team, the National Allied Health Professional (AHP) Lead for stroke has established a national AHP group where best practice in rehabilitation can be shared, and opportunities for improvements identified and implemented.

I am confident the work being led by the national stroke programme team in collaboration with NHS organisations and the Stroke Association will move us in the right direction to achieve the aims set out in the Stroke Quality Statement. I met with everyone involved recently and was pleased to hear the commitment to co-produce the future model for stroke care in Wales with a wide range of stakeholders, and importantly, those with lived experience of stroke.