Northern Ireland-based staff must offer seven-day services to patients with a suspected stroke

It’s disappointing that we’re still awaiting a decision on the introduction of hyperacute centres of excellence ... this will undoubtedly cause further uncertainty for people affected by stroke and for the dedicated and hard-working professionals working in stroke care [Alasdair O’Hara]

Health minister Robin Swann explained that the plan followed the publication of a consultation document on stroke provision, which triggered more than 19,000 responses. But in a foreword to the plan, he admits that an option to introduce hyperacute stroke care, as set out in that consultation document, has been pulled, and that instead a new ‘process for the evaluation of options’ will be established.

Alasdair O’Hara, associate director for the Stroke Association in Northern Ireland, said he was pleased to see the plan’s release as his organisation had been pressing for it for three years. ‘However, it’s disappointing that we’re still awaiting a decision on the introduction of hyperacute centres of excellence, particularly as the minister has recently announced wider plans to reshape hospital services.

‘This will undoubtedly cause further uncertainty for people affected by stroke and for the dedicated and hard-working professionals working in stroke care,' he added.

Failure to meet NICE guidelines

The dire state of TIA services in Northern Ireland was highlighted in an audit that was completed last summer, which showed that just one patient with TIA in three received a specialist assessment with in 24 hours. This compares with a National Institute for Health and Care Excellence guideline, which states that everyone with a suspected TIA should be seen within 24 hours of the onset of symptoms. All HSC trusts currently only offer five-day assessment services.

A section on ‘primary prevention’ points out that ’10 modifiable factors’ – including hypertension, high cholesterol, smoking, obesity and diet, and diabetes – account for 90 per cent of stroke risks. Strategies designed to tackle issues such as diet and physical activity, smoking and alcohol use would be developed in tandem with the Public Health Agency, the plan states.

AI roll-out promised

The plan promises that artificial intelligence (AI) software that aids stroke identification will become more widely available. At present, AI software is only used at the Royal Victoria Hospital in Belfast.

By this December, AI software to assist in the interpretation of scans and the targeting of treatment, including thrombectomy and thrombolysis, will be expanded and a 24-7 thrombectomy service will be installed by the end of 2024, the plan states.

Rehab and workforce issues

Turning to rehabilitation and long-term support, the action plan sets out what are considered to be ‘key services’

• early supported discharge in all trusts
• rehabilitation for as long as it is needed
• stroke patients should have access to timely clinical psychology support
• services should be developed in partnership with the voluntary and community sectors

The action plan states that the ‘stroke workforce’ will play a vital role in its implementation. A ‘targeted review’ of the workforce is promised imminently, with a workforce plan scheduled to be released by the summer of 2023.

'Challenging' financial position

Health minister Robin Swann added: ‘I recognise that the full implementation of this action plan will require additional funding over several years at a time when we face a very challenging financial position.

‘Securing this funding will not be easy or straightforward but I have tasked my officials to explore every opportunity going forward to secure additional funding as the costs of implementation become clearer.’

To see the full version of the action plan, visit: https://www.health-ni.gov.uk/sites/default/files/publications/health/doh-Stroke%20Action%20Plan%20June%202022.PDF