PhysioUpdate 30th June 2022


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

Health and social care trusts in Northern Ireland have been told to start working on plans to introduce seven-day services for people who have experienced a transient ischaemic attack (TIA) by next summer.

That is one of the central messages contained in an action plan, titled Reshaping Stroke Care: Saving lives, reducing disability, that was launched by the Department of Health earlier this week (20 June).

Stroke is said to a ‘major health issue in Northern Ireland, with more than 3,000 people with the condition being admitted to its hospitals annually, while the number of stroke survivors living in the community stands at 39,000.

 

A man with a suspected stroke receives an assessment (stock image)

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

 

 

 



An inability to stand on one leg for 10 seconds linked to a heightened risk of death within 10 years

Physiotherapists and other healthcare professionals should consider incorporating a simple balance test into routine health checks conducted among older patients, according to an international team of researchers.

Led by Claudio Gil Araujo from the Clinimex exercise medicine clinic in Rio de Janeiro, Brazil, the team makes its suggestion in a paper appearing in the current edition of the British Journal of Sports Medicine.

The researchers found a link between an inability to stand on one leg for 10 seconds in mid to later life and a near doubling in the risk of death from any cause within the next 10 years.

They focused on a group of people who took part in the CLINIMEX Exercise cohort study, which was set up in 1994 to assess associations between measures of physical fitness, exercise-related variables, and conventional cardiovascular risk factors, with ill health and death. 

Balance assessments are not a routine part of middle-aged and older people's health checks

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Chief AHPs officer Suzanne Rastrick says five-year AHP strategy will act as a 'catalyst for change'

Suzanne Rastrick, the chief allied health professions (AHPs) officer for England, expressed her ‘pride’ via Twitter earlier today (21 June) in launching a five-year strategy for physiotherapy and the 13 other AHP professions. The gestation of the strategy, the latest in a series, was 'paused' in 2020 due to the impact of the Covid-19 pandemic but resumed in early 2021.

In a foreword to 39-page AHP Strategy for England: AHPs Deliver, Ms Rastrick stresses that it ‘captures the voices of diverse people and communities’. ‘This is intentional: they are central to everything the AHP community plans and delivers, and we continued our co-production commitment through to the final drafting of the strategy.'

 

 

The strategy is leavened with comments from some of the 21,000 contributions received

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