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Breaking down barriers to system change

We at the Stroke Association are boldly pro-reconfiguration. As an organisation representing over a million stroke survivors and advocating for the best possible treatment and care, how could we be anything else? 

We see it as our duty to ensure as many patients as possible get access to world-class treatments and round-the-clock care – both of which are more likely in reconfigured acute stroke services.

Evidence of the benefits of stroke service reconfiguration is overwhelming. Where it has already happened, for example in London and Greater Manchester, reconfiguration is saving hundreds of lives a year, and patients are reporting positive experiences of care in hyper-acute stroke units (HASUs).

But reconfiguring stroke services, as with making changes to any hospital services, is hard work. While the opportunities are great, the obstacles are also significant. That’s why a wide range of people from all parts of health and care came together recently to discuss the challenges, barriers, frustrations, as well as opportunities, we’re all facing in trying to make it happen.

After all, it’s a complicated message we need to communicate. Telling somebody they may need to travel further in an ambulance to receive better care in a HASU could sound contradictory, unless the enormous advantages are also explained. The public can be understandably concerned about their local services shutting down, services that are familiar, nearby, and may have served them for many years – the same services that may even have saved their lives.

Add to that a highly politicised debate around the future of the NHS, distrust in politics and the ever-present fears around increased levels of private sector involvement in health, and that message only gets harder to communicate. But it’s our job to tackle this head on: to bust the myths, to communicate the virtues of reconfiguration powerfully and accessibly, to push for reconfiguration wherever it is possible.

Without proper, meaningful engagement with local people, major systems change will always be challenging, if not impossible.

It may seem obvious, but we believe that, without proper, meaningful engagement with local people, particularly those the proposals are most likely to affect, major systems change will always be challenging, if not impossible. But all of us – whether stroke professionals, health systems leaders, politicians, stroke survivors or the third sector – must play our part to break down the barriers to reconfiguration. Together, we must engage, listen, inform and persuade.

That’s why the Stroke Association is becoming increasingly involved in reconfigurations up and down the country. We’re working to ensure stroke survivors and their families and carers make the most of opportunities to respond to local consultations and help shape the reconfiguration process. We come together with trusts, boards, CCGs, STPs and others to improve the accessibility of consultations, and we help health systems leaders to communicate the evidence and benefits.

We run engagement events, consult our Stroke Association clubs and groups, and respond to local consultations, putting our own position clearly on the record. In partnership with Angus Ramsay and the team at University College London, we’re going to help mobilise their research, making it accessible and understandable to the public. We also work with local politicians where necessary, to share evidence and provide a strong, independent and expert voice amid an often fraught debate.

But conversations don’t just need to happen locally. We’re influencing at a national level too, explaining clearly to Ministers and senior decision makers that we urgently need more areas to reconfigure their stroke services if we’re going to ensure patients have access to the best possible treatment and care. Of course, evidence shows that reconfiguration saves the NHS money in the long-term too. At a time of unprecedented challenges for the health service, this shouldn’t be forgotten, and we shouldn’t underestimate this as a key message for those at the very top of the system.

The new national stroke plan for England – which we’re developing with NHS England – will embed action on reconfiguration across the whole system, and we’re working across all four UK nations to tackle the current postcode lottery of care facing stroke survivors.

Put simply, reconfiguration works. The evidence is clear; it just needs to be heard. Delay reconfiguration, and we risk stroke patients dying or living with severe disability unnecessarily. We cannot let that happen. Working together, we must make clear that reconfiguration is the key to world-class stroke treatment and care.

Mark MacDonald is Head of Policy and Public Affairs at the Stroke Association.

Mark MacDonald1 June 2018

A little something else? If you found this of interest, then we’d suggest taking a look at some related items. And when you’re ready to chat, you can get in touch.