Can I attend the One Stroke Workforce CPD conference?
We are delighted to invite you to this one day conference taking place on Thursday 31st March 2022, in person, for those working in stroke care in Bristol, North Somerset and South Gloucestershire. It’s open to anyone working in this speciality, or those wishing to find out more about working in stroke care, and is free to attend.
You’ll get the chance to network with others and hear from some great speakers throughout the day. Our keynote speaker is Dr Rebecca Fisher, Rebecca is the Rehabilitation and Life After Stroke Workstream lead working with NHS England and NHS Improvement Clinical Policy Unit. Rebecca is also an Associate Director with the Sentinel Stroke National Audit Programme (SSNAP) leading on the development and delivery of the post-acute elements of SSNAP.
You can find out more information, including the programme for the day and how to register to attend on Eventbrite.
Proposed changes to stroke services
Read and download a ‘staff backgrounder’ factsheet covering topics like patient numbers, bed modelling and growth.
What consultation has happened so far?
Between September and June 2021, we ran a 12-week consultation on proposals for stroke services. We consulted with staff who work in delivering stroke services as the proposals affect you.
This was part of the wider Public Consultation and we were seeking your views along with those of the public on the proposed overall approach to how we deliver Stroke services within the BNSSG region. The questions we were asking you to consider were the same as those we were asking the public.
Does this mean we will need another consultation on the specific changes which may affect us as staff?
Yes, the consultation that ran in 2021 is part of the public consultation on proposals and options for change contained within the consultation document; this is distinct from any formal organisational change consultation.
Now that a decision has been made and we have a clearer view on how the proposed changes would affect staff, we will be undertaking the appropriate organisational change consultations.
When will staff be consulted on these aspects?
Formal HR consultation process with directly affected staff is expected to take place between April and July 2022, and last for between four and six weeks (depending on the scale of changes). The consultation will cover any proposed changes to job roles, base location, and TUPE arrangements in line with the recommended organisational changes. Staff will be kept up to date as plans progress.
What updates can we expect?
We will continue to engage with you as we progress through the programme as plans develop and decisions take place.
Are there going to be fewer jobs for staff working in Stroke in the future?
As part of the future delivery of stroke services we anticipate needing more staff rather than fewer but we recognise roles may be configured differently to how things are currently delivered in order to achieve the improvements we are seeking. We are currently planning ways to boost recruitment and encourage staff to join and stay in stroke services in our area.
Because specialist services are being centralised, does this mean I may have to work in a different location or for a different organisation?
It is possible that this may be required. However, through the clinical design processes and service specifications, we are reviewing the optimum balance between delivering the future models with minimising disruption and building a single stroke workforce.
You will have the opportunity of discussing your personal circumstances as part of any organisational change consultation on this.
What do you mean by ‘single stroke workforce’?
This is a term which is used to illustrate a collaborative approach to how we will seek to recruit and develop staff working across BNSSG within stroke. We are identifying new consistent competencies for staff as part of the education and training group of the Bristol Health Partners Stroke HiT and working across organisations on recruitment campaigns.
Additionally, we are exploring the option of creating multi organisational rotational roles which will provide staff with the opportunity to work across the patient pathway and develop skills within new areas.
Does this mean we will all be working for one organisation?
This is very unlikely as we are likely to still have separate healthcare organisations within the pathway but all organisations, teams and staff will be expected to work together as a seamless pathway for patients.
Why has one Acute Stroke Unit (ASU) at Southmead been approved?
Southmead Hospital already has advanced and highly specialised equipment, and the latest treatments. Having one ASU at Southmead Hospital will reduce patient transfer between hospitals. It will also potentially reduce delays in treatment and care and lead to an overall decrease in time spent in hospital for patients. The decision also means a consolidated workforce and improvements in affordability that were identified by health system partners.
Proposed changes for staff
Much of the detail for staff in relation to location or other contractual aspects will be addressed during implementation. However, we have set out below what we think are some of the key questions and we welcome additional questions.
I work in Weston as a nurse on our Stroke ward, what do these proposals mean for me?
All our staff are needed as part of the ambition for a single stroke workforce. We’re currently looking at what services are delivered and at what location.
One specialist Sub-Acute Rehabilitation Units (SSARU) will be located on the Weston General Hospital site, with a similar number of beds to the current service. Additionally we are exploring the option of creating multi-organisational rotational roles which will provide staff with the opportunity to work across the patient pathway and develop skills within new areas.
Does this mean I would need to change organisation?
There would be a number of options available to you and we will consult with you on these options soon. Once implemented the acute services will be based at Southmead Hospital. One of the Stroke Sub-Acute Rehabilitation Units will be based on the Weston General Hospital site and the second will be at South Bristol Community Hospital.
I work as an Occupational Therapist in Southmead on our Stroke ward, what do these proposals mean for me?
There is an ongoing inpatient Stroke requirement at Southmead Hospital. As part of the development of a One Stroke workforce concept, we are also developing multi location rotations to enable staff development and competency maintenance for therapist across the whole patient pathway.
I work in the ASU in the BRI, if there is just one ASU at Southmead Hospital, what happens to my post?
We would explore this with you as part of a formal staff consultations. We would be seeking an overall increase in the workforce requirement to support the HASU, ASU and SSARU options.
If there is no stroke team at the BRI who will see all the outliers?
As part of the overall programme we have worked with organisational leadership teams regarding the impacts of the changes and developed proposals to ensure the needs of any patients affected by the proposed changes including stroke outliers and non-stroke patients with neurological needs have been considered and a future plan proposed. Staff and resource requirements have been included in the plans to ensure an onsite Stroke presence to meet the needs of patients who are unable to transfer to the HASU/ASU.
I do a mixed post with stroke as part of it. Does this mean I won’t see any stroke survivors anymore?
This will depend on what area of the pathway you are working in and what your role is. We will discuss your personal circumstances through the formal staff consultation process.
What if only some of the team who see a mixture of conditions want to work in the ICSS?
We would review how the service could best be configured as there will be a totality of stroke work required and this may therefore require individual discussions or consultations.
Who will be running the Stroke Rehab Unit on the Weston General Hospital site (and other SSARU as part of the ICSS)?
This has yet to be determined and will be for healthcare organisations to propose how this can best be delivered for patients; we will be providing updates on the development of this process as it evolves.
What are the plans for the staff working within the current Early Supported Discharge (ESD) teams?
In future the stroke ESD team will form part of the ICSS. This will be delivered in the community.
Will the rehab support workers currently in ESD be expected to carry our personal care tasks?
The service model has rehabilitative washing and dressing and meal preparation tasks as part of the service. These will be provided by registered therapists as part of assessment and therapy plans carried out by all members of the team but particularly rehab support workers or ringfenced reablement workers under the direction of therapists. There is the expectation that all rehab support workers support with washing and dressing and meal preparation tasks as part of the service users’ goals as well as other therapy programmes.
We value our current rotational opportunities; will we be able to maintain these in the future?
As part of the plans for the future we are keen to maintain and develop rotations across the stroke pathway as we understand this will support skills maintenance and development.
We will be working this up in more detail over the coming months and engage with you on these plans as they develop.
Who will I be employed by?
This will be developed as part of the implementation planning being worked up following the decision. We will of course consult with you on any changes at the appropriate time as part of the implementation phase of these services.
It’s too early to go into employment terms and conditions but we know we need our existing stroke teams to help deliver the vision for stroke and there will be opportunities for staff across the specialist stroke services. We’re keen to work with our staff to find new ways of delivering services that work for as many staff as possible.
What stroke services will be delivered at the site which I work at?
The proposed changes are set out within the Decision-Making Business Case. This confirms that
- The Hyper Acute Stroke Unit (HASU) and Acute Stroke Unit (ASU) will be provided at Southmead Hospital
- One Stroke Sub Acute Unit (SSARU) will be provided at the Weston General Hospital Site and the second at South Bristol Community Hospital (SBCH)
If I have to switch employer, what will the process be for that?
The formal route for a transfer of services (where staff change employers) is known as TUPE but the process for this would be further explained as part of any specific consultation processes required (where applicable) which would likely be between April and July 2022.
Will I still be able to do the same kind of work?
Yes, broadly speaking as we will still be providing excellent care for our stroke patients across the pathway.
Will I be expected to work over different sites?
This will depend on your role and the work you do. Within the design of these services, there runs a theme of flexibility within the single stroke workforce, such as in-reach from the ICSS into acute or subacute units for individual patients, or to support with various pressures.
It’s too early to go into employment specifics but we know we need our existing stroke teams to help deliver the vision for stroke and there will be opportunities for staff across the specialist stroke services. We’re keen to work with our staff to find new ways of delivering services that work for as many staff as possible.
What training and education opportunities will there be?
There are BNSSG training and development opportunities depending on profession which include a number of sessions coordinated by the Stroke HiT Education and Training Group as well as specific learning opportunities through working within differing settings such as the HASU. We will be ensuring a consistent standard and availability of training for staff across BNSSG.
What opportunity for career progression will there be in the single stroke workforce?
Through enhanced collaborative working across the stroke pathway we envisage additional opportunities for career progression along with greater opportunities for developing skills which may have previously have required more formal changes between organisations.
What happens if we are not able to recruit enough staff in stroke services?
We are already working through our BNSSG Resourcing Group to develop collaborative recruitment plans to understand and deliver future stroke staffing levels which will mitigate this risk.
As in any cases, we would look at flexible deployments from other areas or temporary staffing solutions to supplement any short-term gaps which may occur as part of the ongoing management of services. We would of course take into account staff specialisms and skills sets in relation to the individual situation demand to do this most effectively and efficiently.
How many fast positive patients would we be seeing in the future?
What would be the Bed numbers for Acute & Subacute?
- HASU – 20 beds (+1 bed ICU)
- ASU- 22 beds
- SSARU – 42 beds
Are community beds going to be delivering specialist Stroke care? Will there be specialist rehabilitation?
Yes they would be – and yes, there would be specialist beds.
How was the bed numbers modelled?
By length of stay and potential discharges, along with those medically fit for discharge.
Within the Bristol Royal Infirmary we already have patients queuing up for stroke beds, what will happen in the future model with fewer beds?
The bed requirement has been modelled based on assumptions regarding Length of Stay (LOS) and improvements in acute LOS as a result of the increased community services supporting discharge. This has used stroke activity (patient numbers, length of stay etc) reported by each site to understand demand with an assumption then made for growth. Our projections are that if we achieve our community discharge improvements then this will address the issue.
Will this mean potentially increased TIA at BRI?
Yes, provision for transient-ischaemic attack (TIA) services will be bolstered and we are currently working through the modelling to ensure we have the right resource in all areas of BNSSG.
Stroke Services Model
Would ESD be part of ICSS and what would the provision be?
This would the case and a 7 day service for the ICSS. There may be a reduced service at weekends but not if this impacted on patient flow.
What were the considerations about three SSARU’s?
There were a number of reasons why this was discounted but this was predominantly due to concerns about specialist staffing availability along with cost and benefit considerations. The overall bed capacity remains the same with two SSARUs.
What about health & social care capacity?
Social care is very involved in supporting our discharges and is a key feature of our overall capacity considerations.
What about the Therapy staffing levels, would they need to increase?
As part of our development of service models, we want to ensure that we have sufficient staffing to meet the relevant stroke standards.
Are you confident about the funding and workforce levels?
Yes currently we have reviewed our funding models associated with the workforce requirements and these have been reviewed by the directors of finance across BNSSG. Financial analysis and value for money is set out within section 8 of the Decision-Making Business Case with workforce details set out within section 9.