Cardiovascular and Stroke

Health Needs Assessment

This work was commissioned from PHAST by a specialised Stroke network as a pragmatic needs assessment, to help the Board develop the commissioning of the most effective services for the people experiencing a stroke in London, and to prevent stroke in those at increased risk.

The report covers a range of complex issues which need to be understood for the development of an effective sector-wide strategy to improve stroke outcomes for people living in London. The Commissioning Board has already engaged with many of these issues, such as those of consultant workforce numbers and the development of services for Transient Ischaemic Attack (TIA) across the sector.

Rapid Appraisal of Proposal for a Cardiovascular Self Assessment Tool for Mid-life LifeCheck

PHAST was commissioned at short notice by the Department of Health (DH) to undertake a peer review to establish if the proposed CVD risk algorithm is sufficiently robust (sensitive & specific), to warrant its use in a range of pilots that are due to commence in early December 2007. The project was planned, organised and completed over a two week period.

In the public consultation for Our Health, Our Care, Our Say people clearly stated that they want to take more responsibility for their health and well-being. Three quarters of participants identified regular health checks as a top priority. I response, the White Paper, Our Health, Our Care, Our Say announced the development of NHS LifeCheck.

For the Mid-life LifeCheck the DH aimed to take a staged approach to behaviour change for the general population, this project was concerned with the initial 'risk assessment' stage – after which individuals will have the option to undertake the behaviour change stage and access their full results. This may lead to advice to have additional measurements (e.g. follow up to discover blood pressure, cholesterol levels, and lifestyle modification etc.)

More information is available from http://www.nhs.uk/lifecheckers/Pages/MidLifeBackground.aspx.

Epidemiological Health Needs Assessment: Coronary Heart Disease

PHAST was commissioned by a London based Stroke Network to inform their commissioning plans for Coronary Heart Disease (CHD) in their specified area. The project built upon an earlier PHAST project that scoped the design and delivery of a London-wide Health Needs Assessment for CHD.

The aim of the project was to provide a high quality epidemiological health needs assessment of CHD (with a particular emphasis on revascularisation) to inform the commissioning of evidence-based CHD services in the specified area of London and to identify health priorities & inequalities. 

Public health support for programme budgeting: Stroke Services

A PCT based in the North East of London requested public health input to aspects of the Trust's programme budgeting for Stroke Services.

The aim of the project was to produce a comparison of how well the PCT's Stroke Services perform in relation to other PCT's and national stroke services standards to aid planning of stroke services and programme budgeting and aid commissioning decision making by the PCT.

Project specific objectives included the production of public health input to the development of a benchmarking proposal and its presentation to the Trusts Stroke Business Group and to provide public health input on technical and policy aspects of producing the benchmarking report.

Integrated Impact Assessment Pan London Acute Stroke Services

In January 2009 HfL commissioned PHAST and Mott MacDonald (working in partnership) to undertake an IIA of HfL's proposals for the acute stroke and major trauma services. The remit of the IIA was to consider both the positive and negative impacts that each proposal could have on health outcomes, equality groups, deprived populations, access to new services and the resulting carbon dioxide emissions. The IIA was also required to consider mitigation measures for any adverse consequences identified and ways in which the services proposals could be improved to maximise the quality and equality of outcomes for London's population.

To see the full report please visit: http://www.healthcareforlondon.nhs.uk/assets/Stroke-and-major-trauma-con…

Vascular risk assessment: CVD Risk Prevalence Model

Following the Government implementation of a systematic, integrated NHS Health Checks Programme to assess and reduce vascular risk factors, PHAST was commissioned to develop a transparent spreadsheet-based CVD risk prevalence model (including both modified Framingham and QRISK2 risk engine options) which estimated the proportion of PCT and practice populations at >20% CVD risk from 2008 to 2020, and the impacts of the Vascular Risk Assessment Programme (VRAP).

The final product was an Excel-based PCT/LA and practice-based CVD risk (>10% & >20%) prevalence model, including the relative contributions different risk factors are making to overall CVD risk using population attributable risk (PAR), and costings for healthcare interventions. Default values will be the national assumptions i.e. uptake, compliance, attribution and relative risk reductions (RRR's) directly from the DH economic modelling.

Training was also provided for PCT and Network staff to make use of the model and a user manual was also produced. 

London Stroke Health Needs Assessment

Between April 2008 and March 2009 PHAST worked with the North East London Cardiac & Stroke Network in order to undertake a needs assessment for stroke across 4/5's of London. It is a priority for the NHS to improve services for people suffering from stroke in England and Wales. The National Stroke Strategy has already set the agenda with a series of quality markers to be met. This is complemented in London by a process (led by Healthcare for London) designating eight hyperacute stroke care centres to which everyone suffering an acute stroke should be admitted. A larger number of stroke units will receive patients after stabilisation and provide services for those having TIA.

The assessments showed a consistent pattern across all four sectors of London studied. As expected the death rates from stroke are highest in inner city PCT's. Death rates from stroke in inner London PCT's are strikingly high in people under 75 years. By contrast, the largest numbers of deaths occur in PCT's in outer London; these are PCT's with longer life expectancy (so more older people) and less deprivation.

PHAST implemented the use of different stroke prevention scenarios throughout the report. These models highlighted the impact that hypertension and smoking have on the prevalence of stroke in all PCT's. The work also revealed a significant inequality in the cut-off age of the national Vascular Risk Assessment (implemented by all PCT's from April 2009) with the report emphasising the increase in the risk of stroke over the age of 75.

In conclusion to the report PHAST outlined the impact on the London areas involved, and made several principal recommendations most of which have been agreed by the clients.

Health Needs Assessment: Stroke

This work was commissioned from PHAST by two London based Stroke Network Boards as a pragmatic needs assessment, to help the Network to understand local stroke priorities and to support PCT's in the commissioning of local services for people suffering from stroke.

It is a national priority for the NHS to improve the quality of services for people experiencing a stroke in England and Wales. Stroke is one area highlighted in the NHS Next Stage Review 2 as a priority for change, introducing the concept of specialist centres for acute stroke care. Not only should this lead to better outcomes for those suffering a stroke, but there is also the opportunity to more effectively prevent strokes from occurring. The National Stroke Strategy 3 published in 2007, has already set a comprehensive agenda with a series of national quality markers to be met over time. The national agenda is complemented in London by a complex process to determine the designation of acute stroke care centres, running in parallel with the work to produce this report.

Meanwhile there has been the additional need for cardiac and stroke network boards across London to understand the epidemiological picture of stroke deaths and prevalence within the populations in their sectors, the patterns of hospital admissions and the opportunities to prevent strokes and TIA's.

This project aimed to perform a systematic review of incidence, prevalence and impact of Stroke and TIA within a selected area of London, with comparison made between the sectors and both London and England as a whole. This report builds on earlier work undertaken by PHAST to assess stroke health needs in other parts of the London sector.

Vascular Surgery Scoping Agreement

Following the expansion of service provision for a London based Stroke Network, PHAST was asked to prepare a report providing a brief overview of the nature of the services in question, prepared as an introduction to the issues for commissioners.

The project team was tasked to provide a useful and succinct introduction to the issues underlying the commissioning of services for people with vascular disease. The final report covered the nature of vascular services, information about the diseases treaded by vascular services, the treatments used in vascular services, relevant national policy statements and standards and an analysis of activity in London.