Innovations in major system reconfiguration in England: a study of the effectiveness, acceptability and processes of implementation of different models of stroke care

Funded by the National Institute for Health Research Health Services and Delivery Research (HS&DR) Programme

September 2011 – March 2016

Key contact: Dr Angus Ramsay

Chief investigator: Professor Naomi Fulop

Project team: Professor Anthony Rudd, Professor Pippa Tyrrell, Professor Ruth Boaden, Professor Charles Wolfe, Dr Christopher McKevitt, Professor Steve Morris, Dr Angus Ramsay, Nanik Pursani, Sally Standley, Rachael Hunter

Significant changes in provision of clinical care in the English NHS have been discussed in recent years, with the proposal to concentrate specialist services in fewer centres serving larger populations. Clear evidence of unacceptable variations in quality of care has prompted radical reorganisation (or ‘reconfiguration’) of stroke services in several regions of England.

This study aims to analyse stroke service reconfigurations in London, Greater Manchester and the Midlands and East of England. It brings together quantitative data on ‘what works and at what cost?’ and qualitative data on ‘understanding implementation and sustainability’, to examine factors influencing the planning, implementation and sustainability of reconfigurations, whether changes delivered real improvements in quality of care and clinical outcomes, and the cost-effectiveness of changes.

It is likely that health services will continue to be reconfigured. Lessons drawn from this evaluation should be of relevance to stroke and other acute services, such as major trauma, and vascular and cardiac surgery.