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

Funder

Amount

Duration

National Institute for Health Research Health Services and Delivery Research (HS&DR) Programme
£1,022,831.00
Sep 2011 to Jun 2017

Key contact: Dr Angus Ramsay, Michelle Morton

Chief investigator: Professor Naomi Fulop

Co-investigators: Professor Anthony Rudd, Professor Pippa Tyrrell, Professor Ruth Boaden, Professor Charles Wolfe, Prof Christopher McKevitt, Professor Steve Morris, Dr Angus Ramsay and 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.

Publications:

Fulop et al (2016) Explaining outcomes in major system change: a qualitative study of implementing centralised acute stroke services in two large metropolitan regions in England. 

Turner et al (2016) Lessons for major system change: centralisation of stroke services in two metropolitan areas of England

Ramsay et al (2015) Effects of centralizing acute stroke services on stroke care provision in two 2 large metropolitan areas in England

Fulop et al (2013) ‘Innovations in major system reconfiguration in England: a study of the effectiveness, acceptability and processes of implementation of two models of stroke care’ – published in Implementation Science

Case study summary published in NHS Atlas of Variations in Diagnostics Services

Morris et al (2014) ‘Impact of centralising acute stroke services in English metropolitan areas on mortality and length of hospital stay: difference-in-differences analysis’ – published in BMJ

Publicity associated with Morris et al (2014)

Summaries:

Turner et al (2016) Lessons for major system change: centralisation of stroke services in two metropolitan areas of England

Ramsay et al (2015) Effects of centralizing acute stroke services on stroke care provision in two 2 large metropolitan areas in England

Fulop et al (2016), Turner et al (2016) Lessons for planning and implementing major system change: the case of centralising acute stroke services