Strokes: progressive stroke pathway

The progressive stroke pathway, produced by the National Advisory Committee for Stroke (NACS), sets out a vision of what progressive stroke care in Scotland should comprise.

12. Workforce

The quality of stroke services provided is hugely dependent on the availability of knowledgeable, skilled and experienced healthcare professionals. This is influenced by access to high quality education and supported learning, and staff turnover.

Stroke services should provide specialist medical, nursing, allied health professional neuropsychology, and other rehabilitation staffing levels matching the Royal College of Physicians and British Association of Stroke Physicians Guidelines.

It is recognised that there is significant attrition of stroke trained staff from acute stroke rotas and services and retention of trained staff remains a challenge for future service provision. It is imperative that burnout risk is minimised in a speciality with unpredictable intensity and requiring complex decision making. To support this, it will be necessary to:

  • Ensure that working patterns and staffing levels, especially for healthcare staff contributing to out of hours care, are sustainable to attract and retain staff.
  • Consider novel remuneration rates for unsociable hours which may save on external locum costs for rota gaps.
  • Ensure that there are adequate levels of support staff and access to IT to optimise the efficiency of clinical staff and optimise patient facing time.

Through the review process for this document, staffing available to deliver equitable rehabilitation services was raised as a concern, with particular reference to limited access to psychology & neuropsychology services across the country.

The rehabilitation workforce challenges mean that in practice, few stroke rehabilitation services are able to offer a seven-day service with appropriate intensity. To be able to provide a progressive stroke rehabilitation service these workforce challenges should be addressed.

12.1.1 Education and training

Stroke services should have an education programme for all staff providing acute, hyperacute stroke care and rehabilitation.

There is currently a national education template which outlines the training required for staff involved in the care of stroke patients. It is important that all NHS boards enable staff involved in delivery stroke care to undertake the education outlined by this template. Dedicated trainers can support this.

  • All professional groups potentially dealing with hyperacute patients should have been trained in core stroke competencies, STAT+, STARS Advanced Modules and Hyperacute stroke treatment decision making for clinicians.
  • Stroke physicians and radiologists should have up to date training in advanced imaging for stroke.
  • Training should be supported by rolling educational plans with blended learning, web based and simulation-based training.
  • Training should include a focus on supporting staff with having difficult conversations.
  • Regular national educational sessions will support shared learning amongst professional groups.
  • Education development framework with clear career progression opportunities important for retaining staff.
  • Mentoring for junior staff, opportunities to rotate into other parts of the stroke pathway or undertake secondments and gain wider knowledge and appreciation of their role within the entire system.

To support health boards to deliver effective training and education, at a national level, there will be a continued:

  • Investment in developing and maintaining interactive online training which can be accessed at the convenience of the learner.
  • Delivery of live training sessions which can be delivered remotely via an appropriate online platform (e.g., MS Teams) to a large live audience across many NHS Boards, and also be recorded for others to access later.
  • Coordinated national training programmes tailored to each group of healthcare staff involved in stroke services.

NHS Boards should keep records of the staff working within stroke services, their training needs and training received. When new staff join a stroke service their training needs should be identified and a plan made to meet those needs promptly.



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