ondon neuroscience strategic clinical network november 2014 · strategic clinical networks serve to...

Lo n d o n n e u r o s c i e n c e s t r at e g i c c L i n i c a L n e t w o r k

London organisational audit of secondary and tertiary neurological care providers

november 2014

Summary 3Introduction 4scope 4 Aim of audit 4Method 5Hospital establishment 5Results 5Conclusion 11List of tables 14Appendix 1: Working group 51Appendix 2: Proforma of questions | Acute standards Neuroscience centre 52 Acute general hospital 56Appendix 3: London provider services and participants 60Appendix 4: Regional centre and acute general hospital links 61

Table of contents

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The Quality and Safety work stream within the London Neuroscience Strategic Clinical Network car-ried out an organisational audit to provide a baseline picture of London’s hospital based neurologi-cal services.

It encompassed the neuroscience/surgery regional centres, specialist neurological centres (no surgery), and acute general hospitals (AGH). Additional information was collected on community rehabilitation which will be the subject of a separate report.

The aim of the audit was to identify a set of standards for London commissioners that describes fit for purpose, modern, acute neurological services, and provides recommendations for the London Neuroscience Strategic Clinical Network workplan for improvement programmes. All regional centres and specialist neurological centres as well as half (52 per cent) of acute general hos-pitals provided data for the audit. The data collected included information on staffing, infrastructure, and protocols. Most neurological resources were naturally concentrated in the regional centres and, although they provide a similar specialised service, they have variation in both personnel and infrastructure. Acute general hospi-tals are reliant on visiting neurologists from the regional and specialist centres. No neurology service is pro-vided on a 24/7 basis. Additionally, there appears to be no systematic application of organisational frame-works to allow for consistent availability of remote advice and cover, or widespread agreement through protocols for the management of patients with acute neurological emergencies. Other significant areas of variation include support and access for patients through specialists (eg clinical nurse specialists, neuropsy-chiatrists, pharmacists, access to 24 hour MRI; training of general staff and links with social services).

The organisation of acute secondary care neurological services in London does not promote ownership of patients with neurological problems by neurologists. No hospital within the audit found patients being sys-tematically admitted under a neurological specialist even with a primary neurological diagnosis. All AGHs and hospitals with a co-located neuroscience centre operate on a consulting basis, with only a small minor-ity of patients transferred to regional centres. This lags far behind other medical specialities where early consultant opinion and ownership are key standards, and have been implemented in many areas to drive improvement in quality, safety and patient outcomes1,2.

The recommendation from the audit is for the Network to establish an acute neurology workstream. This will encompass:

1. A case for change which provides a clear evidence base showing how ownership improves patient outcome

2. Development of process standards for the management of patients with acute neurological conditions 3. Creation of models of service delivery that allow the standards to be implemented 4. Identification of early adopters who could host evaluations of acute neurology units, in areas where

infrastructure is appropriate.

1. Adult emergency services: acute medicine and emergency general surgery, Commissioning standards, London Health Programmes, September 20112. Stroke Strategy for London, London Health Programmes, November 2008

Summary

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INTRODUCTIONStrategic clinical networks serve to bring providers, commissioners and patients together to create align-ment around programmes of transformational work to improve patient care.

The London Neuroscience Strategic Clinical Network developed its work programme from national priorities consulted on and endorsed at a stakeholder event in September 2013. Quality and safety was identified as a major priority, and a workstream was established which developed an organisational audit to provide a baseline of London’s neurological services.

This report describes the current picture of service delivery obtained from the organisational audit and makes recommendations for future improvement. Following on from the audit, the workstream will develop a case for change and neurological quality and safety standards.

The provision of neurological services is complex; commissioning arrangements are split between Clini-cal Commissioning Groups (CCGs) and specialised commissioning (NHS England). Social care support is funded by local government and neurological services are provided by community services, acute hospitals, primary care and specialist hospitals.

Neuroscience services within London consist of: » Regional centres, providing neuroscience and neurosurgery services. Services include specialist

diagnostics and treatments for rare or complex neurological conditions. They will receive referrals from other neurological providers. Regional centres will also provide general neurological services to local populations. Commissioned by NHS England specialised commissioning and CCGs.

» Specialist neurological centres providing a similar degree of specialism as the regional centres, but without a neurosurgical service. Commissioned by NHS England specialised commissioning and CCGs.

» Acute general hospitals provide general neurological services for their local population and will refer rare and complex neurological patient to regional or specialist hospitals. Commissioned by CCGs.

» Specialised rehabilitation commissioned by NHS England specialised commissioners » Community rehabilitation commissioned by CCGs » General practice » Social care provision is provided by local government services based on need rather than the

neurological condition.

SCOPEThis audit focussed on the neuroscience/neurosurgical regional centres, specialist neurological centres and acute general hospitals. An organisational audit on community rehabilitation has been completed and will be published as a separate report as further work on neurological rehabilitation awaits national guidance.

AIM OF AUDIT » To provide a service provision picture and baseline of neurological services within London. » To develop a set of standards for London commissioners that describes a fit for purpose modern acute

neurological services. » To confirm with local data the conclusion of national reports of shortfalls in neurological services3 (See

also the London Neuroscience Strategic Clinical Network Strategy 20134.) Common feedback highlights an inequality in service provision. Most reports take a national view resulting in a lack of detailed evidence in how London is performing.

» To provide recommendations for the London Neuroscience Strategic Clinical Network workplan for improvement programmes.

Neurological organisational audit in London

3 National Audit Office, Services for people with neurological conditions (2011). 4 London Strategic Clinical Network, 2013-14 Strategy, August 2013 London.

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METHODA working group was established through application and advertisement at the stakeholder event. They reviewed existing standards e.g. NICE, national frameworks, available status reports on neurological ser-vices and best practice, and identified a manageable audit structure and questions (for membership of the working group see Appendix 1).Audit structure: » Staff provision » Infrastructure » Protocol and transfer standards » Communication and training standards » Patient information and support services » Database and registry » Audit and research

The audit was distributed to identified personnel within the service provider organisations as an Excel spreadsheet with a deadline of four weeks to complete and return. For London provider services who partic-ipated, see Appendix 3.

All data used in this audit was provided by the provider units on their services.

HOSPITAL ESTABLISHMENTSecondary and tertiary neurological services within London consist of: » 6 neuroscience and neurosurgery regional centres. » 2 specialist neurological centres (specialised commissioned but without neurosurgery). » 22 acute general hospitals (AGHs)

The neuroscience and surgery centres have established relationships with a number of AGHs including agreed patient pathways and joint staff contracts. For regional centre and AGH links, see Appendix 4.

The response rate was as follows: » Regional centre: 100% (n=6) » Specialist centres: 100% (n=2) » Acute general hospitals: 52% (n=21)

RESULTS

Staff provision

Consultant neurologistsThe majority of consultant neurologists are contracted to the six regional centres, 94.9 Whole Time Equiva-lent (WTE) in total (all centres provided data), with the National Hospital for Neurology and Neurosurgery (NHNN) an outlier with 36 WTE and with the other centres ranging from 8 to 16 WTE. For the specialist neurological centres Guys and St Thomas’s (GSST) had 6 WTE, and Royal Free Hospital (RFH) had 10 WTE. The 11 AGHs who responded had 19.2 WTE – no data from two AGHs (Table 1).

London is fortunate to have more consultant neurologists than other regions within England5. Based on 2006 data the population served by one FTE neurology consultant for London was one per 51,395 com-pared with England overall one per 117,526.


5 Royal College of Physicians and Association of British Neurologists, Local adult neurology services for the next decade 2011

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Regional centre and consultant level WTERegional centre Consultant neurologists

WTEConsultant neurosur-geons WTE

The Royal London Hospital 8 7Queen’s Hospital 8 8Charing Cross Hospital 15 6.8National Hospital for Neurology and Neurosurgery 36 16St George’s Hospital 11.9 8King’s College Hospital 16 13

It is difficult to create a ratio for consultant numbers of a centre with another variable such as population for benchmarking as the data is not accurate. Compared to the local adult neurology services for the next decade 2011 ratios the regional centre ratios are:

Consultant level WTE within regional centres only

Total WTE London regional centres

Total for London population (8.3 million)

Consultant neurologists 94.9 1:87,460Consultant neurosurgeons 58:8 1:141,156

The majority of consultant neurologists working within a regional centre and specialist neurological centre have joint contracts with AGHs. The WTE numbers within AGHs is smaller with a range of 1-5 (majority below 3) made up by a number of visiting neurologists.

For AGHs a neurologist is present for ward rounds 4-5 days per week and medical admissions ward round 0-5 days per week with only one trust 7 days per week. (See Table 1)

Neurology services generally operate on a consulting basis (i.e. not named responsible consultant/admitting consultant) in acute general hospitals because of the peripatetic organisation of consultant job plans.

Despite the numbers of neurologists within London and the co-location of regional centres with large teach-ing or acute general hospitals, no patients with a primary neurological diagnosis attending emergency de-partments are systematically admitted under a consultant neurologist (Table 26, 27, 28). There is also only provision of an acute neurology clinic (Monday to Friday) with the capacity to see patients within 24 hours in one regional centre, both specialist centres and three AGHs (Table 26,27,28).

All regional centres provide an on call service with 24 hour specialist neurology registrar, and neurosur-gery registrar. All but one regional centre provide 24 hour specialist registrar for neuro Intensive Therapy Unit (ITU) (Table 23). Both specialist centres and all but two AGHs have a 24 hour specialist registrar on call service mainly through their linked regional/specialist centre. For all but one regional centre and both specialist centres the on call neurology service at a consultant level was separate from the on call stroke service, but this question was not examined for junior staff, who in many instances may provide direct ad-mitting services for stroke patients to hyper acute stroke units.

Neurologists at regional centres provide a seven day 24 hour access to consultant opinion onsite or by telephone to half the AGHs. For the other half of AGHs, there is a Monday to Friday 9-5pm on-site acute neurology service available with access to a telephone service outside 9-5pm from the on-call team at the serving centre (Table 28).


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Other neurologic professionalsThere is also variation with WTE of other neurologic professionals based at regional centres with some cen-tres having no consultant neurointensivists, consultant neuropathologists, consultant neuropsychologists, consultant in neurorehabilitation or head injury specialist (Table 2).

As the numbers of WTE are small, some are vulnerable to lack of cover especially consultant neuropsychia-trists and consultant neuropathologists. The absence or low WTE of some specialisms has impact on the 24 hour access to opinion (Table 30).

The current WTE of interventional consultant neuroradiologists at a centre level could not provide 24 hour cover, but networking would enable this.

Specialist nursesAll regional centres and specialist centres have clinical nurse specialists for multiple sclerosis, epilepsy and Parkinson’s disease. The levels are well below that recommended by the relevant charities but with the most employed for patients with MS, range: 1-4. As expected for a rare condition such as Motor Neurone Disease (MND) there are far fewer specialist nurses – two regional centres, both specialist centres and all but one AGH had none. The WTE numbers are low with little opportunity for cover (Table 4, 6, 7).

For AGHs under half had a clinical nurse specialist mainly MS, and Parkinson’s, and only one had a MND nurse. Eight of the 12 AGHs did not have an epilepsy specialist nurse (Table 7).

NursingAll regional centres and one specialist centre have 24/7 neurologically trained nursing workforce. Only one AGH has a 24/7 neurologically trained nursing workforce. See ITU below for ITU nursing (Table 8, 12, 13)

Allied health professionals, pharmacists and social workersNot all regional centres provided allied health professionals (AHP) data. For those that did all but one had access to physiotherapy, occupational therapy, and speech and language therapy (Table 9). Specialist centres had access less one specialist centre for occupational therapists (Table 12). For AGHs most had access to physiotherapy and speech and language therapy with occupational therapy with the worst ac-cess (Table 13). All except one AGH had access to rehabilitation facilities, e.g. gym, occupational therapy kitchen, speech and language equipment.

There was variation in the access to pharmacists with two regional centres having no specialist clinical pharmacists (Table 10).

Only one regional centre and one specialist centre and seven AGHs had access to social workers within their organisational structure (Table 11, 12, 13).

Infrastructure

Neuro intensive therapy unitAll six regional centres have access to Neuro Intensive Therapy Unit (NITU) (Table 30). Previous research6 has shown that having Neurosurgical and Neuromedical patients treated in a dedicated NITU by dedicated Neuro Intensivists improves outcome. Across the NITUs in London, only 4 out of the 6 have dedicated Neuro Intensivists (Table 2). One of the regional centres out of hours cover for the Neuro Intensive Therapy Unit is provided by anaesthetists, rather than intensivists. This is against the recently published Intensive Care Society Guidelines (ICS)7.


6 Health Technol Assess. 2013 Jun;17(23):vii-viii, 1-350. doi: 10.3310/hta17230. Risk Adjustment In Neurocritical care (RAIN)--prospective validation of risk prediction models for adult patients with acute traumatic brain injury to use to evaluate the optimum location and comparative costs of neurocritical care: a cohort study.7 ICS Standards for Intensive Care Units, 1.1.1, 1.1.2, 1.1.5

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Five out of six regional centre NITUs have a supernumery nurse co-ordinator as suggested by ICS guide-line. Only three centres had neuro ITU nurses: range 55-80), the remaining had none (Table 8). Only three AGHs had ITU nurses (Table 12). All but one regional centre had neurologically trained ITU nursing work-force (Table 8).With the increasing complexity of the medical record, and large volumes of data only one regional centre had patient records on neuro ITU computerised (Table 57).

There was wide variation in the number of beds within regional centres. All have designated neurological beds range: 8 – 45, and neurosurgical beds range: 29-96. Three out of six centres had no level 3 neuro-critical care beds, two had no level 2 critical care beds, two had no access to neuro rehabilitation beds and four had no access to psychiatry beds. All had neuroscience day case bed allocation, range: 2-50 (Table 16). Only one specialist centre provided data on designated neurology beds, however, both had access to neurosurgical, neurocritical and neurorehabilitation beds. Only one had a neuroscience day case bed allocation (Table 17). For AGHs only one had designated neurological beds, two thirds had access to neuro-surgical, neurocritical and neurorehabilitation beds but none had a neuroscience day case bed allocation (Table 18).

Most regional and specialist centres had seven day 24 hour access to CT, MRI, EEG, NCS/EMG and lum-bar puncture. One regional centre had no access to seven day 24 hour MRI and two regional centres had no access to 24 hour MRI general anaesthesia service for unconscious patients (Table 20). MRI is being seen as the critical diagnostic modality for several Neurological diseases and in a subspecialty hospital it is not unreasonable for this service to be provided.

The specialist centres had seven day 24 hour access to CT, MRI, EEG, NCS/EMG and lumbar puncture (Table 21).

For AGHs all had access to emergency CT and lumbar puncture. Access to EEG, NCS/EMG had greater variation with nearly half having no on site access (Table 22).

Protocols and resultsTwenty eight questions were asked to identify existence of written protocols and whether they were regu-larly reviewed. There was wide variation in the use of protocols. Where present, existing protocols covered diverse areas on governance, services, transfer, clinical guidelines, assessment, referral, mental health to social care.

The percentage of protocols in place within regional centres ranged from 29 per cent to 86 per cent.Half of the regional centres did not have agreed written protocols to support prompt transfer of patients to district or local services from regional centres (Table 48).

Regional centresQuestions 67-87 (including all subsections for Q71 and Q73)

No Yes Null Percentage met

Charing Cross Hospital 15 6 29%King’s College Hospital 9 12 57%National Hospital for Neurology and Neurosurgery 12 9 43%Queen’s Hospital 7 14 67%St George’s Hospital 3 18 86%The Royal London Hospital 12 8 1 38%


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Specialist neurological centresQuestions 52-68 (56 and 57 all parts)

No Yes Unknown Null Percentage met

Guy’s and St Thomas’ Hospitals 1 24 96%Royal Free Hospital 1 24 96%

Acute general hospitalsQuestions 52-68 (56 and 57 all parts) No Yes Unknown Null Percentage

metBarnet Hospital 11 14 56%Central Middlesex Hospital 1 24 4%Croydon University Hospital 13 12 48%Ealing Hospital 7 18 72%Hammersmith Hospital 17 8 32%Lewisham Hospital 16 1 8 4%Northwick Park Hospital 15 5 5 20%St Helier Hospital 15 7 3 60%St Mary’s Hospital 19 4 2 16%Whipp’s Cross Hospital 20 5 20%Whittington Hospital 19 6 24%

The audit did not assess whether the centres who had written protocols used them.

Communication and training standardsSix questions were asked covering communication and training.

Regional and specialist centresStandards Regional centre Specialist centreFormal telephone +/- email communication routes in place for GPs to obtain rapid specialist neurologi-cal advice about urgent clinical problems

1 out of 6 centres do not have

2 out of 2 have

Regular nursing training provided by neurology nurse specialists to general nursing staff

3 out of 6 centres do not provide

2 out of 2 provide

Neurological care plans that are available to all staff.


2 out of 2 have

Regular involvement from specialist services in providing advice and training for staff in general hospitals and other care settings.


2 out of 2 provide

Dedicated training to maintain head injury observa-tion and recording skills.


2 out of 2 have

Agreed contact service/key person with social care 2 out of 6 centres do not have

2 out of 2 have

For the AGHs many of the above standards were not met. Most did have formal telephone/email communi-cation for GPs: 8 out of 12, but training was limited with only 2-3 Trusts able to provide it. Only three AGHs made neurological care plans available to all staff.


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Patient information and support servicesEight questions covering patient information and support standards and were provided for by most of the centres.

The percentage of questions met by a centre ranged from 50 to 100 per cent.

Standard Regional centre Specialist centreProvision of condition specific information, local services and support available to patients following a diagnosis.


Both provide

The provision of personal care plans for patients and carers.


Both provide

Provision of a named contact coordinating care. 3 out of 6 centres do not provide

Both provide

Provision of family and carer support through verbal and written information.

6 out of 6 centres provide this support

Both provide

Patient and carer involvement in development of neurology services.

1 out of 6 centres do not involve patients or of carers. In another, involvement was described as limited.

Both provide

Access to education and self-management pro-grammes for patients and carers.

4 out of 6 do not provide Both provide

Provision of patient advice and liaison service. All centres provide a service Both provide a ser-vice

Provision of local patient and carer support groups. 1 out of 6 centres do not pro-vide support groups

Both provide support groups

Most centres met the patient information and support standards identified. The weakest compliance was for the provision of a named contact for coordinating care.

For AGHs the weakest areas were provision of named contact coordinating care, with only four out of 12 providing it and patient involvement, again four out of 12 formally involving patients in the development of neurological services.

Database and registryFive questions were asked about database and registry. Data collection and data systems were not well developed and this reflects the lack until recently of a national neurological dataset. This recently launched data set is predominantly based on Hospital Episode Statistics (HES)8 data and what is currently available to collect – not what might be needed. The dataset will evolve and how it will be managed is unknown; for example will it be mandatory like the cancer registry.

Regional centresStandard Regional centre Specialist centreProvision of a neuroscience database 3 out of 6 centres did not have Both haveDirect wed-based access to critical diagnostic imaging in referring units

2 out of 6 did not have Not requested

Provision of a neuroscience database which interlinks with specialist inpatient rehabilitation and community services.

3 out of 6 centres did not have 1 out of 2 does not have

Electronic patient records on neuro ITU 5 out of 6 did not have access Not requestedOn-going data collection and monitoring. 1 out of 6 centres did not collect Both collect


8 Hospital Episode Statistics

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For AGHs only four had a neurological database and tended to be focussed upon one or two specific condi-tions not all neurology. Few databases were linked to inpatient rehabilitation and community services.

Audit and researchFive questions were asked about audit and research and all centres were involved in audit and research.

Regional centresStandard Regional centre Specialist centreAn agreed audit and research clinical lead 1 out of 6 centres did not

have Both have

Agreed yearly audit programmes. All centres have Both haveTrust participation in National programmes for audit.

All centres participated Both participated

Trust participation in national ITU audits through the intensive care national audit and research centre (ICNARC)

All centres participated Not requested

Regular morbidity and mortality review meet-ings.

1 out of 6 did not hold Both did hold

As expected AGHs audit and research involvement was more variable, but most had a lead and agreed an audit programme. Half of AGHs held regular morbidity and mortality review meetings. Nearly all participat-ed in national programmes for the centres.

CONCLUSIONThe organisation of acute secondary care neurological services in London does not promote ownership of patients with neurological problems by neurologists. Our audit identified no hospital where patients with a primary neurological diagnosis were systematically admitted under a neurological specialist. All AGH’s and hospitals with a co-located neuroscience centre operate on a consulting basis, with only a small minority of patients transferred to regional centres. This lags far behind other medical specialities where early consul-tant opinion and ownership are key standards, and have been implemented in many areas to drive improve-ment in quality, safety and patient outcome. In addition there appears to be no systematic application of organisational frameworks that allow for con-sistent availability of remote advice and cover, or widespread agreement through protocols for the manage-ment of patients with acute neurological emergencies. Having a protocol in place is an important part of the service for ensuring that there is a uniform service. Lack of written protocols may result in individual clini-cians varying care at will. Opportunity for sharing good practice and providing example protocols for adop-tion is lost.

It is also clear that although regional centres provide a similar specialised service they have variation in both personnel and infrastructure.

Neurology core non surgical staff and bedsCentre Number of WTE neurolo-

gists per neurology bedNumber of WTE specialist nurses per neurology bed

The Royal London Hospital 0.8 0.5Queen’s Hospital 1.0 0.5Charing Cross Hospital 2.5 0.7National Hospital for Neurology and Neurosurgery 0.8 0.2St George’s Hospital 0.4 0.2King’s College Hospital 0.7 0.2


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Other significant areas of variation include support of patients through specialists e.g. clinical nurse special-ists, neuro interventionists, neuropsychiatrists, pharmacists; access to dedicated NITU beds, rather than being looked after on a general ITU, access to 24 hour MRI; training of general staff and links with social services.

Acute neurologyIt is highly likely that a planned approach to the management of local acute neurology would reduce admis-sions, improve management and hasten discharge. The Royal College of Physicians estimate as a mini-mum this would require two neurology consultant programmed activities daily in each admitting hospital to manage acute neurological emergencies, including daily clinical decision unit ward rounds, inpatient super-vision, emergency clinics to avoid admission and other referrals arising in the hospital.

It is clear from the audit that this would not be possible in AGH’s under the current configuration of staffing. However for some hospitals co-located with a regional unit it seems possible that this could be delivered with existing infrastructure.

In addition the funding stream through Payment by Results (PbR) is already established. Many of the hospi-tals co-located with regional units also run HASU’s where stroke patients and those with stroke mimics are currently admitted and looked after by neurology trainees. Any strategy to improve ownership is likely to be self-funding, preventing admissions, reducing medical error and shortening lengths of stay through better targeted investigation and intervention.

Neurology bedsIt is likely that an average size teaching hospital would require between 10–15 dedicated neurology beds (excluding stroke care) to deal with local inpatient neurology care. The number of beds however would be calculated from an appropriate case mix and could include post neurosurgical repatriation and head injury, and a programmed investigation unit for lumbar puncture and intravenous therapy. Where possible, these beds could be co-located with acute / hyperacute stroke units, because of the overlap of nursing, medical and diagnostic expertise, and rota demands. Whereas existing infrastructure may allow such development in teaching hospitals co-located with regional units, it is clearly not possible in acute general hospitals. The National Clinical Director for Neurological Conditions has proposed that where smaller sized AGHs occur in close proximity, one hospital could specialise in acute neurology, and appropriates cases from the neigh-bouring hospitals should be rapidly transferred to this unit. However at present any model of delivery is speculative and needs further evaluation.

Next steps1. A case for change now needs developing which provides a clear evidence base showing how

ownership improves patient outcome2. With this principle in mind process standards will be derived for the management of patients with acute

neurological conditions 3. Models of service delivery that allow the standards to be implemented can then be debated4. Early adopters will be identified who could host evaluations of acute neurology units, in areas where

infrastructure is appropriate.


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Page Table

15 Table 1 AGH neurology - consultant level WTE16 Table 2 Regional centre other consultants16 Table 3 Specialist neurological centres - other consultants. 17 Table 4 Regional centre clinical nurse specialists17 Table 5 Regional centre clinical nurse specialists by neurological condition18 Table 6 Specialist neurological centre clinical nurse specialists18 Table 7 AGH clinical nurse specialists19 Table 8 Regional centre nursing19 Table 9 Regional centre allied health professionals20 Table 10 Regional centre pharmacists20 Table 11 Regional centre social workers21 Table 12 Specialist neurological centre – nursing, AHPs, social services22 Table 13 AGH nursing, AHPs, social services23 Table 14 Regional centre – leads of services23 Table 15 Regional centre infrastructure24 Table 16 Regional centre beds24 Table 17 Specialist neurological centre beds 25 Table 18 AGH beds26 Table 19 Regional centre theatres26 Table 20 Regional centre diagnostics27 Table 21 Specialist neurological centre diagnostics27 Table 22 AGH diagnostics28 Table 23 Regional centre on call28 Table 24 Specialist neurological centre on call29 Table 25 AGH on call29 Table 26 Regional centre neurological services30 Table 27 Specialist neurological centre neurological services30 Table 28 AGH neurology services31 Table 29 Regional centre link with stroke services31 Table 30 Regional centre access to opinion or another service


Null = no data provided

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Page Table

32 Table 31 Specialist neurological centre access to opinion or another service32 Table 32 AGH access to opinion or another service33 Table 33 Regional centre general neurology services - protocols33 Table 34 Specialist neurological centre general neurology services – protocols34 Table 35 AGH general neurology services – protocols35 Table 36 Regional centre condition specific protocols35 Table 37 Specialist neurological centre condition specific protocol36 Table 38 AGH condition specific protocols37 Table 39 Regional centre headache protocols37 Table 40 Specialist neuroscience centre headache protocols38 Table 41 AGH headache protocols38 Table 42 Regional centre rehabilitation protocols39 Table 43 Specialist neurological centre rehabilitation protocols39 Table 44 AGH rehabilitation protocols40 Table 45 Regional centre protocols with other providers40 Table 46 Specialist neurological centre protocols with other providers41 Table 47 AGH protocols with other providers41 Table 48 Regional centre transfer protocols42 Table 49 Specialist neurological centre transfer protocols42 Table 50 AGH transfer protocol43 Table 51 Regional centres communication and training standards43 Table 52 Specialist neurological centre communication and training standards44 Table 53 AGH communication and training standards45 Table 54 Regional centre patient information and support45 Table 55 Specialist neurological centre patient information and support46 Table 56 AGH patient information and support47 Table 57 Regional centres database and registry 47 Table 58 Specialist neurological centre database and registry48 Table 59 AGH database and registry49 Table 60 Regional centres audit and research49 Table 61 Specialist neurological centre audit and research50` Table 62 AGH audit and research


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Acute general hospitalSite / Consultant neurologists Consultant neu-

rologists WTENumber of visit-ing consultant neurologist num-bers

State the number of days per week on av-erage each consultant neurologist is present at the AGH hospital

State the number of days per week on average ward consultations are seen

State the number of days per week on average a medi-cal admissions unit ward round is car-ried out

The numbers pro-vided take into ac-count study leave, holidays or other absences

Barnet Hospital 5 8 2.5 5 5 NoCentral Middlesex Hospital 1.3 2 3 4 0 NoCroydon University Hospital 3 1.68 Null 4 Null NoEaling Hospital 0 3 3 4 4 NullHammersmith Hospital 1 6 5 5 0 YesLewisham Hospital 3 3 2 4 Null NullNorthwick Park Hospital 1.4 3 2.2 4 4 NoSt Helier Hospital 2 2 4 4 0 YesSt Mary’s Hospital 1 3.6 2.05 days / 1.63 days Null 7 YesWhittington Hospital Null 3 3 5 5 NoWhipps Cross Hospital 1.5 1.5 2.5 4.5 4.5 No

Specialist neurological centreSite / Consultant neurolo-gists

Consultant neurolo-gists WTE

Number of visiting consultant neurolo-gist

State the number of days per week on average each consultant neurolo-gist is present at the AGH hospital

State the number of days per week on average ward consultations are seen

State the number of days per week on average a medi-cal admissions unit ward round is car-ried out

The numbers pro-vided take into ac-count study leave, holidays or other absences

Guy’s and St Thomas’ 6 12 5 7 N/A YesRoyal Free Hospital 10 0 5 7 7 Yes

Table 1: Neurological consultant level WTE

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Table 2: Regional centre | Other consultants

Site / Staff provision Neuro in-tensivists

Neurora-diologists - Interven-tional

Neurophysi-ologists

Neuropa-thologists

Neuropsy-chiatrists

Neuropsy-chologists

Neuroreha-bilitation

Head injury specialist consultant

Specialist neurology registrar’s

The Royal London Hospital 0 2 4 1 0 0 0.5 0.5 4Queen’s Hospital 6 3 2 0 0 2 0 1 4Charing Cross Hospital 0 3 3 0.5 0 2 0.2 2.5 7National Hospital for Neurol-ogy and Neurosurgery

3 5 6 2.5 4 17 2.3 1 16

St George’s Hospital 8 3 2 2 1.2 8.5 3 1 12.6King’s College Hospital 4 3 8 3 0 1 2.6 0 6

Table 3: Specialist neurological centre | Other consultants

Access to other consultant spe-cialties

Neurosur-geon

Neuro in-tensivist

Neuroradi-ologists

Neurophysi-ologist

Neuropa-thologist

Neuropsy-chiatrist

Neuropsy-chologist

Rehabilita-tion

Head injury specialist

Specialist neurology registrar

Guy’s and St Thomas’ hospitals

1 * * * * * * *

Royal Free Hospital

2 X * * * * * * * *

* Onsite access1 King’s College Hospital and National Hospital for Neurology and Neurosurgery2 National Hospital for Neurology and Neurosurgery

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Site / Clinical nurse specialists Multiple sclerosis clini-cal nurse specialists

Epilepsy clinical nurse specialists

Parkinson’s clinical nurse specialists

Motor neuron disease clinical nurse specialists

The Royal London Hospital 2 1 1 1Queen’s Hospital 1 1 1 1Charing Cross Hospital 2 1 1 0National Hospital for Neurology and Neurosurgery 4 3 2 1St George’s Hospital 3 2 1 0King’s College Hospital 1 1 1 1

Table 4: Regional centre clinical nurse specialists

* Estimates from the Neuronavigator. A support tool for commissioners developed by Neurological Commissioning Support

Clinic nurse specialist WTE

Range WTE (not incl NHNN)

NHNN WTE Total WTE London regional centres

Total for London (population 8.3 million)

Ratio for condition population - Regional Centres (n) (NCS*)

Epilepsy clinical nurse specialists 1-2 3 9 1:922,222 1:4,444

(n=40,000)Motor neuron disease clinical nurse specialists 0-1 1 4 1:2,075,000 1:148

(n=591)Multiple sclerosis clinical nurse 1-3 4 13 1:638,461 1:1,046

(n=13,600)Parkinson clinical nurse specialists 1 2 7 1:185,714 1:2,353

(n=16,472)

Table 5: Regional centre clinical nurse specialists by neurological condition

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Table 6: Specialist neurological centre clinical nurse specialists

Site / Clinical nurse specialists Multiple sclerosis clinical nurse specialist(s)

Epilepsy clinical nurse specialist(s)

Parkinson clinical nurse specialist(s)

Motor neuron disease clini-cal nurse specialist(s)

Guy’s and St Thomas’ hospitals X

Royal Free Hospital X

Table 7: AGH clinical nurse specialists

Clinical nurse specialists Multiple sclerosis clinical nurse specialist(s)

Epilepsy clinical nurse specialist(s)

Parkinson clinical nurse specialist(s)

Motor neuron disease clinical nurse specialist(s)

Barnet Hospital X X

Central Middlesex Hospital X X X XCroydon University Hospital X X X XEaling Hospital X XHammersmith Hospital XLewisham Hospital X XNorthwick Park Hospital X X X XSt Helier Hospital X XSt Mary’s Hospital X X XWhittington Hospital Whipps Cross Hospital X X X

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Site / nursing WTE Neuro ITU nurses 24/7 supernumerary nurse clinical coordinator in critical

care unit

24/7 neurologically trained nursing workforce

24/7 neurologically trained ITU nursing workforce

The Royal London Hospital 0 XQueen’s Hospital 55 Charing Cross Hospital 0 National Hospital for Neurology and Neurosurgery 80 St George’s Hospital 73 King’s College Hospital 0 X

Table 8: Regional centre nursing

Site / AHP WTE Physiotherapists (neurology)

Occupational therapists (neurology)

Physiotherapist SALT (critical care)

The Royal London Hospital 3 3 Null 2Queen’s Hospital 4 4 4 2Charing Cross Hospital Null Null Null 2National Hospital for Neurology and Neurosurgery Null Null Null 0.5

St George’s Hospital 1.5 2.4 7.7 1King’s College Hospital 0 0 Null Null

Table 9: Regional centre allied health professionals

20

Table 10: Regional centre pharmacists

Site / pharmacist WTE Specialist clinical pharmacist for level 3 critical care beds

Specialist clinical pharmacist for level 2 critical care beds

The Royal London Hospital 0 1Queen’s Hospital 1 2Charing Cross Hospital 1 0National Hospital for Neurology and Neurosurgery 0 0St George’s Hospital 1 1King’s College Hospital 1 1

Table 11: Regional centre social workers

Site / Social worker WTE Social workers WTEThe Royal London Hospital 0Queen’s Hospital 0Charing Cross Hospital 0National Hospital for Neurology and Neurosurgery NullSt George’s Hospital 4King’s College Hospital 0

21

Site / Nurses, AHPs, social work-ers

Neuro ITU nurses

Physiotherapist(s) (neurology)

Occupational therapist(s) (neurology)

Physiotherapist(s) (critical care)

SALT (critical care)

Social worker(s)

24/7 neurolog-ically trained nursing work-force

Guy’s and St Thomas’ hospitals X X X X

Royal Free Hospital X

Table 12: Specialist neurological centre | Nursing, AHPs, social services

22

Site / Nurses, AHPs, social workers Neuro ITU

nursesPhysiotherapist(s)

(neurology)

Occupational therapist(s) (neurology)

Physiotherapist(s) (critical care)

SALT (critical care) Social worker(s)

24/7 neuro-logically trained nursing work-

forceBarnet Hospital X X X XCentral Middlesex Hospital X X X X X X XCroydon University Hospital X X Null X XEaling Hospital Null

Hammersmith Hospital X XLewisham Hospital X XNorthwick Park Hospital X X XSt Helier Hospital X XSt Mary’s Hospital Whittington Hospital X Null

Whipps Cross Hospital X X

Table 13: AGH nursing, AHPs, social services

23

Designated clinical leads, allo-cated 1 SPA to perform duties

Neurology Neurosurgery Neurocritical care Neuroradiology Neuropsychiatry Neurophysiology

The Royal London Hospital X X X

Queen’s Hospital X X

Charing Cross Hospital X X National Hospital for Neurology and Neurosurgery

St George’s Hospital X King’s College Hospital

Table 14: Regional centre leads of services

Site / Geography Co-location of services

Number of AGHs served

Comment

The Royal London Hospital Yes 3 Services co-located with neurology and neurosurgery Share two wards with ENT and OMFS

Queen’s Hospital Yes 6 Services co-located with: King George’s Hospital Beech Ward, NE London rehab consortium

Charing Cross Hospital Yes 8 Services co-located with: neurology/ neurosurgeryNeurophysiology/neuroradiology/ neuropathology/ hyperacute stroke/ rehab (acute brain injury unit)

National Hospital for Neurology and Neurosurgery

Yes 6 Co-located neurology hospital

St George’s Hospital Yes 9 Services co-located with: neurosurgery, neurology, stroke, neuroradiology, neuro-physiology, neurorehabilitation, neuropathology, plus full range of other specialities across medicine and surgery

King’s College Hospital Null 9 Level 1 major trauma centre, HASU/SU acute General hospital

Table 15: Regional centre geography

24

Table 16: Regional centre beds

Site / Number of designated beds Neurological beds

Neurosurgical beds

Level 3 neuro critical care

beds

Level 2 neuro critical care

beds

Neurorehabili-tation beds

Neuroscience day case bed

allocation

Established ac-cess to neuro-

psychiatry bedsThe Royal London Hospital 10 30 0 4 0 5 XQueen’s Hospital 8 42 6 6 0 2 XCharing Cross Hospital 6 29 0 0 4 11 XNational Hospital for Neurology and Neurosurgery 45 96 14 6 28 50 St George’s Hospital 30 38 9 5 46 4 XKing’s College Hospital 24 64 0 0 15 10

Table 17: Specialist neurological centre beds

Site / Access to beds Number of designated neurological beds

Access to designated neurosurgical beds

Access to designated neurocritical care beds

Access to designated neurorehabilitation

beds

Neuroscience day case bed allocation

Guy’s and St Thomas’ hospitals Null XRoyal Free Hospital 13

25

Site / Access to beds Number of designated neurological beds

Access to designated neurosurgical beds

Access to designated neurocritical care beds

Access to designated neurorehabilitation beds

Neuroscience day case bed allocation

Barnet Hospital Null X X X

Central Middlesex Hospital 0 X X X NullCroydon University Hospital 0 X

Ealing Hospital 0 X X

Hammersmith Hospital 0 X X X

Lewisham Hospital 0 X

Northwick Park Hospital 0 X

St Helier Hospital 0 X

St Mary’s Hospital 2 X

Whittington Hospital 0 X X X XWhipps Cross Hospital 0 X X X

Table 18: AGH beds

26

Table 19: Regional centre theatres

Site / theatres Number of dedicated neurosurgery operating the-atres Immediate access to an emergency theatre

The Royal London Hospital 2 Queen’s Hospital 8 Charing Cross Hospital 2 National Hospital for Neurology and Neurosurgery 5 St George’s Hospital 4 King’s College Hospital 4

Table 20: Regional centre diagnostics

Site / Access to diagnostic services

Urgent access to CT imaging for head injury

Access to portable CT scanner(s) on neuro ITU

On-site access to 7 day 24 hour MR scan-ning

On-site ac-cess to 7 day 24 hour MRI general anaes-thesia service for unconscious patients

On-site access to 7 day 24 hour CT scan-ning

On-site access to EEG

On-site access to NCS/EMG

7 day 24 hour access to lumbar puncture procedure

The Royal London Hospital X X X Queen’s Hospital X X Charing Cross Hospital X National Hospital for Neurology and Neurosurgery

X

St George’s Hospital X King’s College Hospital X

27

Site / Access to diagnostic services Urgent access to CT imaging for head injury

On-site access to 7 day 24 hour MR scanning

On-site access to 7 day 24 hour CT scanning



7 day 24 hour access to lumbar puncture proce-dure

Guy’s and St Thomas’ hospitals Royal Free Hospital

Table 21: Specialist neurological centre diagnostics

Site / Access to diagnostic services

Urgent access to CT imaging for head injury

On-site access to 7 day 24 hour MR scanning

On-site access to 7 day 24 hour CT scanning



7 day 24 hour access to lumbar puncture procedure

Barnet Hospital X X X Central Middlesex Hospital X X Croydon University Hospital X Ealing Hospital X X X Hammersmith Hospital X Lewisham Hospital X X X Northwick Park Hospital X X St Helier Hospital X St Mary’s Hospital X Whittington Hospital X Whipps Cross Hospital X X X

Table 22: AGH diagnostics

28

Table 23: Regional centre on call

Site / On call arrangements 24-hour specialist registrar on-call service provided: Neurology

24-hour specialist registrar on-call service provided: Neu-rosurgery

24-hour specialist registrar on-call service provided: neuro ITU

Separate consultant on-call service for neurology and stroke

The Royal London Hospital On-call Resident No neuro ITU Queen’s Hospital On-call On-call Resident XCharing Cross Hospital Resident On-call Resident National Hospital for Neurology and Neurosurgery

Resident Resident Resident

St George’s Hospital On-call Resident Resident King’s College Hospital Resident Resident Resident

Table 24: Specialist neurological centre on call

Site / On call arrangements 24-hour specialist registrar on-call service provided Separate consultant on-call service for neurology and strokeGuy’s and St Thomas’ hospitals Royal Free Hospital

29

Site / On call arrangements 24-hour specialist registrar on-call service provided Barnet Hospital Central Middlesex Hospital Croydon University Hospital Ealing Hospital Hammersmith Hospital Lewisham Hospital Northwick Park Hospital XSt Helier Hospital St Mary’s Hospital Whittington Hospital PartialWhipps Cross Hospital

Table 25: AGH on call

Site / Neurological services All patients with a primary neurology diagnosis are admit-ted under a consultant neurologist

Provision of an acute neurology clinic Mon-day to Friday with ca-pacity to see patients within 24 hours

Provision of an acute neurol-ogy clinic Monday to Friday with capacity to see patients within 24 hours: Number of consultant neurologists at-tending the clinic

Weekly neurology multidisciplinary meetings

Weekly neurosur-gery multidisci-plinary meetings

The Royal London Hospital X X N/A Queen’s Hospital X X N/A Charing Cross Hospital X X N/A National Hospital for Neurology and Neurosurgery

X X N/A

St George’s Hospital X X N/A King’s College Hospital X 1

Table 26: Regional centre neurological services

30

Table 27: Specialist neurological centre neurological services

Site / Neurologist services Provision of an acute neurology clinic Monday to Friday with capac-ity to see patients within 24 hours

Number of consul-tant neurologists attending the clinic

7 day 24-hour ac-cess to consultant opinion on site or by telephone

Access to a tele-phone service out-side 9-5 pm from the on-call team at the serving centre

All patients are admitted under a consultant neu-rologist

24-hour specialist registrar on-call service provided

Guy’s and St Thomas’ hospitals 1 N/A X Partial

Royal Free Hospital 1 N/A X

Table 28: AGH neurology servicesSite / Neurologist services Provision of an acute

neurology clinic Mon-day to Friday with ca-pacity to see patients within 24 hours

Number of con-sultant neurolo-gists attending the clinic

7 day 24-hour access to con-sultant opinion on site or by telephone

9-5 pm on-site acute neurology service available with access to a telephone service outside 9-5 pm from the on-call team at the serving centre

All patients are admitted under a consultant neurolo-gist

24-hour specialist registrar on-call service provided

Barnet Hospital X N/A N/A X Central Middlesex Hospital X N/A X X Croydon University Hospital X N/A N/A X Ealing Hospital 3 N/A X Hammersmith Hospital X N/A N/A X Lewisham Hospital X N/A X X Northwick Park Hospital X N/A X X XSt Helier Hospital X N/A X X St Mary’s Hospital X N/A N/A X Whittington Hospital 1 X X PartialWhipps Cross Hospital X N/A X X

31

Site / Link with stroke Provision of an acute stroke thrombolysis service

Provision of an acute stroke thrombolysis service. Number of consultant neurologists working in the acute stroke thrombolysis service

Separate consultant on-call ser-vice for neurology and stroke

The Royal London Hospital 1 Queen’s Hospital 4 X

Charing Cross Hospital 10 National Hospital for Neurology and Neurosurgery 12 St George’s Hospital 19 King’s College Hospital 2

Table 29: Regional centre link with stroke services

Site / Access to opinion or other services

Access to prompt and on-going advice and support from specialist nurses

24 hour access to neuro-surgical advice

24 hour access to clinical neuro-physiology

24 hour access to specialist neuroradiol-ogy

24 hour availabil-ity of ITU services with skilled staffing

Access to neuropsychol-ogy and neu-ropsychiatry assessment and support

Ac-cess to liaison psy-chiatry services

Access to incon-tinence services

Access to rehab facilities i.e. access to physio gym, OT kitchen, SALT equip-ment

The Royal London Hospital X X Queen’s Hospital X X X Charing Cross Hospital X National Hospital for Neurology and Neurosurgery

St George’s Hospital X X King’s College Hospital

Table 30: Regional centre access to opinion or another service

32

Table 31: Specialist neurological centre access to opinion or another service

Site / Access to opinion or other services

24 hour access to clinical neuro - physiology opinion

24 hour ac-cess to spe-cialist neuro - radiology opinion

24 hour avail-ability of ITU services with skilled staffing


Access to neuropsychol-ogy and neu-ropsychiatry assessment and support

Access to liaison psychiatry services

Access to incontinence service

Access to re-hab facilities i.e. access to physio gym, OT kitchen, SALT equip-ment

Guy’s and St Thomas’ hospitals X Royal Free Hospital X

Table 32: AGH access to opinion or another serviceSite / Access to opinion or other services

24 hour access to clinical neuro - physiology opinion

24 hour ac-cess to spe-cialist neuro - radiology opinion

24 hour availabil-ity of ITU services with skilled staffing


Access to neu-ropsychology and neuropsy-chiatry assess - ment and support

Access to liaison psychiatry services

Access to incontinence service

Access to rehab facilities i.e. ac-cess to physio gym, OT kitchen, SALT equipment

Barnet Hospital X X X X Central Middlesex Hospital X X X X X X XCroydon University Hospital X X X Ealing Hospital X Hammersmith Hospital X X Lewisham Hospital X Northwick Park Hospital X X X X St Helier Hospital X X St Mary’s Hospital X Whittington Hospital X X X Whipps Cross Hospital X X X X

33

Site / Neurological protocols Governance structures monitor-ing performance of national clinical standards

An agreed written op-erational policy in place for neurology, neurosur-gery and neuro inten-sive care services

Agreed written clinical guidelines for neurology and neurosurgery including, referral, admission, diagnostic, treatment, discharge and follow-up criteria

Agreed outpatient review assessments for all conditions



Charing Cross Hospital X National Hospital for Neurology and Neurosurgery X X

St George’s Hospital King’s College Hospital X X

Table 33: Regional centre general neurology services - protocols

Site / Neurology protocols Governance structures monitor-ing performance of national clinical standards

Agreed written operational policy in place for neurol-ogy services

Agreed written transfer policy in place to neurology +/- neurosurgery centres

Agreed written on-going liaison policies with a neuroscience unit when a transfer is not possible

Agreed written clinical guidelines for neurology including, referral, admission, diag-nostic, treatment, discharge and follow-up criteria

Agreed outpa-tient review as-sessments for all conditions

Guy’s and St Thomas’ hospitals X

Royal Free Hospital

Table 34: Specialist neurological centre general neruology services - protocols

34

Table 35: AGH general neurology services - protocols

Site / Neurology protocols Governance structures monitor-ing performance of national clinical standards

Agreed writ-ten operational policy in place for neurology services

Agreed written transfer policy in place to neurol-ogy +/- neuro-surgery centres


Agreed written clinical guide-lines for neurology including, referral, admission, diagnos-tic, treatment, discharge and follow-up criteria

Agreed outpatient re-view assess-ments for all conditions

Barnet Hospital X X X

Central Middlesex Hospital Null Null Null Null Null XCroydon University Hospital X X

Ealing Hospital X

Hammersmith Hospital X X X Lewisham Hospital X X X X X

Northwick Park Hospital X Null X

St Helier Hospital X X X X X XSt Mary’s Hospital X X X X X XWhittington Hospital X X X X X XWhipps Cross Hospital X X X X X X

35

Site / Agreed written clini-cal guidelines for neurology and neurosurgery including, referral, admission, diag-nostic, treatment, discharge and follow-up criteria

Agreed clinical protocols for epilepsy and headache

Agreed admis-sion criteria pro-tocols for head injury

Agreed imaging protocols

Agreed head injury proformas for assessment and observation

Agreed dis-charge protocol for head injury

Agreed written AE assessment protocols for epilepsy, head-ache and head injury

Agreed written network/sector clinically effec-tive condition specific care pathways

The Royal London Hospital Null X X

Queen’s Hospital X Charing Cross Hospital X X X

National Hospital for Neu-rology and Neurosurgery

X X

St George’s Hospital King’s College Hospital X Null X X

Table 36: Regional centre condition specific protocols

Table 37: Specialist neurological centre condition specific protocols

Site / Condition specific protocols


Agreed admis-sion criteria protocols for head injury

Agreed imag-ing protocols

Agreed head injury profor-mas for as-sessment and observation

Agreed dis-charge protocol for head injury

Agreed written A&E assess-ment protocols for epilepsy, headache and head injury

Agreed written network/sector clinically effec-tive condition specific care pathways


36

Table 38: AGH condition specific protocols

Site / Condition specific protocols


Agreed admis-sion criteria protocols for head injury

Agreed imag-ing protocols

Agreed head in-jury proformas for assessment and observation

Agreed discharge protocol for head injury

Agreed written A&E assessment protocols for epi-lepsy, headache and head injury

Agreed written network/sector clinically effective condition specific care pathways

Barnet Hospital Central Middlesex Hospital Null Null Null Null Null Null NullCroydon University Hospital X Ealing Hospital X

Hammersmith Hospital X X X

Lewisham Hospital X X X X X X Not knownNorthwick Park Hospital Null X Null X Null X

St Helier Hospital X X X St Mary’s Hospital X X X X X

Whittington Hospital X X X X

Whipps Cross Hospital X X X X X X

37

Table 39: Regional centre headache protocols

Site / Headache protocols An agreed written protocol for the investigation and treat-ment of acute onset head-ache

Defining who performs lum-bar puncture procedure

The use of the WFNS sub-arachnoid haemorrhage grad-ing to access patients

An agreed transfer protocol for subarachnoid haemor-rhage patients

Guy’s and St Thomas’ hospi-tals

Royal Free Hospital

Table 40: Specialist neuroscience headache protocols

Site / Headache protocols An agreed written protocol for the investigation and treat-ment of acute onset head-ache

An agreed written protocol for subarachnoid haemorrhage including information on optimal timing of treatment for aSAH* patients.

An agreed written protocol for subarachnoid haemorrhage including information on WFNS SAH grading to as-sess patients.

An agreed written protocol for subarachnoid haemorrhage including information on pre-operative care of aSAH patients


Queen’s Hospital Charing Cross Hospital X National Hospital for Neurol-ogy and Neurosurgery

St George’s Hospital X King’s College Hospital

38

Table 41: AGH headache protocols

Site / Headache protocols An agreed written protocol for the investigation and treatment of acute onset headache

Defining who performs lum-bar puncture procedure

The use of the WFNS sub-arachnoid haemorrhage grad-ing to access patients


Barnet Hospital Central Middlesex Hospital Null Null Null NullCroydon University Hospital X X X XEaling Hospital X X Hammersmith Hospital X X X XLewisham Hospital X X X XNorthwick Park Hospital X X X XSt Helier Hospital X X X XSt Mary’s Hospital X X X XWhittington Hospital X X X XWhipps Cross Hospital X

Table 42: Regional centre rehabilitation protocols

Site / Rehabilitation protocols Agreed written protocols for specialist neurorehabilitation assessment

Agreed written transfer policy to neuro-rehabilitation centres

Agreed written referral pathways from AGH/Centre to community rehabilitation providers

Agreed written protocols for rehabilitation needs

The Royal London Hospital X X Queen’s Hospital X Charing Cross Hospital X X X XNational Hospital for Neurol-ogy and Neurosurgery

St George’s Hospital King’s College Hospital X

39


An agreed written transfer policy to neuro-rehabilitation centres

Agreed written referral path-ways from AGH to community rehabilitation providers


Guy’s and St Thomas’ hospitals Royal Free Hospital X

Table 43: Specialist neurological centre rehabilitation protocols



Agreed written referral path-ways from AGH to community rehabilitation providers


Barnet Hospital X X X XCentral Middlesex Hospital Null Null Null NullCroydon University Hospital X X X

Ealing Hospital X X X

Hammersmith Hospital X X X XLewisham Hospital Not known Not known Not known Not knownNorthwick Park Hospital X X X St Helier Hospital X St Mary’s Hospital Not known X

Whittington Hospital X X X XWhipps Cross Hospital X X X X

Table 44: AGH rehabilitation protocols

40

Table 45: Regional centre protocols with other providers

Site / Protocols for other service providers Agreed written protocols for liai-son with community care teams +/- specialist teams

Agreed written protocols for mental health service needs

Agreed written shared care proto-cols with social care

The Royal London Hospital X X Queen’s Hospital X Charing Cross Hospital X X XNational Hospital for Neurology and Neurosurgery X X XSt George’s Hospital King’s College Hospital X X X

Table 46: Specialist neurological centre protocols with other providers

Site / Protocols for other service providers

Agreed written protocols for liaison with community care teams +/- spe-cialist teams


Agreed written shared care protocols with social care


41

Site / Protocols for other service providers

Agreed written protocols for liaison with community care teams +/- spe-cialist teams


Agreed written shared care protocols with social care

Barnet Hospital X X XCentral Middlesex Hospital Null Null NullCroydon University Hospital X X XEaling Hospital Hammersmith Hospital X X XLewisham Hospital Not known Not known Not knownNorthwick Park Hospital X X XSt Helier Hospital X Not known Not known St Mary’s Hospital X X XWhittington Hospital X X XWhipps Cross Hospital X X X

Table 47: AGH protocols with other providers

Site / Transfer protocols Agreed written protocols to support prompt trans-fer of patients to district or local services from specialist centres

An agreed written neu-rology/neurology and surgery centre transfer policy in place


Agreed written trans-fer policy to neuro-rehabilitation centres

Agreed written transfer policy to neuropsychiatry specialist beds

The Royal London Hospital X X

Queen’s Hospital X

Charing Cross Hospital X X X X XNational Hospital for Neurology and Neurosurgery

X X X X

St George’s Hospital X

King’s College Hospital X

Table 48: Regional centre transfer protocols

42

Table 49: Specialist neurological centre transfer protocols

Site / Transfer protocols Agreed written transfer policy in place to neurology +/- neu-rosurgery centres

Agreed written on-going liai-son policies with a neurosci-ence unit when a transfer is not possible


An agreed transfer pro-tocol for subarachnoid haemorrhage patients


Table 50: AGH transfer protocols

Site / Transfer protocols Agreed written transfer policy in place to neurology +/- neu-rosurgery centres

Agreed written on-going liai-son policies with a neurosci-ence unit when a transfer is not possible



Barnet Hospital X X Central Middlesex Hospital Null Null Null NullCroydon University Hospital X X

Ealing Hospital X Hammersmith Hospital X X X XLewisham Hospital X X Not known XNorthwick Park Hospital X X X XSt Helier Hospital X X X XSt Mary’s Hospital X X X

Whittington Hospital X X X XWhipps Cross Hospital X X X

43

Site / Communication and training standards

Formal telephone +/- email commu-nication routes in place for GPs to obtain rapid spe-cialist neurologi-cal advice about urgent clinical problems


Neurological care plans are avail-able to all staff

Regular involve-ment from spe-cialist services in providing advice and training for staff in general hospitals and oth-er care settings

Dedicated training to maintain head injury observa-tion and recording skills

Agreed contact service/key per-son with social care

The Royal London Hospital X X X X


Charing Cross Hospital X National Hospital for Neurology and Neurosurgery

St George’s Hospital King’s College Hospital X X X

Table 51: Regional centre communication and training standards


Formal telephone +/- email commu-nication routes in place for GPs to obtain rapid spe-cialist neurologi-cal advice about urgent clinical problems


Neurological care plans are avail-able to all staff

Regular involve-ment from special-ist services in pro-viding advice and training for staff in general hospitals and other care settings

As appropriate, dedicated training to maintain head injury observa-tion and recording skills

Agreed contact service/key per-son with social care


Table 52: Specialist neurological centre communication and training standards

44

Table 53: AGH communication and training standards


Formal telephone +/- email communication routes in place for GPs to obtain rapid special-ist neurological advice about urgent clinical problems


Neurological care plans are available to all staff

Regular involve-ment from specialist services in providing advice and training for staff in general hospitals and other care settings

As appropriate, dedicated training to maintain head injury observation and re-cording skills

Agreed con-tact service/key person with social care

Barnet Hospital X X X Central Middlesex Hospital X X X X X XCroydon University Hospital X X X X X

Ealing Hospital X X Hammersmith Hospital Lewisham Hospital X X Northwick Park Hospital X X X X Null XSt Helier Hospital UNKNOWN UNKNOWN UNKNOWN UNKNOWN UNKNOWN

St Mary’s Hospital X X X X UNKNOWN XWhittington Hospital X X X X X

Whipps Cross Hospital X X X X X

45

Site / Patient information and support services

Provision of condition specific information, local services and support available to patients following a diagnosis

The provision of personal care plans for patients and carers

Provision of a named contact coordinating care

Provision of family and carer support through verbal and written information

Patient and carer in-volvement in development of neurology services

Access to edu-cation and self-management programmes for patients and carers

Provision of patient advice and liaison service

Provision of local patient and carer support groups


Queen’s Hospital X X Charing Cross Hospital X National Hospital for Neu-rology and Neurosurgery

St George’s Hospital King’s College Hospital X X

Table 54: Regional centre patient information and support services


Provision of condition specific information, local services and support available to patients following a diagnosis

The provi-sion of per-sonal care plans for patients and their carers

Provi-sion of a named contact coordinat-ing care

Provision of family and carer support through verbal and written information



Provision of patient advice and liaison service

Provision of local patient and carer support groups


Table 55: Specialist neurological centre patient information and support services

46

Table 56: AGH patient information and support services


Provision of condition specific information, local services and sup-port available to patients following a diagnosis

The pro-vision of personal care plans for patients and their carers

Provision of a named contact coordinat-ing care

Provision of family and carer sup-port through verbal and written infor-mation



Provision of patient advice and li-aison service

Provision of lo-cal patient and carer support groups

Barnet Hospital X X X Central Middlesex Hospital X X X X X X X XCroydon University Hospital X Null Some Null

Ealing Hospital Hammersmith Hospital X Lewisham Hospital Northwick Park Hospital X X X St Helier Hospital X St Mary’s Hospital X X X X Whittington Hospital X X X X Whipps Cross Hospital X X X X

47

Site / Database and registry Provision of a neurosci-ence database

Direct web-based ac-cess to critical diagnos-tic imaging in referring units

Provision of a neurosci-ence database which interlinks with specialist inpatient rehabilitation and community services

Electronic patient re-cords on neuro ITU

On-going data collec-tion and monitoring


Queen’s Hospital X Charing Cross Hospital X X National Hospital for Neurology and Neurosurgery

X

St George’s Hospital X X King’s College Hospital X X X X

Table 57: Regional centre database and registry

Site / Database and registry Provision of a neuroscience database Provision of a neuroscience database which interlinks with specialist inpa-tient rehabilitation and community services

On-going data collection and monitor-ing

Guy’s and St Thomas’ hospitals X Royal Free Hospital *

Table 58: Specialist neuroscience centre database and registry

* For some specialities (eg MS)

48

Table 59: AGH database and registry

Site / Database and registry Provision of a neuroscience database Provision of a neuroscience database which interlinks with specialist inpatient rehabilitation and community services

On-going data collection and moni-toring

Barnet Hospital Central Middlesex Hospital X X Croydon University Hospital X X XEaling Hospital X X XHammersmith Hospital X X Lewisham Hospital X X XNorthwick Park Hospital X X St Helier Hospital X St Mary’s Hospital X X XWhittington Hospital X X XWhipps Cross Hospital X X

49

Site / Audit and research An agreed audit and research clinical lead

Agreed yearly audit programmes

Trust participation in National programmes for audit

Trust participation in national ITU audits through the intensive care national audit and research centre (IC-NARC)

Regular morbidity and mortality review meet-ings

The Royal London Hospital Queen’s Hospital Charing Cross Hospital X X

National Hospital for Neurol-ogy and Neurosurgery

St George’s Hospital King’s College Hospital

Table 60: Regional centre audit and research

Site / Audit and research An agreed audit and re-search clinical lead

Agreed yearly audit pro-grammes

Trust participation in National programmes for audit (cen-tres)

Regular morbidity and mor-tality review meetings


Table 61: Specialist neurological centre audit and research

50

Table 62: AGH audit and research

Site / Audit and research An agreed audit and research clinical lead

Agreed yearly audit pro-grammes

Trust participation in National programmes for audit (cen-tres)

Regular morbidity and mortal-ity review meetings

Barnet Hospital Central Middlesex Hospital X X

Croydon University Hospital X Ealing Hospital Hammersmith Hospital X X

Lewisham Hospital Northwick Park Hospital X

St Helier Hospital St Mary’s Hospital X X X

Whittington Hospital X X X

Whipps Cross Hospital X X X

51

Name Job title TrustDr Jo Jarosz (chair) Clinical Director and Quality and Safety

LeadKing’s College NHS Foundation Trust

Dr Bal Athwal Consultant Neurologist Royal Free London NHS Foun-dation Trust

Heather Campbell Neuro-Rehab Pathway Manager at GSTT Community Health Services

Guy’s and St Thomas’ NHS Foundation Trust

Dr Michael Dilley Consultant Neuropsychiatrist and Lead Clinician

South London and Maudsley NHS Foundation Trust

Dr Oliver Foster Consultant Neurologist St George’s Healthcare NHS Trust

Dr Harri Jenkins

Consultant Neurologist Imperial College Healthcare NHS Trust

Dr Nassif Mansour GP NHS Kingston CCG

Katie Nichol Project Manager London Neuroscience Strategic Clinical Network

Mr Jonathan Pollock Consultant Neurosurgeon Barking, Havering and Red-bridge University Hospitals NHS Trust

Dr Sanjay Wijayatilake Intensive Care Consultant Barking, Havering and Red-bridge University Hospitals NHS Trust

Appendix 1: Working group

52

Hospital site:Trust:Clinical lead:

Staff provision State WTE provision:1 Consultant neurologists2 Consultant neurosurgeons3 Consultant neuro intensivists4 Consultant neuroradiologists (1) Interventional (2) Non-interventional5 Consultant neurophysiologists6 Consultant neuropathologists7 Consultant neuropsychiatrists8 Consultant neuropsychologists9 Consultant in neurorehabilitation10 Head injury specialist consultant11 Specialist neurology registrars12 Multiple sclerosis clinical nurse specialists13 Epilepsy clinical nurse specialists14 Parkinson clinical nurse specialists15 Motor neuron disease clinical nurse specialists16 Neuro ITU nurses17 Physiotherapists (neurology)18 Occupational therapists (neurology)19 Physiotherapist 20 SALT (critical care)21 Social workers22 Specialist clinical pharmacist for level 3 critical care beds23 Specialist clinical pharmacist for level 2 critical care beds24 24/7 supernumerary nurse clinical coordinator in critical care unit25 24/7 neurologically trained nursing workforce26 24/7 neurologically trained ICU nursing workforce27 Designated clinical leads, allocated 1 SPA to perform duties: (1) Neurology (2) Neurosurgery (3) Neurocritical care (4) Neuroradiology (5) Neuropsychiatry (6) Neurophysiology

Appendix 2: Proforma of questions | Acute standards: Neuroscience Centre

53

Infrastructure28 Co-location of services (provide detail)29 Number of acute general hospitals being served30 Number of designated neurological beds31 Number of designated neurosurgical beds32 Number of designated level 3 neurocritical care beds33 Number of designated level 2 neurocritical care beds34 Number of designated neurorehabilitation beds35 Neuroscience day case bed allocation36 Established access to neuropsychiatry beds37 Number of dedicated neurosurgery operating theatres38 Immediate access to an emergency theatre39 24-hour specialist registrar on-call service provided (1) Neurology (2) Neurosurgery (3) Neuro ITU40 7 day 24 hour access to an interventional radiologist41 7 day hospital neurorehabilitation access for neurosurgery, head injury and stroke42 Are all patients with a primary neurology diagnosis admitted under a consultant neurologist 43 Separate consultant on-call service for neurology and stroke44 Access to prompt and on-going advice and support from specialist nurses.45 Provision of an acute neurology clinic Monday to Friday with capacity to see patients within 24 hours (1) Number of consultant neurologists attending the clinic46 Provision of an acute stroke thrombolysis service (1) Number of consultant neurologists working in the acute stroke thrombolysis service47 A blocked ICU consultant rota with separate cover for NICU and neuro theatres48 Urgent access to CT imaging for head injury49 Access to portable CT scanner(s) on neuro ITU50 On-site access to 7 day 24 hour MR scanning51 On-site access to 7 day 24 hour MRI general anaesthesia service for unconscious patients52 On-site access to 7 day 24 hour CT scanning53 On-site access to EEG54 On-site access to NCS/EMG55 7 day 24 hour access to lumbar puncture procedure56 24 hour access to neurosurgical advice57 24 hour access to clinical neurophysiology58 24 hour access to specialist neuroradiology59 24 hour availability of ITU services with skilled staffing60 ICU building fully compliant with national standards61 Access to neuropsychology and neuropsychiatry assessment and support62 Access to liaison psychiatry services63 Access to incontinence services64 Access to rehab facilities i.e. access to physio gym, OT kitchen, SALT equipment65 Weekly neurology multidisciplinary meetings66 Weekly neurosurgery multidisciplinary meetings

Appendix 2: Proforma of questions | Acute standards

54

Protocol and transfer standardsIs/are there written and regularly reviewed:67 Governance structures monitoring performance of national clinical standards68 An agreed written operational policy in place for neurology, neurosurgery and neuro intensive care

services69 An agreed written neurology/neurology and surgery centre transfer policy in place70 Agreed written on-going liaison policies with a neuroscience unit when a transfer is not possible71 Agreed written clinical guidelines for neurology and neurosurgery including, referral, admission,

diagnostic, treatment, discharge and follow-up criteria (1) Agreed clinical protocols for epilepsy and headache (2) Agreed admission criteria protocols for head injury (3) Agreed imaging protocols (4) Agreed head injury proformas for assessment and observation (5) Agreed discharge protocol for head injury72 An agreed written protocol for the investigation and treatment of acute onset headache73 An agreed written protocol for subarachnoid haemorrhage including information on: (1) defining who performs lumbar puncture procedure (2) optimal timing of treatment for aSAH patients (3) WFNS SAH grading to assess patients (4) pre-operative care of aSAH patients74 An agreed written policy for organ donation75 Agreed written A&E assessment protocols for epilepsy, headache and head injury76 Agreed written network/sector clinically effective condition specific care pathways77 Agreed written transfer policy to neuropsychiatry specialist beds78 Agreed written network/sector clinically effective neuropsychiatry care pathways79 Agreed written protocols for specialist neurorehabilitation assessment 80 Agreed written transfer policy to neuro-rehabilitation centres81 Agreed written protocols to support prompt transfer of patients to district or local services from

specialist centres82 Agreed written referral pathways from AGH/Centre to community rehabilitation providers83 Agreed written protocols for rehabilitation needs84 Agreed outpatient review assessments for all conditions85 Agreed written protocols for liaison with community care teams +/- specialist teams86 Agreed written protocols for mental health service needs87 Agreed written shared care protocols with social care Communication and training standards88 Formal telephone +/- email communication routes in place for GPs to obtain rapid specialist neu-

rological advice about urgent clinical problems89 Regular nursing training provided by neurology nurse specialists to general nursing staff90 Neurological care plans are available to all staff91 Regular involvement from specialist services in providing advice and training for staff in general

hospitals and other care settings92 Dedicated training to maintain head injury observation and recording skills93 Agreed contact service/key person with social care


55

Patient information and support services 94 Provision of condition specific information, local services and support available to patients fol-

lowing a diagnosis95 The provision of personal care plans for patients and carers96 Provision of a named contact coordinating care97 Provision of family and carer support through verbal and written information98 Patient and carer involvement in development of neurology services99 Access to education and self-management programmes for patients and carers100 Provision of patient advice and liaison service101 Provision of local patient and carer support groups Database and registry102 Provision of a neuroscience database103 Direct wed-based access to critical diagnostic imaging in referring units104 Provision of a neuroscience database which interlinks with specialist inpatient rehabilitation and

community services105 Electronic patient records on neuro ITU106 On-going data collection and monitoring Audit and research Is/are there:107 An agreed audit and research clinical lead108 Agreed yearly audit programmes109 Trust participation in National programmes for audit110 Trust participation in national ITU audits through the intensive care national audit and research

centre (ICNARC)111 Regular morbidity and mortality review meetings


56

Hospital site:Trust:Clinical lead:

1 Specialist neurological centre linked to the acute general hospital2 Specialist neurosurgical centre linked to the acute general hospitalStaff provision State WTE provision:3 Consultant neurologists. (1) State base and visiting consultant neurologist numbers. (2) State the number of days per week on average each consultant neurologist is present at the

AGH hospital. (3) State the number of days per week on average ward consultations are seen. (4) State the number of days per week on average a medical admissions unit ward round is car-

ried out. (5) The numbers provided in 1-4 above take into account study leave, holidays or other absences.4 Access to a consultant neurosurgeon (provide detail)5 Access to a consultant neuro intensivist (provide detail)6 Access to a consultant neuroradiologists (provide detail).7 Access to a consultant neurophysiologist (provide detail).8 Access to a consultant neuropathologist (provide detail).9 Access to a consultant neuropsychiatrist (provide detail).10 Access to a consultant neuropsychologist (provide detail).11 Access to a consultant in rehabilitation (provide detail).12 Head injury specialist.13 Specialist neurology registrar(s)14 Multiple sclerosis clinical nurse specialist(s).15 Epilepsy clinical nurse specialist(s).16 Parkinson clinical nurse specialist(s).17 Motor neuron disease clinical nurse specialist(s).18 Neuro ITU nurses.19 Physiotherapist(s) (neurology).20 Occupational therapist(s) (neurology).21 Physiotherapist(s) (critical care).22 SALT (critical care).23 Social worker(s).24 24/7 neurologically trained nursing workforce.

Appendix 2: Proforma of questions | Acute standards: Acute general hospital

57

Infrastructure25 Co-location of services (provide detail)26 Number of designated neurological beds27 Provision of an acute neurology clinic Monday to Friday with capacity to see patients within 24 hours (1) Number of consultant neurologists attending the clinic28 Provision of an acute stroke thrombolysis service (1) Number of consultant neurologists working in the acute stroke thrombolysis service29 Access to designated neurosurgical beds30 Access to designated neurocritical care beds31 Access to designated neurorehabilitation beds32 Neuroscience day case bed allocation33 7 day 24-hour access to consultant opinion on site or by telephone34 If no to Q31, instead 9-5 pm on-site acute neurology service available with access to a telephone ser-

vice outside 9-5 pm from the on-call team at the serving centre35 All patients are admitted under a consultant neurologist36 24-hour specialist registrar on-call service provided 37 Separate consultant on-call service for neurology and stroke38 Urgent access to CT imaging for head injury39 On-site access to 7 day 24 hour MR scanning40 On-site access to 7 day 24 hour CT scanning41 On-site access to EEG42 On-site access to NCS/EMG43 7 day 24 hour access to lumbar puncture procedure44 24 hour access to clinical neurophysiology opinion45 24 hour access to specialist neuroradiology opinion46 24 hour availability of ITU services with skilled staffing47 Access to prompt and on-going advice and support from specialist nurses48 Access to neuropsychology and neuropsychiatry assessment and support49 Access to liaison psychiatry services50 Access to incontinence service51 Access to rehab facilities i.e. access to physio gym, OT kitchen, SALT equipment Protocol and training standards Is/are there written and regularly reviewed:52 Governance structures monitoring performance of national clinical standards53 Agreed written operational policy in place for neurology services54 Agreed written transfer policy in place to neurology +/- neurosurgery centres55 Agreed written on-going liaison policies with a neuroscience unit when a transfer is not possible56 Agreed written clinical guidelines for neurology including, referral, admission, diagnostic, treatment,

discharge and follow-up criteria (1) Agreed clinical protocols for epilepsy and headache (2) Agreed admission criteria protocols for head injury (3) Agreed imaging protocols (4) Agreed head injury proformas for assessment and observation (5) Agreed discharge protocol for head injury


58

57 An agreed written protocol for the investigation and treatment of acute onset headache including: (1) Defining who performs lumbar puncture procedure (2) The use of the WFNS subarachnoid haemorrhage grading to access patients (3) An agreed transfer protocol for subarachnoid haemorrhage patients58 An agreed written policy for organ donation59 Agreed written A&E assessment protocols for epilepsy, headache and head injury60 Agreed written network/sector clinically effective condition specific care pathways61 Agreed written protocols for specialist neurorehabilitation assessment62 An agreed written transfer policy to neuro-rehabilitation centres63 Agreed written referral pathways from AGH to community rehabilitation providers64 Agreed written protocols for rehabilitation needs65 Agreed outpatient review assessments for all conditions.66 Agreed written protocols for liaison with community care teams +/- specialist teams67 Agreed written protocols for mental health service needs68 Agreed written shared care protocols with social care

Communication and training standards 69 Formal telephone +/- email communication routes in place for GPs to obtain rapid specialist neuro-

logical advice about urgent clinical problems70 Regular nursing training provided by neurology nurse specialists to general nursing staff71 Neurological care plans are available to all staff72 Regular involvement from specialist services in providing advice and training for staff in general hospi-

tals and other care settings73 As appropriate, dedicated training to maintain head injury observation and recording skills74 Agreed contact service/key person with social carePatient information and support services 75 Provision of condition specific information, local services and support available to patients following a

diagnosis76 The provision of personal care plans for patients and their carers77 Provision of a named contact coordinating care78 Provision of family and carer support through verbal and written information79 Patient and carer involvement in development of neurology services80 Access to education and self-management programmes for patients and carers81 Provision of patient advice and liaison service82 Provision of local patient and carer support groupsDatabase and registry 83 Provision of a neuroscience database84 Provision of a neuroscience database which interlinks with specialist inpatient rehabilitation and com-

munity services85 On-going data collection and monitoringAudit and research86 An agreed audit and research clinical lead87 Agreed yearly audit programmes88 Trust participation in National programmes for audit (centres)89 Regular morbidity and mortality review meetings


59

London neuroscience and neurosurgery centresBarking Havering Redbridge Hospitals NHS Trust

Queen’s Hospital

Barts Health NHS Trust The Royal London Hospital Imperial College Healthcare NHS Trust

Charing Cross Hospital

King’s College Hospital NHS Foundation Trust

King’s College Hospital

St George’s Healthcare NHS Trust

St George’s Hospital

University College London Hospi-tals NHS Foundation Trust

National Hospital for Neurology and Neurosurgery

100%

London specialist neurological centresThe Royal Free Hospital NHS Foundation Trust

The Royal Free Hospital

Guy’s and St Thomas’ Hospitals NHS Foundation Trust

Guy’s Hospital

Guy’s and St Thomas’ Hospitals NHS Foundation Trust

St Thomas’ Hospital

100%

Appendix 3: London provider services and participants

60

London acute district hospitalsBarking, Havering and Redbridge Hospitals NHS Trust King George Hospital XRoyal Free London NHS Foundation Trust Barnet Hospital

Chase Farm N/ABarts Health NHS Trust Newham Hospital X

Whipps Cross Hospital Croydon Health Services NHS Trust Croydon University Hospital Chelsea and Westminster Hospital NHS Foundation Trust Chelsea & Westminster XEaling Hospital NHS Trust Ealing Hospital Epsom & St Helier University Hospitals NHS Trust Epsom Hospital X

St Helier Hospital Homerton University NHS Foundation Trust Homerton Hospital XImperial College Healthcare NHS Trust Hammersmith Hospital

St Mary’s Hospital Kingston Hospital NHS Trust Kingston Hospital XLewisham and Greenwich NHS Trust Lewisham Hospital

Queen Elizabeth Hospital XNorth Middlesex University Hospital NHS Trust North Middlesex Hospital XNorth West London Hospitals NHS Trust Central Middlesex Hospital

Northwick Park Hospital The Hillingdon Hospitals NHS Foundation Trust Hillingdon Hospital XWest Middlesex University Hospital NHS Trust West Middlesex Hospital XWhittington Health NHS Whittington Hospital

Appendix 3: London provider services and participants

61

AGH Linked Regional/Specialist Neu-rological Centre

Linked Regional Neurosurgical Centre

Barnet Hospital * The Royal Free Hospital* National Hospital for Neurology & Neurosurgery*

Chase Farm Hospital The Royal Free Hospital* National Hospital for Neurology & Neurosurgery *

Central Middlesex Hospital* Charing Cross Hospital* Charing Cross Hospital*Chelsea and Westminster Hospi-tal

Charing Cross Hospital* Charing Cross Hospital*

Croydon University Hospital* St George’s Hospital* St George’s Hospital*Ealing Hospital* Charing Cross Hospital* Charing Cross Hospital*Epsom Hospital St George’s Hospital* St George’s Hospital*Guy’s Hospital* – for neurosur-gery

Guy’s and St Thomas’ Hospitals* King’s College Hospital* / National Hospital for Neurology & Neuro-surgery*

Hammersmith Hospital* Charing Cross Hospital* Charing Cross Hospital*Homerton Hospital The Royal London Hospital* The Royal London Hospital*Hillingdon Hospital Charing Cross Hospital* Charing Cross Hospital*King George Hospital Queen’s Hospital* Queen’s Hospital* Kingston Hospital St George’s Hospital* St George’s Hospital*Lewisham Hospital* King’s College Hospital* King’s College Hospital*Newham The Royal London Hospital* The Royal London Hospital*North Middlesex Hospital The Royal Free Hospital / Na-

tional Hospital for Neurology & Neurosurgery*

National Hospital for Neurology & Neurosurgery*

Northwick Park Hospital* National Hospital for Neurology & Neurosurgery*


Queen Elizabeth Hospital King’s College Hospital* King’s College Hospital*St Helier Hospital* St George’s Hospital* St George’s Hospital*St Mary’s Hospital* Charing Cross Hospital* Charing Cross Hospital*St Thomas’ Hospital* – for neuro-surgery

Guy’s and St Thomas’ Hospitals* King’s College Hospital* / National Hospital for Neurology & Neuro-surgery*

The Royal Free Hospital – for neurosurgery

The Royal Free Hospital* National Hospital for Neurology & Neurosurgery*

Whipp’s Cross Hospital* The Royal London Hospital* The Royal London Hospital *Whittington Hospital* The Royal Free Hospital* / Na-

tional Hospital for Neurology & Neurosurgery*


West Middlesex Hospital Charing Cross Hospital* Charing Cross Hospital*

* Returned audit data for this audit

Appendix 4: Regional centre and acute general hospital links

About the Strategic Clinical Networks

The London Strategic Clinical Networks bring stakeholders -- providers, commissioners and patients -- together to create alignment around programmes of transformational work that will improve care.

The networks play a key role in the new commissioning system by providing clinical advice and leadership to support local decision making. Working across the boundaries of commissioning and provision, they provide a vehicle for improvement where a single organisation, team or solution could not.

Established in 2013, the networks serve in key areas of major healthcare challenge where a whole system, integrated approach is required: Cardiovascular (including cardiac, stroke, renal and diabetes); Maternity and Children’s Services; and Mental Health, Dementia and Neuroscience.

Strategic Clinical Networks | NHS England (London Region) 020 7932 3700 | [email protected] NU-OA-DOC-112014-rev1

ondon neuroscience strategic clinical network november 2014 · strategic clinical networks serve to...

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