Mass screening! – an innovative healthcare delivery approach to stroke prevention in Wandsworth

Stroke-busting health checks at-a-glance

• In Wandsworth, nearly 2000 people have undiagnosed atrial fibrillation (one of the main risk factors for stroke) and 35,000 people have undiagnosed hypertension.
• Detection of AF through health checks will prevent strokes, helping communities live longer, healthier and happier lives.
• If you are Black and of African or Caribbean origin you are twice as likely to have a stroke, and at a younger age, than the Caucasian population. This project aims to reduce inequalities by making sure everyone has access to the care they need.
• It’s a better experience – tailored to what people actually want and need.
• Trains people who are embedded in their communities to do new roles that can support the health service and introduces new models of care for people by working closely with community groups and faith leaders to target at-risk communities.

Stroke-busting health checks for Wandsworth

To increase detection of the main cardiovascular risk factors across the most deprived areas of the borough, HIN Innovation Grants will fund a new project to offer ‘Stroke Busting Health Checks’ to 1,000 people at greatest risk of stroke in Wandsworth.

This co-produced, community-led scheme will see the NHS partner closely with faith and community groups, led by Wandsworth Community Empowerment Network, to use mobile ECG devices to test people for irregular heart rhythms (a warning sign for stroke) and offer wider health advice. The health checks will include Atrial Fibrillation (AF) checks using innovative mobile ECG devices, diabetes testing, blood pressure, cholesterol, and body mass index. They will be an opportunity to talk about the risk of smoking, including the direct link to stroke.

It is widely recognised that hard to reach groups have greater health inequalities and poorer health outcomes, with Black, Asian and minority ethnic (BAME) communities at substantially higher risk of poor health and early death, including due to stroke. Traditional NHS approaches aren’t working well enough – these communities are less likely to attend NHS health checks, despite being the most at risk. Therefore, this team is going to work in an innovative new way to go to these communities and work alongside local leaders to engage people.
In total, the project aims to perform at least 1,000 “Stroke Busting Health Checks” in hard-to-reach communities at high risk of stroke. It will use healthcare assistants from local GP practices to offer regular checks through a hub and spoke model of engagement in high volume places of worship and association, including temples, mosques and churches.
To support the checks and help engage the community in this work, the team will also produce a bespoke film, distributed through social media, featuring local faith and community leaders with a call to action to take part in the checks. This culturally specific content can support other health projects elsewhere in the borough and beyond.

The project is expected to increase awareness of stroke and cardiovascular disease as well as reduce the prevalence of stroke in the Borough. All those identified at risk of stroke through the checks will be supported to attend further tests and commence treatment. Faith and community leaders will trained and upskilled to support and encourage their communities to access additional services where needed, including registering with GPs.

Find out more about our work in stroke prevention

Innovator Spotlight

Dr. Nicola Jones, a GP and Chair of Wandsworth Clinical Commissioning Group said:

“The people of Wandsworth can look forward to a new and innovative local approach to stroke prevention. At the moment, over a third of people invited for a health check do not attend. We’re using this funding to kickstart an innovative new collaboration between Wandsworth community leaders and the health service, working hand-in-hand with local groups to get our services to those who need them most.

By targeting hard-to-reach communities we will reduce health inequalities and we expect this grant to be the first step in developing a new approach to screening that will benefit the communities we serve.”

Malik Gul, Director of Wandsworth Community Empowerment Network, Wandsworth, said:
“Together, we’re bringing health checks into the community in a way that is unique and transformational. The approach unlocks the value and capabilities held in communities – in mosques, churches, temples, as well as in community groups and associations. This is a vital network of microsystems – the project is creating an innovative, emergent system that can offer the NHS new ways to make early health interventions more effective and work towards reducing health inequalities.

“Leadership has been essential – senior people across Wandsworth have been brave enough to say yes, we need change and yes, we’re ready to get behind this. Without strong collaborative and cross-sector leadership, the NHS would not be working in these new ways.”

A new online tool will help prevent strokes and save lives

An estimated 68,000 people in London are living with undetected AF and at risk of blood clots, stroke, heart failure and other heart-related complications. The Health Innovation Network’s Fay Edwards talks about the launch of an important new tool.

This week together with our partners we launched the Pan-London Atrial Fibrillation (AF) toolkit. The online toolkit is the culmination of a collaboration between the three London Academic Health Science Networks (AHSNs) and the London Clinical Network (LCN).

Visualised in 2016, it is targeted at commissioners and providers who want to find more people with AF (Detect), Treat more people with AF (Protect) and improve the outcomes of those people receiving treatment (Perfect). The toolkit focuses on each of these three areas and is laid out in a logical order, first setting the scene with an introduction from Tony Rudd (National Clinical Director for Stroke, NHS England) and Matt Kearney (National Clinical director for Cardiovascular Disease Prevention, NHS England) highlighting the unmet need for appropriate anticoagulation and improved detection of AF.

Within each of the three domains there are three “opportunities for improvement” designed to stimulate ideas and focus efforts. These contain case studies, resources and best practice examples which provide guidance on how to replicate. With all quality improvement it is vital for teams to understand their ‘current state’ before embarking on the future. The AF improvement cycle (on page 7) encourages teams to consider the quality and performance of their service compared to national standards and highlights the need for them to understand and interpret their own service level data. The AF improvement cycle is a complete and concise methodology which has been developed through the understanding of the critical success factors needed to undertake AF improvement work. It can be applied to any of the three domains and opportunities for improvement.

Complementing the AF improvement cycle is a series of infographics for each London CCG which clearly and pictorially presents data on prevalence, anticoagulation rates, those known to be at risk of stroke and those who have had a stroke in the past year. These have already proved very powerful in engaging interest and understanding a starting point. For those teams outside of London, or for data more focused on each domain (Detect, Protect and Correct) there is a useful table of data sources laid out within each of these.

Supporting all of this is the AF business case model. Designed by Public Health England and the AHSNs this tool uses publically reported data of AF to help organisations identify areas for improvement in the identification management of AF. It will also quantify the cost and savings associated with addressing these opportunities.

Detect

Within detect there is a focus on AF Awareness campaigns, the importance of manual pulse rhythm checks and AF detection devices. This includes the Health Innovation Network’s AF detection device review, a detailed report which defines the current technology and software designs available to enhance AF detection. It contains examples of how to use these devices and improve actual prevalence in a variety of settings.

Protect

Within protect there is focus on how to improve anticoagulation, Initiating anticoagulation in community settings, correcting heart rhythm and rate where necessary.

Perfect

Perfect encourages high quality anticoagulation services which provide patient education, a range of treatment options and support of self-monitoring. It contains the ‘Excellence in Anticoagulation Care’ document from the London Clinical Network – a guide for commissioners and service providers to help deliver high quality anticoagulation services.

A pathway for service review is contained in this section including a checklist to assist commissioners in benchmarking their anticoagulation service or create a service specification.

There are also educational resources for patients and staff n to support self-management and self-monitoring of International Normalisation Ratio (INR) for those prescribed Warfarin.

Mythbusters

Designed to dispel the common myths and misconceptions encountered when prescribing anticoagulation, by providing an evidenced based explanation.

I hope the toolkit will inform clinicians and commissioners in the design of local services to deliver the best patient care and optimum outcomes.

Download the toolkit here.