Transforming the stroke care pathway


A case study on how the Greater Manchester Stroke Delivery Network became the best-rated in the country.

The network, set up in 2015, is a partnership between NHS providers of stroke care in Greater Manchester and eastern Cheshire. It works closely with ambulance trusts, commissioners and the local strategic clinical network to improve services.

Governed by a board, it is run by a small team that includes a manager, coordinator, administrator and two clinical leads.

What was the aim?

The network wanted to:

  • encourage partnership working between multi-professional teams from the ambulance service, hospitals and community services
  • collect, analyse and present information (eg audit data) to help drive service improvements locally and regionally
  • support the training and education of staff involved with stroke care, including allied health professionals
  • promote effective change management through collaboration and communication with stakeholders.

What was the solution?

Partnership working

The network coordinator organises and chairs three separate sector forums every quarter. These forums bring together local staff involved in stroke care (eg nurses, therapists) to resolve operational challenges and promote best practice. The coordinator will allocate follow-up action and check progress subsequently.


The coordinator leads work on using stroke national audit data, and led development of an information dashboard providing detailed analysis of specific pathway areas, such as the therapy time provided to patients by stroke units.

Sharing best practice is another key feature of the role. Pathway staff co-designed and implemented outcome measures so the region can better benchmark community rehabilitation services.

A dashboard for community data has also been introduced.

Training and education

The coordinator lectures on paramedic and stroke programmes at two local universities. This has enabled the network to influence understanding of stroke and the regional pathway, which has improved compliance with protocols.

The coordinator helped develop a clinical decision app for paramedics to improve recognition of stroke and conveyance to the correct hospital.

The network produced stroke-specific educational videos in collaboration with AHPs in the Scottish Ambulance Service, which will help reduce incorrect transfers of patients to specialist centres.

What were the results?

Greater Manchester's acute stroke pathway is now the best-rated in the country, according to the Sentinel Stroke National Audit Programme.

What were the learning points?

The network's success is due to:

  • partnership working including all stakeholders on the pathway
  • collecting data to inform local, regional and national audit
  • using training and education aids to improve recognition and diagnosis of stroke
  • embedding a culture of learning and improvement across the network
  • sharing best practice and learning across the regions.

Next steps

The network continues to try to eliminate breaches of the pathway - recently, by helping introduce a reporting procedure so that ambulance clinicians receive feedback and education from their seniors.

It has also developed a mobile phone app to help crews follow the stroke pathway correctly.

Want to know more?

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