Why the lack of detail in Welsh Gov’s Stroke Delivery Plan has consequences

Matt O’Grady

No kid answers the question “What do you want to do when you grow up” by telling people “I want to read extensive Welsh Government health strategy and policy documents”.

I certainly didn’t. I wanted to be a train driver, or a baker. Something, somewhere, went badly wrong. But alas, this is the situation I find myself in once again with the release of the Welsh Government’s new National Clinical Framework, along with the associated ‘Quality Statements’ for Cancer and Heart Conditions.

The Framework looks at the “planning and delivery of clinical services in the context of the strategic approaches set out by the Welsh Government”, including digital health service, NHS workforce and development and the shift of focus to primary and community services.

The Clinical Framework has some lovely diagrams, which I mostly understand, as well as detailing actions on a national level, local level and for professionals. But in using the terms ‘actions’, it might be being a little generous. They’re broad, ‘top-line’ and interpretable in a large number of ways.

Many don’t feel new either. How does the action “National programmes and clinical networks design higher value interventions” differ from the ‘A Healthier Wales’ principle of “Higher Value”?

The Quality Statements themselves repeated this pattern of broad brush statements. The Heart Conditions has commitment to “Detection, diagnosis and effective management of high risk conditions such as high blood pressure, raised cholesterol and atrial fibrillation”.

A statement no-one, and certainly not the Stroke Association, would argue against. But what does this mean in practice? How will the delivery of preventative services actually change as a result?

Think of it as a sandwich where someone has forgotten the filling. Lots of bread to create the structure, but none of the vital tasty bit in the middle.

No doubt Welsh Government would point to the forthcoming ‘Implementation Plans’ which will fit under the Quality Statements. These seem destined to replace the current condition specific ‘Delivery Plans’. I sincerely hope there is sufficient detail in the implementation plans, but experience causes concern about whether this will be the case.

The Stroke Delivery Plan is a good example of why. While more specific than the examples I’ve used so far, it lacked the detail to drive forward stroke care towards the vision it tried to communicate.

‘Consequences’ 

This lack of detail has consequences. Reconfiguring our existing stroke units to larger, regional stroke units has the potential to improve outcomes for stroke care, save lives and lower the number of people who leave hospital with severe disabilities after a stroke.

The Stroke Delivery Plan mentions “re-defining of the current Wales stroke units”, but doesn’t give timescales for local health boards to complete this work. Progress has been slow, if not non-existent. Despite the statement in the Stroke Delivery Plan, and after four years of discussions in some areas, no local health board has finalised their plans.

What causes further concern is that last year the Cross Party Group on Stroke was told that the Clinical Framework would contain an explicit commitment to change stroke units, with a draft of the wording even presented during an evidence session. This has not materialised in the final version of the Clinical Framework, which doesn’t mention stroke specifically even once.

This seems to be a theme I’ve noticed. I’ve seen numerous drafts of documents with really clear detail, or been told by Civil Servants what they intend to a document to say, only for the final version to become much more vague, top-line and for those specific commitments to disappear during the political machinations of getting a document published.

To be honest, I suspect this frustrates those who author the documents as much as those who read them.

We need the details. They need to go somewhere, so third sector organisations can hold the Welsh Government, our local health boards and the forthcoming NHS Executive to account. Details matter when we’re talking about health policy. Sandwiches need fillings.

We don’t need more strategic documents. We have a whole suite of these. I know, I’ve read them.

The implementation plans are an opportunity for Welsh Government to start providing these details. They must have the specifics, such as timescales and details on who is responsible to show how each priority of the Welsh NHS will be driven forward. This is how the visions of those strategic documents will become a reality, and ensures my fevered reading has not been in vain.

Matt O’Grady is the Policy, Information and Campaigns Officer, Wales for the Stroke Association. This article is written in a personal capacity.