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Temporary changes to stroke services in Gwent, which have seen patients treated at just the Grange Hospital and Ysbyty Ystrad Fawr, will continue for another year. 

The Aneurin Bevan University Health Board (ABUHB) agreed in July last year that services should be consolidated, with Ysbyty Ystrad Fawr, in Ystrad Mynach, the only stroke rehabilitation site in Gwent since November 2023. 

The specialist Hyper Acute Stroke Unit is based at the Grange University Hospital in Cwmbran. 

Following the planned one year review since the policy was implemented, the board has backed extending the temporary arrangements for a further 12 months while a long-term strategy is agreed. 

A report for the board’s November meeting however said staffing the unit still remains a challenge – while therapy staff on wards remain 50% below national guidance, as per a 2022 therapy review it commissioned. 

The review however found services have improved, with the Sentinel Stroke National Audit Programme reporting, for April to June 2024, a significant improvement – with the board’s ‘D’ grade improved to a ‘C’ with better scanning, and discharge processes. 

The length of time patients stay in hospital has reduced, which is an improvement since late 2022, while the review found further improvement in January this year and “particular improvements in April and a sustained improvement over recent months”. 

Patients stay at Ysbyty Ystrad Fawr for an average of 30 days, but the length of stay has also been impacted by an increase in acquired brain injury and neurology patients centralised at the hospital, which wasn’t part of the original proposal. 

There has been a reduction of 0.8 days in the length of stay of patients at the acute unit at the Grange.

Other improvements include all patients receiving the same model of care, while there is greater support for staff working together, with senior staff available on site. However, weaknesses include challenges to identify and transfer stroke patients admitted to Newport’s Royal Gwent and Nevill Hall in Abergavenny. 

There is also limited Neurology input at Ystrad Fawr compared with the Royal Gwent due to proximity to clinics. 

Ystrad Fawr also has a lack of space for some therapy work, while some patients can’t always access the day room. 

Poor public transport links to Ystrad Mynach for visiting relatives were also highlighted as a weakness. 

When the original decision was taken, it was feared there would be less beds available for patients from Caerphilly borough and they would be “displaced” to the Royal Gwent and Nevill Hall – but this has been lower than anticipated. 

The changes have saved the board around £1.6 million, mainly through a reduction in variable pay for nurses, including covering for vacancies or maternity leave, and reduced locum hours. 

A full consultation will have to be held on the future provision of services and any permanent changes.