Hull Annual Report 2006/7

COMMUNITY STROKE TEAM …………………………………………………. 9

TRAINING & EDUCATION …………………………………………………….. 10

USER/CARER SUPPORT GROUP ……………………………………………... 10

NATIONAL SENTINEL AUDIT ………………………………………………… 10

ACUTE PHYSIOTHERAPY REPORT …………………………………………. 11 -14

STRATEGIC OBJECTIVES FOR 2007/08 ……………………………………… 18

A total of 624 patients received Acute Stroke Care through the Stroke Care pathway for 2006/2007. All aspects of stroke care are now receiving very high profile and clear direction nationally, and this year we will receive guidance from the Department of Health via a National Stroke Strategy. In addition to this, NICE guidance is due out in the Spring of next year and there is a lot of emphasis on the management of Acute Stroke Care.

Locally, the Hull & East Riding Stroke Service are year on year, managing to co-ordinate the pathway of care for stroke patients well above the national average in as much as over 70% of our stroke population do get to the Acute Stroke Unit for at least 50% of their hospital stay. We are (at present) less effective in ensuring that stroke patients get directly to the Acute Stroke Unit on the day of admission which is an important criteria for Acute Stroke Care and in terms of Thrombolysis, absolutely essential.

In 2006/07, 39% of stroke patient were admitted directly to the Acute Stroke Unit (246 patients). For those that got directly to the Unit, 101 (15%) were admitted to the Stroke Unit on the same day as their hospital admission, 132 (21%) admitted 1-2 days post admission and 10 patients (2%) took between 3 – 7 days to get directly from the Assessment Unit to the Acute Stroke Unit.

A further 205 patients (33%) of the total stroke population were transferred from an outlying ward to the Stroke Unit and the majority of these got to the Stroke Unit within a week of hospital admission. A further 173 (28%) of patients were supported by the Stroke Team on an outlying ward. This means that their clinical management was supported by the Acute Stroke Co-ordinator, Stroke Physician and Nurse Consultant in Stroke but they did not transfer to the Acute Stroke Unit during their hospital stay.

375 (60%) of the total stroke population had a length of stay 14 days or less with a further 249 (40%) staying longer than 15 days. The overall average length of stay in the Acute hospital for stroke was 12.3 days. This reduced length of stay in relation to the National Average and tariff for stroke patients has been reflected locally in a local tariff agreement, but may require further negotiation to reflect the high proportion of patients spending limited time in the Acute Hospital.

The national average for death within 30 days of stroke is approximately 21%. The total number of deaths within 30 days of stroke for the Hull & East Riding Stroke Service was 14% (85 patients)

RIPS WITHIN 30 DAYS OF STROKE

Gender Age Band Total

Female 0-64 1

65-74 5

75+ 51

Gender Total 57

Male 0-64 2

65-74 7

75+ 19

Gender Total 28

Report Total 85

The Hull & East Riding Stroke Service has now implemented a Thrombolysis pilot project with the support from the Yorkshire Ambulance Service and A&E Medical and Nursing staff.

The Service will be evaluated in the autumn of 2007 and will be supported by recommendations from the Specialist Stroke team together with Acute Hospital managers who will provide the necessary business case to enable this acute management of stroke care to be initiated on a 24hr/7 day a week basis.

A considerable amount of effort has been made over this past year to highlight to Commissioners and Providers, the additional support required to ensure that prompt diagnosis and treatments in stroke care can be made available without delay. In particular access to Carotid Doppler scanning is currently very limited and discussions have been initiated with Commissioners both in the Hull and East Riding PCTs to support the way forward with this.

The TIA Nurse Specialist, with support from the Vascular Department in the Acute Hospital is undergoing training for Carotid Doppler screening skills to help reduce the current impacts for the Vascular Laboratory at Hull Royal Infirmary.

Last year 180 patients were admitted to the Hull Royal Infirmary as an inpatient for diagnostic assessment following Transient Ishcaemic Attack (TIA or Minor Stroke). This equated to £214,561 in acute hospital admission charges. It is routinely accepted that stroke patients coming through the acute hospital pathway will have Carotid Dopplers and 24 hour tapes as an outpatient post discharge from their acute hospital episode and in order to get urgent assessment, patients have to wait as an inpatient in the acute hospital.

Current waiting times for outpatient CT head is 4 weeks and Carotid Doppler is more than 8 weeks. The National recommendations are for all investigations to be done within 7 days post Stroke/TIA.

“The TIA service continues to grow in terms of numbers of patients referred. Dr Abdul Hamid is now supported fully by Dr Tarafder (Consultant Nuerologist) with one more Consultant clinic per week. This has meant that there has been enough Consultant support to open another nursw led clinic which has allowed us to provide a 4 day servive over both HRI and CHH sites.

The way that CT's are appointed has changed and the ring fenced slots have been removed but the service is running efficiently, promptly and the facility to "walk" patients through has not been affected. The doppler waiting list continues to grow because of unforseen problems within Vascular Services but as a team we are trying several ways to addres this and hope to be able to put forward a structured solution very soon."

This reflects a similar picture year on year in terms of the use of the Community Stroke Rehabilitation facilities. Reduction in the number of available rehabilitation beds, particularly at Beverley Westwood Hospital impacting on the number of patients who required access to the rehabilitation facilities in Hull city centre.

Again a high percentage of patients transferring from a rehabilitation unit to their own homes remains encouraging at 71%

Total number of patient who transferred to long term care following their stroke (from both the Acute and Community settings) was 92 (15%)

The Community Stroke Co-ordinating team have now been established for a year. From April 2006 to the end of March 2007, the team received 1009 new referrals. All patients transferring through the Acute Hospital Pathway are followed up by the Community Stroke Team post discharge from the acute hospital or community rehabilitation.

In addition to this 166 referrals were received outside of the Hull & East Riding Acute Stroke Pathway (i.e. patients referred from other community Health and Social Care Professionals, self referrals from stroke survivors or their families who needed further advice and support, as well as patients who were transferred from alternative acute stroke pathways including Scarborough, York and Scunthorpe hospitals and back into the East Riding).

The team provided follow up support and training to nursing and care staff in Nursing and Residential home settings for 61 stroke patients and provided direct support to Health & Social Care professionals on request for 116 individual requests in addition to their normal day to day liaisons with multidisciplinary Health and Social Care teams.

Additional actions by the Community Stroke team included activating support for patients with post stroke depression for 63 individuals, providing additional support for patients with self medication difficulties, 30 patients.

Monitoring of stroke risk factors is carried out by the team on each visit and the team activated additional blood pressure management for 75 patients and activated investigations for 13 patients with undiagnosed Atrial Fibrillation. They activated support via the Community Health Teams for patients with additional post stroke complications including post stroke pain, increased limb spasticity and other identified medical problems for 56 patients. 36 patients were identified with new or existing swallowing problems that raised concerns and required further intervention.

Close liaison with multiple professions resulted in a range of action to gain support and advice from other professionals and services including Carer Support Services, Stroke Groups, Social Services, Community Matrons, GPs, Consultant Stroke Physician, TIA Nurse Specialist, Practice & District Nurses, Community Occupational Therapy, Physiotherapy, Speech & Language Therapy, Consultant Nurse in Stroke, Smoking Cessation, Falls clinic, Epilepsy Nurse Specialist, Intermediate Care teams, referrals to Mental Health, Continence Nurse Specialist, access to benefits, Neurology Support Nurse Specialist.

All patients received further advice about their stroke and a risk factor management plan which was backed up with written information as required. In addition to this, the team assessed and gave advice for patients who wanted to return to driving and concerns were raised with regards to safety and driving on 35 occasions.

The information collated to date is a first year attempt and will undoubtedly be much richer in another years time. Patients are seen and supported as required. This year 627 (or 62%) of patients have been discharged from the active caseload but there is always an open access for self referral should patients or their carers require further advice and support. In addition to this, the Nurse Consultant in Stroke together with the Nurse Specialists within the Community Team have supported the ongoing clinical management of 234 patients transferred to the three Inner City Rehabilitation units as well as the East Riding Community Hospitals.

A new stroke support group for young stroke survivors has been set up by the Community Stroke team and is now well established in Hull but accessible to ALL young stroke survivors in the East Riding and is proving to be extremely successful. The Community Stroke Team also supports a range of Stroke Support Groups in Pocklington, Bridlington, Withernsea, Driffield, Beverley, Market Weighton, Goole and Hull.

The following training and education has taken place over the past year within the Stroke Service, delivered by professionals within the service:

October 2006 – 26 attendees (10 Health and Therapy professionals; 16 from Private sector)

March 2007 – 20 attendees (9 Health and Therapy professionals, 11 from Private sector)

To all staff in Accident and Emergency at Hull Royal Infirmary, Staff on Ward 110, Hull Royal Infirmary, Staff on Ward 2, Castle Hill Hospital as well as one to one training by the Specialist Stroke team to First Contact Practitioners, Paramedic teams and Acute Stroke Unit staff.

The User/Carer support group within the Hull & East Riding Stroke Service has re-established and has worked very closely with professionals within the service over the past year. Their support includes working with professionals to review patient information (now in place), providing one to one support for stroke survivors as required particularly in the rehabilitation units in Hull, providing support at the range of different stroke clubs in the area, facilitation of annual stroke survivors and carers meeting which in conjunction with the Stroke Service professionals, individuals are updated about service developments and have an opportunity to make further enquiries for themselves, support by attendance at the Stroke Working Group meetings throughout the year, support with workshops including review of service developments facilitated by the Nurse Consultant in Stroke and review of service developments facilitated by the Hull Cardiovascular ISIP Working Group.

The Hull & East Rising Stroke Service has maintained it’s position in the top 25% Acute Trusts maintaining a score of 77% for the 12 key clinical indicators (National Average 57%)

Dr Abdul-Hamid has registered with the IST3 (International Stroke Trial) for Thrombolysis patients.

We provide therapy to patients admitted to the acute stroke unit. We have a tacit referral system and evaluate the physiotherapy needs of every patient admitted to the ward including medical outliers. Physiotherapy works to help patients regain movement, balance and mobility after stroke and prevent/manage the complications of immobility. Chest physiotherapy is a significant part of the case load. Dysphagia has been reported to occur in 28-45% of patients with acute stroke (Odderson and McKenna 1993) Aspiration has been found in 31-51% of patients with stroke and dysphagia (Barer 1984 and 1989, Gordon et al 1987) Pneumonia is a complication of aspiration (Gordon et al 1987) and is also the second most frequent cause of death within the first month after stroke accounting for nearly one third of stroke deaths. (Bounds et al 1982). Physiotherapy evaluates every patient for risk of respiratory complications and works closely with Speech and Language therapy to monitor the respiratory system of dysphagic patients who are beginning oral trials. It is common for patients who do develop pneumonia to require chest physiotherapy 2 – 3 times per day in addition to any scheduled evening therapy or night call outs. Chest physiotherapy is available 24 hours per day, 365 day per year provided by the out of hours respiratory physiotherapy service.

The NSF for older people recommends that rehabilitation starts within the first 24 hours. Ottenbacher and Jannell(1993) performed a meta-analysis of 36 trials evaluating the effectiveness of stroke rehabilitation programmes and concluded that the improvement in functional performance appeared to be related to early initiation of treatment.

The 2004 National Sentinel Audit revealed that 85% of stroke patients admitted to HRI were evaluated by a physiotherapist within 72 hours. (The National average was 63%.) Data for 2006 is not yet available but patients admitted to ward 110 are seen by the physiotherapy service within 1 working day of admission to the ward except in exceptional circumstances. However, for those patients for whom a bed on ward110 is not immediately available, there may be a delay in the initiation of therapy, depending on the equipment and staff available on whichever ward they are admitted to. We do not have adequate staffing to provide an outreach service except occasionally on a one off basis. There is also an inevitable delay for any patient admitted over a weekend, before a bank holiday or late on a Friday.

Physiotherapy has worked closely with nursing staff, particularly moving and handling link trainers in order to facilitate safe early mobilisation when qualified therapy staff are not available. We have one therapy assistant who provides a limited amount of therapy set by qualified staff on a Saturday morning, but she cannot evaluate new patients, is working alone and also has work set by Speech and Language and Occupational Therapy.

Through early mobilisation and the prevention/management of complications, physiotherapy facilitates reduced lengths of stay as patients are able to return more quickly to their own homes or transfer to on going rehabilitation facilities. The average length of stay for all patients on ward 110 in 2006 was 12.33 days.

Early mobilisation is associated with a reduction in mortality and morbidity (Indredavik et al., 1999). Frequent therapy is associated with better outcome (Kwakkel et al., 1997) Patients should receive as much therapy appropriate to their needs as they are willing and able to tolerate. (Intercollegiate stroke working group 2004)

Many patients however could tolerate and benefit from more therapy than we are able to provide. Stroke rehabilitation is time consuming and especially in the acute phase, staff intensive. Many patients require two or three therapists to manually handle. Physiotherapy and occupational therapy often work together in joint treatment/assessment sessions in order to maximise the efficiency of staff available. Assistants deliver individualised exercise programmes, we involve families where possible and we use group therapy when there are suitable patients with similar needs and abilities on the unit. Despite, or perhaps because of, the high patient flow through, and the pressure on all ward 110 staff to quickly evaluate and initiate therapy, there is a sense of urgency to progress rehabilitation towards discharge. Informal feedback from patients about this is varied, some have reported that they liked the sense of momentum; others have said that they prefer the less stressed atmosphere of the community units.

When different models of delivery across the world are compared, there is some discussion that a 7 day a week service contributes to shorter lengths of stay and improved functional outcomes. (CSP Interactive)There is also research to contradict this. Ruff et al 1999 found no benefits from a 7 day a week service compared to a 6 day a week service and 82% of the patients studied preferred the 6 day service. Despite the expectations and perceptions of some patients and families, ward 110 is designed and staffed as an acute assessment ward, not a rehabilitation ward. Without significant changes in staffing levels we could not hope to emulate the frequency and intensity of therapy provided elsewhere. Many studies are conducted in the USA where patients in rehab are required to receive a minimum of 3 hours per day of therapies (combined PT, OT and SALT) or Sweden where younger patients receive up to four hours of activities per day We must also recognise that while variations in therapy provision undoubtedly contribute to outcomes, other cultural and health care/benefit system differences also play a major role.

Staffing has fluctuated during the past few years; we have recently benefited from some extra sessions a week from a senior therapist but lost 30 hours of therapy assistant.

During 2006, 11 Physiotherapy degree students completed a placement on the stroke unit. We had students for 33 weeks of the year. Physiotherapy students are accepted in the 2:1 model which is being encouraged by the universities. (2 students to 1 clinical educator) Student feedback indicates particular benefit from the opportunity to work in a supportive multi-disciplinary team environment. We have recently developed a pre and post placement tool which will allow students to formally reflect on and evaluate the learning experience. Student placements also enable patients who require treatment by two or more physiotherapy staff at any one time, to be seen for longer and more often than would otherwise be possible.

During 2006 the clinical lead therapist completed the York ST John University Evidence Based Stroke Management module. This has developed the units evidence based practice approach and knowledge of National standards and guidelines.

Physiotherapy has been heavily involved in fundraising for the ward. This has allowed the unit to purchase new ward chairs, including symetrikit chairs which provides individualised postural support for our most disabled patients, a data scope monitor which is in use in the high observation bay and will be used on thrombolised patients and an electrical stimulation/TNS unit which can contribute to treatment of pain and subluxed shoulder.

Physiotherapy is involved in the education of all new nursing staff on ward 110 and we have recently begun joint therapy and nursing staff ward meetings led by the lead therapist and the ward manager. We are also involved in quality improvement teams with nurses, this is to promote multidisciplinary team working and consistency of approach. In addition to physiotherapy students we accepted B-tech National Diploma in Health Studies students. Physiotherapy presented jointly with SALT and OT on acute stroke rehab at the neurology CME meeting in October, and is involved in the ongoing education programme for therapy assistants.

We conducted a notes audit in November following which we have altered our documentation and included validated outcome measures to comply with NICE, RCP, CSP and Trust guidelines

In response to the 2006 national patient survey which highlighted for the Trust the issue of tailored patient information, we are developing a therapies specific patient information leaflet which will incorporate an area where patients can give feedback about therapies and contribute to quality improvement.

We will to use the new documentation to audit the functional level at admission and discharge from ward 110 therefore measure our effectiveness and possibly contribute to the evidence base about frequency and intensity of therapy.

We will audit the number of patients who require more than one staff to treat at admission and at discharge. This may have implications for staffing for the acute trust and for the continued therapy in the rehabilitation wards and units.

The vacant assistant post has been appointed. Once trained, the new employee will contribute to the productivity of the entire therapy team.

We will be reviewing the therapy assistant CARBS and linking them where possible to the KSF descriptors.

We are working with nursing staff to pilot, and evaluate use of a multi-disciplinary postural management care plan.

We will conduct joint risk assessments with nursing of the ward 110 environment and working with the safety team we hope to develop protocol/guidelines for the management and manual handling of bariatric stroke patients.

In the longer term and with assistance from the Research and Development Physiotherapist we plan to develop and eventually validate an outcome measure for static and dynamic sitting balance. We also hope to begin work with SALT to audit the number of patients requiring chest physiotherapy and look at how this relates to management of dysphagia.

This has been a year of change for the Acute Trust Stroke Service; restructuring has enabled us to re-focus on patient services. The emphasis is now on single site working with lead therapists looking into development issues to fulfil the knowledge and skill framework.

This framework will support new Band 5 rotations from which stroke will benefit on both acute sites. New supervision structures and training initiatives will ultimately lead to better services for stroke patients.

In spite of the recruitment freeze earlier in the year, posts have been released; new therapy assistants have been recruited to the Stroke Unit and to Ward 2 at Castle Hill. The senior post on the Stroke Unit remains vacant and will be advertised in the near future. Following the retirement of the present clinical specialist post holder in March, this post will be advertised very shortly

There have been opportunities to contribute to the education of others; twice at the Stroke Foundation Course, where feedback from those attending remains very positive, and at the Neurology Clinical Governance Forum on Stroke.

Goal setting has been introduced on Ward 2, allowing therapists to meet with patients and their families to discuss aspects of rehabilitation meaningful to patients.

In summary, it has been a year of structure and development to underpin the delivery of services to stroke patients in Hull and East Riding. However, the occupational therapy acute service remains under resourced, and is not able to provide the intensity and duration of intervention to patients as indicated in the Intercollegiate Guidelines for Stroke. In the current health care climate, where timely discharges and transfers are essential, commissioners must be made aware of the value that occupational therapy provides for patients health, well being and independence.

Since the set up of the Stroke Service no further funding for Stroke Rehabilitation has been made available for the East Riding. Staffing remains as follows:

Stroke Rehabilitation continues to be provided as an integral part of the existing Community Rehabilitation Service for both In-patients and Services provided in the community.

Patients continue to be seen by the Occupational Therapists working in the Community Hospitals in Hornsea, Withernsea, Driffield and Beverley. All patients are seen within the standard of three working days following receipt of referral to Occupational Therapy.

Shortfalls in providing the service continue due to limited funding made available for Stroke Rehabilitation, the rural nature of the East Riding, and the limited staffing levels in particular in the Holderness area. These shortfalls will continue to be raised in business planning.

In Hull, Occupational Therapists are members of a dedicated multi- disciplinary Stroke Team

In Hull Occupational Therapists continue to play a significant role in developing the Rehabilitation Service for stroke patients at Alderson, Rossmore and St Mary’s Rehabilitation Units. All patients are seen within the standard three working days of receipt of referral.

Occupational Therapy continues to be developed with the provision of Domestic ADL, and Gardening to enhance a return to pre-stroke occupations for the patients.

Referrals continue to be received for ongoing Occupational Therapy in patients own homes following their time with Intermediate Care or HAHTS. Referrals are also received for patients whose stroke is long standing but require another episode of therapy.

Rehabilitation in the community continues to be under funded There is minimum provision for these patients from the staff providing a service to the Step-down stroke rehabilitation beds in Hull, resulting in a long wait for Occupational Therapy and to some patients falling through the net and not receiving the input required to maintain their functional ability. Monitoring of the shortfall continues and will continue to be raised in business planning.

The Occupational Therapy Stroke Clinical Specialist 1.00 WTE contributes to the clinical governance of the service in the East Riding of Yorkshire and Hull by carrying out clinical supervision for all Occupational Therapists involved in stroke rehabilitation on a case by case basis.

The Clinical Specialist is also involved in the Stroke Foundation Course and delivery of in-service training to Occupational Therapists. The Stroke service has recently been audited against national standards and changes are being made with support from the Clinical Specialist to allow improvements to be made in the Occupational Therapy Service provided to stroke patients across Hull and the East Riding of Yorkshire.

Head Occupational Therapist, Clinical Specialist Stroke, Community Rehabilitation

The Therapy Services Partnership provide Speech and Language Therapy input to the stroke service in the following areas: Ward 2 at Castle Hill Hospital, The Hull Community Stroke Rehabilitation units at Alderson Resource, St Mary’s Nursing Home and Rossmore Nursing Home and Bridlington Hospital. We also provide outpatient services across the East Riding Community area (with the exception of Holderness) and within that service we see clients at Beverley Westwood and Alfred Bean Community Hospitals and clients on East Riding Intermediate Care (including the Holderness area).

Over the past year we have seen a return to previous staffing levels, which had been severely compromised in 2005/6 due to maternity leave. We have also moved into new accommodation at Hessle Primary Care Centre where a significant proportion of our community services are now based. Currently we have a senior member of staff on maternity leave and a high proportion of junior staff who require training and support. Whilst waiting times for our community services have reduced significantly they still routinely fall short of our 10 working day standard for urgent dysphagia and 1 month standard for new communication and routine dysphagia referrals. Therefore whilst it remains a challenge to provide a full and responsive SLT service to our clients, we are looking optimistically to the future.

Ward 2 (Stroke Rehabilitation) Castle Hill Hospital

The service to ward 2 is currently provided by 0.2 to 0.3 WTE of a band 7 and 0.3 of band 6. The band 7 therapist concerned also has responsibility for attending the videofluoroscopy clinicsfor. We accept all referrals from the ward, not only clients who have had a stroke. Both therapists are dysphagia trained, the band 6 therapist successfully completing her dysphagia training early this year. This has enabled better cover for the ward whilst therapists are on annual leave. Given the limited therapist time for the ward we have continued to work closely with the therapy assistant to enable clients, where appropriate, to continue with therapy tasks on a more intensive basis. Along with other members of the MDT we have been actively involved in the development of joint goal setting for clients on the ward and establishing a key worker system.

Currently the service for the three units is provided by 0.4 WTE of a band 7 and 0.4 WTE of band 6. The band 6 position is now filled by a therapist who is developing a specialism in adult neurology and will be completing her dysphagia training this year. This provides a great opportunity to pursue service developments and allows a more flexible level of cover for the units to cover sick or annual leave. Over the past year we have provided further communication training to staff at Rossmore, this along with the addition of computer facilities has enabled the staff there to become more confident in delivering therapy activities. This allows for intensive levels of therapy to continue even when SLT cover is compromised. Our priority for the next year is look at achieving this at the other two units, Alderson and St Mary’s. Refresher training has also been provided in the management of swallowing difficulties.

Dietitians prevent nutrition-related problems by influencing food-related behaviour. They enable people to take personal responsibility for their health by making more appropriate choices about food and lifestyle as an individual.

Dietetics is the discipline, which interprets and communicates the science of nutrition to enhance the quality of life of individuals and groups in health and disease.

Dietitians provide informal training to healthcare staff and take part in delivering the Stroke Foundation Course

Nutritional support and secondary prevention of stroke are core to the work of the dietitian.

Referrals are accepted from any Health Care Professional for dietetic assessment or review for patients with:-

· Dysphagia - Assessment and Treatment with Modified Consistency Diet while maintaining adequate nutrition

· Prescribed Nutritional Sip Feeds – monitoring of nutritional adequacy and appropriateness of prescription for taste and nutritional content

· Enteral Tube Feeding to maintain nutrition and during subsequent rehabilitation

· Body Mass Index 30 or more with an identified patient benefit for weight reduction/monitoring of anti-obesity medication effectiveness

A diet sheet giving advice for those on Warfarin therapy has been developed and is available on the East Riding of Yorkshire PCT web site. This is envisaged to be used a resource for health staff and patients to access.

A Catering “Red tray” system has been implemented on Community Hospital wards along with nutritional screening (MUST)

Identified dietetic staffing needs have been fed into the ERYPCT Community Strategy for patient care

· To benchmark dietetic input to the Stroke Service for patients with secondary risk factors

Members of the Stroke and TIA team supported the Humber Rotary Club to promote National Blood Pressure week, checking blood pressures and giving Primary and Secondary Healthcare prevention to over 200 people at Asda Supermarket on Hessle Road in April 2007.

Destination	Number of Patients		Transfer to own home (final destination)	Transfer to Nurse/Res Home	Return to Acute	RIP	Length of stay
							Average number of days	Average Number of weeks
Alderson	69	9 still in	47(92%)	1(2%)	3(3%)	0	50	7
St Marys	70	7still in	34(61%)	16(28.5%)	4(7%)	2(3.5%)	36	5
Rossmore	56	6 still in	34(77%)	9(20%)	1(2%)	0	48	7
Beverley	39	7 still in	22(88%)	3(12%)	0	0	32	7
Alfred Bean	11	2 still in	7(77%)	2(23%)	0	0	44	6
Hornsea	6	2 still in	1(50%)	0	0	1(50%)	57	8
Withernsea	18	2 still in	10(71%)	4(29%)	0	0	36	5

Total	234	35(15%)	155(78%)	33(17%)	8(4%)	3(1%)	43.2	6