Quality of care in the balance

As a junior doctor back in 2005, I remember the sadness of caring for someone who had suffered a stroke. The irreversible, sudden and devastating disabilities the patient had to cope with, the weeks of waiting in a hospital bed for adaptive equipment funding or nursing home availability, the frustrations of family meetings as all those caring for the patient tried to come to terms with the need to manage expectations. 

That picture for stroke patients is changing. Big advances have been made in stroke care. Decades of research have identified and helped put in place best practice, including the sheer miracle of emergency thrombolysis. National level clinician and patient engagement in policy making has brought the frontline to the national perspective. There have been coordinated investment and policy interventions, new staff roles like stroke consultants and coordinators, and a set of clear gold standards of care from NICE. Better data collection and feedback is inspiring improvement through the stroke audit, and public awareness campaigns have also contributed. All of these advances mean that today family meetings with stroke patients feel more inspiring, collaborative and productive. 

Which is why, in co-authority the Health Foundation’s new briefing Quality of care in the English NHS: In the balance, the improvements in quality we’ve highlighted in the report have felt real, from my perspective as a doctor, but also fragile because of the pressures the NHS is now facing.