Progress in improving stroke care services

The Department of Health’s strategy for stroke care has increased the priority and awareness of the condition and started to improve patients’ care and outcomes, according to a report by the National Audit Office (NAO). Actions taken since 2006 have improved the value for money of stroke care; but improvements have not been universal and improvements in follow-up care have not matched those of acute care services. In November 2005, the NAO published Reducing brain damage: faster access to better stroke care, which concluded that historically stroke had been regarded as a low priority within the NHS. It was seen as an inevitable risk of growing old, and medical and technological developments which could improve patient outcomes were not being implemented widely. The NAO identified considerable variations in the efficiency and effectiveness of treatment, and scope for potential savings as the result of more efficient practices. The report formed the basis of a hearing of the Committee of Public Accounts, whose report in June 2006 concluded that the human and economic costs of stroke could be reduced by reorganising services and using existing capacity more wisely. The Committee made a number of recommendations for the Department of Health (the Department) and NHS organisations, and asked the NAO to report back on progress in improving stroke care. The latest report, Progress in improving stroke care, examines how stroke care has changed over the last four years, the extent to which these changes have improved the value for money of stroke care provision nationally, and the risks and issues to be managed to ensure that stroke care services continue to improve in future. The report, published in February of this year, concluded that there has been a major change in the Department’s approach to stroke care. The National Stroke Strategy has been underpinned by strong national leadership and performance indicators as well as £59 million of central funding over the first two years, £30 m of which was allocated to local authorities specifically to provide support services to stroke patients and their carers. With this clear focus from Ministers and the Department, the NHS is now starting to deliver better care from stroke services, and outcomes for patients are also improving. The NAO estimates that stroke patients’ chances of dying within 10 years have reduced from 71% to 67% since 2006. Patients treated in a specialist stroke unit are more likely to survive, have fewer complications and regain their independence, and all relevant hospitals in England now have such a unit, although the services provided and time spent in the unit vary. Stroke patients should be immediately admitted to a specialist stroke unit. However, in 2008, only 17% of stroke patients reached the stroke unit within four hours of arrival at hospital. Brain imaging is also very important for stroke patients but many patients are not given a scan quickly enough and access at weekends and evenings is significantly more limited.

 Public awareness

There is better awareness of the symptoms of stroke, and that it is a medical emergency, following the Department’s “Stroke: Act FAST” advertising campaign, launched in February 2009. The number of calls categorised as being a suspected stroke during April to June 2009 increased by 54% in comparison with the same period in 2008. However, health and social care services are not working as well together as they could. A third of patients are not getting a follow-up appointment within six weeks and only a half of stroke survivors in the NAO’s survey said that they were given advice on further stroke prevention when leaving hospital. Edward Leigh MP, chairman of the Committee of Public Accounts, further commented that rehabilitation for stroke patients is still a “Cinderella service”, while patients lack proper post-hospital support from the social services and information about benefits and employment.