RCP: Stroke care improving - but no room for complacency
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Monday, 15, Sep 2008 12:00
There has been a major improvement in the organisation of stroke care over the last two years, according to the latest National Sentinel Organisational Audit of Stroke.
The audit, funded by the Healthcare Commission, was carried out on behalf of the Intercollegiate Stroke Group by the Royal College of Physician's Clinical Effectiveness and Evaluation Unit (CEEu).
The audit has been carried out every two years for the last ten years. The 2008 audit found particular improvements in acute stroke care and the management of transient ischaemic attack ('mini stroke'). The involvement of strategic health authorities and cardiac and stroke networks in planning the delivery of comprehensive high quality stroke care for all should result in continuing rapid improvements.
However there are still areas where more work is needed and all hospitals need to understand that stroke is a treatable disease that needs to be recognised as a medical emergency and that patients with residual disability need high quality rehabilitation services and longer term support.
The audit looked at all aspects of stroke care and has made a series of recommendations covering everything from acute care to community stroke care. The main recommendations include:
All patients with acute stroke should be admitted directly to an acute stroke unit equipped and staffed to be able to deliver high quality care
Thrombolysis should only be provided when all the other components of acute stroke care are of high quality
All hospitals managing stroke and transient ischaemic attack (TIA) patients need to ensure they comply with the recommendations in the NICE guidelines for acute stroke and TIA for imaging, and the Department of Health's document on imaging after stroke and TIA
Hospitals should make sure they do not have patients without stroke occupying beds in the stroke unit while stroke patients are managed off the unit
Stroke services should urgently review policies that exclude certain groups from admission to the stroke unit - for example where there is judged to be 'no rehabilitation potential' - as there is no evidence to support such a policy
Levels of nurse staffing on acute stroke units need to be increased in many units.
Dr Tony Rudd, Chair of the Intercollegiate Stroke Group, said:
"I am delighted that there has been a significant improvement in the organisation of stroke care over the last two years. Hopefully these results will not induce a sense of complacency because we still have a long way to go before all patients can be assured of high quality care wherever and whenever they have their stroke."
Health Minister, Ann Keen said:
"I welcome the publication of this report that shows that there have been major improvements in NHS stroke care in the past two years.
"The report shows that stroke patients can expect to receive tailored and expert treatment on the NHS, with 96% of hospitals in England now offering specialist acute stroke care and 98% having a consultant with specialist knowledge of stroke.
"We are continuing our efforts to prevent strokes and improve outcomes for stroke patients and have invested £105 million to support the implementation of our National Stroke Strategy over the next three years.
"We have already made good progress on this strategy with more Stroke Care Networks being set up and ring-fenced grants for Local Authorities to support the long term needs of stroke survivors.
"The national vascular checks programme to be rolled out next year represents a further advance in the National Stroke Strategy."
Robin Burgess, Chief Executive of HQIP said:
"We are encouraged by the steady improvement in the standards of care being delivered to people after stroke. The recent release of the National Stroke Strategy and the NICE and Royal College of Physicians Guidelines on Stroke set very challenging standards for everyone involved in stroke care to meet, and the National Sentinel Audit of Stroke has highlighted areas where improvement is needed. This audit has been providing high quality data for 10 years and demonstrates the value of on-going audit as a driver for quality improvement."
Joe Korner, Director of Communications at The Stroke Association said:
"At last we are seeing all of the hard work in campaigning for better stroke services and the development of the National Stroke Strategy paying off. There is a powerful consensus for change and this audit demonstrates that we are gaining momentum. But we have a long way to go. Of course The Stroke Association is impatient for change - thousands of lives are at stake. We firmly believe that with stroke the top health priority for the Government and the NHS, and with the amazing dedication of stroke champions around the country, we will see the step change in stroke service provision which we have been calling for."
Note to Editors
All applicable hospitals that admit patients for stroke in England, Wales, Northern Ireland, Isle of Man and the Channel Islands took part in the audit - 224 hospitals in total. The public report is attached to this email. The Executive Summary with national results starts on page 8 of the pdf. Individual hospital results will be released on the RCP website at 10.00 am on Monday 15 September.
Journalists: For further information contact Linda Cuthbertson, Press and PR Manager on 020 7935 1174 ext.254 or e-mail Linda.Cuthbertson@rcplondon.ac.uk.
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