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Stroke, the brain equivalent of heart attack, is one of the top three causes of death in England, and the leading cause of adult disability. There are around 110,000 strokes each year in England, a quarter of which occur in people under 65. Some 300,000 people in England are living with moderate to severe disabilities as a result of stroke. However many strokes are preventable; and developments over the last decade have shown that fast and effective acute treatment of stroke, and high quality rehabilitation, can significantly reduce death and disability.
Stroke costs the economy about £7 billion a year. The direct cost to the National Health Service is around £2.8 billion—more than the cost of treating coronary heart disease—yet stroke has not, to date, been given as high a priority by the Department of Health as coronary heart disease and cancer.
On the basis of a Report[1] by the Comptroller and Auditor General, the Committee took evidence from the Department of Health on the provision of stroke care in England.
We found that the cost of stroke, in both economic and human terms, could be reduced by re-organising services and using existing capacity more wisely to prevent more strokes from occurring, to provide more rapid and responsive acute stroke treatment, and to coordinate post-acute support and rehabilitation services more effectively.
Under the National Health Service's current approach to stroke care
- Stroke is not treated as a medical emergency in the same way as a suspected heart attack, though the shorter the time between the stroke and the treatment, the greater the chance of reducing damage to brain tissue.
- Brain scans for many stroke patients are being delayed, though a scan is vital for determining appropriate treatment.
- A significant proportion of stroke patients are not being treated on a specialist stroke unit, despite evidence that this is the most clinically effective model for acute care.
- There is considerable variation between hospitals as to what a specialised stroke service entails.
- Public awareness of the symptoms and impact of stroke, and how strokes can be prevented, is very low.
- There are insufficient nursing, therapist and other specialist staff with expertise in stroke care across the primary and secondary healthcare sectors, and there is scope to improve training for the existing stroke workforce in the National Health Service (for example, by training stroke consultants to interpret brain scan results).
- The carers of stroke survivors, and stroke survivors living on their own, are often not accessing the social and care services they need.
- There is low awareness on the part of members of the public and general practitioners about the fact that a transient ischaemic attack ('mini stroke') is a strong indication of increased risk of major stroke, and requires immediate investigation and treatment.
The Department of Health has accepted that it needs to do more to raise public and professional awareness of the seriousness of stroke, improve rapid access to brain scanning and appropriate treatment for stroke patients, deliver stroke care through organised stroke units, and provide high quality rehabilitation and coordinated post-acute support for patients and carers, as recommended in the C&AG's Report. It has agreed that implementing these recommendations could save the NHS £20 million a year, and save as many as an extra ten lives each week. It has established a Vascular Programme Board which is now developing a stroke strategy drawing on the approaches it has taken to improve coronary care over the last five years.
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