Conclusions and recommendations
1. In response to the shortcomings outlined
in our 2006 report, Reducing Brain Damage: Faster access
to better stroke care, the Department has achieved
some commendable improvements in stroke care.
We welcome the higher priority that is now being given to stroke
care, including the greater awareness of the importance of a fast
response. A key development has been the Department's campaign,
Stroke—Act F.A.S.T., which has improved public awareness
of stroke and the responsiveness of ambulance and hospital staff.
2. It is not good enough that only 59% of
patients are scanned within 24 hours of having a stroke.
Although immediate scanning is vital to achieve the best outcome
for stroke patients, too many hospitals are still failing to operate
their scanning services 24 hours a day. During 2010-11, the Department
should use the Best Practice Tariff and the Stroke Improvement
Programme to require all hospitals to provide timely access to
scanning for all patients who might be eligible for the clot-busting
drug, thrombolysis. In particular, we expect the Department
to make substantial improvements in notably poor performing hospitals,
such as Grimsby's Diana Princess of Wales Hospital.
3. Although treatment on a specialist stroke
unit is recognised as the best way to help patients, many stroke
patients are still not treated on such a unit.
The Department should require Strategic Health Authorities and
Primary Care Trusts to use their performance management arrangements
to certify that all applicable hospitals meet its expectation
that 80% of stroke patients spend at least 90% of their hospital
stay on a stroke unit by March 2011.
4. There are not enough specialist staff on
stroke units and the understanding of stroke by other health and
social care professionals who care for people with stroke remains
poor. The Department should work with
the Stroke Forum to develop effective training for all hospital
staff so that, for example, all patients with aphasia or physiotherapy
needs receive safe and effective care.
5. Not enough hospitals arrange early supported
discharge for stroke patients, even though it provides better
outcomes for many patients and can save money.
The Department should ask commissioners across the health service
to develop business cases for introducing or increasing the use
of early supported discharge and should report back to us on the
progress it has made within 12 months.
6. The Department lacks evidence about what
types of post-hospital support and long-term care are most effective
for stroke patients and does not have a clear plan as to how such
care should be funded. There is a risk
that the current level of service will not be sustained once the
funding given to local authorities for this purpose ends next
year. The Department should develop the evidence-base for post-hospital
stroke services by identifying and disseminating examples of good
practice. Strategic Health Authorities should track the level
of provision across their region, using the metrics currently
being developed by the Department. They should seek an improvement
in the quality of long-term care and report on the progress made
in 12 months.
7. Despite 11% of stroke patients being newly
admitted to care or residential homes after their stroke, there
is little understanding of what services stroke patients need
in these settings. The Department should
work with the Care Quality Commission and Skills for Care (the
employer-led authority on the training needs of social care staff)
to develop proposals for the accreditation and training of care
home staff in stroke awareness and care.
8. Whilst an estimated 4,500 strokes could
be prevented each year through better detection and treatment
of atrial fibrillation, many people remain undiagnosed or fail
to receive the recommended treatment.
The National Institute for Health and Clinical Excellence (NICE)
should review whether GPs' incentives are aligned with clinical
guidelines so as to reward best practice in the treatment of atrial
fibrillation. At the local level, Primary Care Trusts should encourage
all healthcare providers to use existing opportunities to check
and record patients pulses, for example during flu clinics.
9. One of the main barriers to more effective
stroke services is the persistent failure of health and social
care to work effectively together. We
welcome the fact that the Department has asked Primary Care Trusts
to work with their local authority to develop local plans for
stroke care by March 2010. In addition, by the end of 2010-11,
all people who have a stroke should on discharge receive an agreed
joint care plan to help them and their carers navigate post-hospital
stroke services.
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