Work still to be done to achieve a first-class stroke service, says The Stroke Association

The care that stroke patients receive in England, Wales and Northern Ireland still varies considerably, says The Stroke Association, commenting on the Royal College of Physicians' 2004 Sentinel Stroke Audit published today. The report also reveals that standards for the treatment of stroke are still second-class and far behind those for other major conditions such as cancer and heart disease. This suggests that if unnecessary suffering is to be avoided, clinical guidelines on the implementation of stroke care need to be progressed. Stroke is the UK's third biggest killer and the leading cause of severe disability.

The Stroke Association welcomes the government's continuing commitment to stroke care. Improvements in care have widened and developed quickly, particularly in the increase in the number of hospital based stroke units. In 2002, 73% of hospitals had a stroke unit; this has risen to 79% in 2004. However, the care that is locally available to patients varies nation-wide. It also seems that gains in acute care have been made at the expense of hospital and community based rehabilitation, possibly due to a redirecting of resources. Rehabilitation after a stroke is often a lengthy process, making first-class rehabilitation services vital.

The report also raises a number of concerns for patients on specific elements of stroke care including:

Transfer of acute stroke patients to hospital
· Stroke is still not being identified as a medical emergency; only 4% of hospitals have arrangements with local ambulance services for the rapid transfer of acute stroke patients to hospital over and above existing systems

Staffing
· 31% of hospitals have no stroke co-ordinator, stroke specialist nurse, consultant nurse or therapist
· Services to help stroke patients, their families and carers with the psychological and social aspects of life after stroke remains incomplete. Only 28% of stroke units have clinical psychologists, and a third do not have a social worker
· Only 8% of mobile stroke teams have a social worker
· Only 3% of mobile stroke teams have a psychologist
· Physicians have a median of three weekly sessions for stroke work. An average district of 250,000 people requires two whole-time equivalent stroke physicians to administer an adequate stroke service
· Care assistants administer much of nursing care for stroke patients
· Nursing staff ratios are higher in acute stroke units than rehabilitation units
· Most stroke specialists' nursing work is done in hospital than in the community

Specialist stroke units
· Only 79% of hospitals have stroke units and the majority are dedicated to rehabilitation only
· Only 15% of hospitals immediately admit patients to stroke units when they first present with stroke
· Many stroke units remain an insufficient size to cope with demand for care. For example, on a typical weekday just over half of stroke patients are actually in a stroke unit
· 44% of acute stroke units are unable to offer continuous physiological monitoring. These may mean that they are unable to treat acute patients appropriately

Rehabilitation and Community-based services
· Just 14% of hospitals in England have specialist teams that support the early discharge of patients back into the community, and only half have nursing involvement
· Only 25% hospitals have any form of specialist community based services for long-term care of patients, and few community based specialist rehabilitation services exist
· There is evidence that standards in generic rehabilitation units may have dropped

Treatment of Transient Ischaemic Attacks (TIAs) or 'mini strokes'
· Between 10-20% of patients who have a TIA will go on to have a stroke within a month
· Despite the National Service Framework for Older People (NSF) emphasising their importance, only two-thirds of hospitals have specialist neurovascular services that can investigate TIAs, and the median waiting time for an appointment is 14 days. Recent clinical guidelines recommend that TIA patients should be referred to and investigated by a clinic within seven days of symptoms.

"The Stroke Association has continuously campaigned for better services for people affected by stroke, and we are pleased to see the progress that the government has made.", commented Jon Barrick, Chief Executive of The Stroke Association. "We look forward to continuing to work with health service providers and the Department of Health to build on these achievements and help create a first-class service for stroke patients."

"The care that stroke patients receive is still woefully inadequate. Stroke is the UK's third biggest killer, with over 130,000 people having a stroke every year. Stroke is also the major cause of severe disability in the UK. Therefore, it is unacceptable that current standards in care do not reflect the impact of stroke.

The National Service Framework set milestones for the establishment of specialist stroke services and protocols for the treatment of TIAs to be achieved by April 2004 in England. We look forward to seeing the continuous monitoring and evaluation of services to ensure that the momentum of change is maintained.

The Stroke Association receive calls daily from stroke patients who feel abandoned after they have left hospital. They need a comprehensive service that supports them at all stages of their condition. It can take months, sometimes even years, to recover from the devastating effects of a stroke, and much of the recovery process takes place out of hospital. It is essential that there is a seamless transfer of care from hospitals to the community to ensure that stroke patients, their families and carers receive the support they need."

Notes to editor

For further information, please contact the Media Team at The Stroke Association on 020 7566 0328/1515, e-mail Media Team

Please note we have an ISDN facility.

1. Each year over 130,000 people in England and Wales have a stroke. Of all people who suffer from a stroke, about a third are likely to die within the first 10 days, about a third are likely to make a recovery within one month and about a third are likely to be left disabled and needing rehabilitation. Stroke has a greater disability impact than any other medical condition. A quarter of a million people are living with long-term disability as a result of stroke in the UK. The cost of stroke to the NHS is estimated to be £2.5 billion a year . This accounts for 6% of total NHS and Social Services expenditure, and it is nearly twice the cost of coronary heart disease.

2. Key members of The Stroke Association are available to comment on the findings of the 2004 Sentinel Stroke Audit and what they mean for stroke patients, their families and carers. The Stroke Association also has a number of medical experts who specialise in various aspects of stroke care from prevention, treatment to rehabilitation, and can offer a clinical perspective on the results of the audit.

3. The Stroke Association is the only national charity solely concerned with combating stroke in people of all ages. It funds research into prevention, treatment and better methods of rehabilitation and helps stroke patients and their families directly through its community services. These include dysphasia support, family support, information services, welfare grants, publications, and leaflets. We also campaign, educate, and inform to increase knowledge of stroke at all levels of society and we act as a voice for everyone affected by stroke.

4. A stroke happens when the blood supply to the brain is disrupted. Most strokes occur when a blood clot blocks the flow of blood to the brain. Some strokes are caused by bleeding in or around the brain from a burst blood vessel. When the blood supply is disrupted, parts of the brain become damaged or destroyed. Some strokes are fatal whist others can cause permanent or temporary paralysis to one side of the body and loss of the ability to speak, read or write. Recovery may be slow and can vary from person to person.

5. The National Sentinel Audit for Stroke was carried out by the Royal College of Physicians and describes the current organisation of stroke care in the UK, with the exception of Scotland. All 256 hospitals that admit stroke patients participated.

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