Juliet Bouverie, Chief Executive of the Stroke Association, tells us how the NHS Long Term Plan and National Stroke Programme have the potential to transform stroke services across England in the next five years
This is an exciting time to be working in stroke. We know how to detect and manage the two main risk factors for stroke, there are real advances in stroke treatment and stroke research is started to indicate some exciting breakthroughs. In England, there is a clear recognition now, from those in government and across the stroke community, that we must work together to tackle one of the biggest health challenges of our time. The NHS Long Term Plan and National Stroke Programme are vital to achieving this.
NHS Long Term Plan and the National Stroke Programme
Stroke affects 1.2 million people across the UK and remains the fourth biggest killer and the largest cause of adult disability. Every five minutes, stroke destroys lives. And it turns the lives of carers and families upside down. This is why it is reassuring to see stroke included as a new clinical priority in the NHS Long Term Plan.
As well as saving half a million lives through improved CVD prevention, NHS England’s plan promises to increase access to thrombolysis and thrombectomy treatments, to overhaul the stroke workforce and to transform rehabilitation models post-stroke. This is a big opportunity for us all. Collectively achieving these ambitions would help hundreds of thousands more people each year to rebuild their lives after stroke.
In partnership with NHS England and others, the Stroke Association has developed the National Stroke Programme for England, supporting the Long Term Plan’s aims. As co-chair of the Stroke Programme Delivery Board, I’m encouraged to see work progressing across the five main priority areas – preventing strokes, redesigning acute stroke services, improving rehabilitation and ongoing care, modernising the workforce and strengthening date and research.
The vehicle for change: hyper-acute stroke units
Across England, we need to look at the very basic structure of stroke services. Do local stroke pathways actually make sense, provide quality care for all and integrate acute and post-acute services?
Here, the hyper-acute stroke unit (HASU) model of stroke services, taking patients to hyper-acute centres of excellence rather than the nearest hospital A&E department, is vital. Robust evidence shows us that this model is effective at saving lives, reducing the chance of disability and shortening the time spent in hospitals. This is why the Stroke Association fully supports efforts to reconfigure stroke services into HASUs.
In London and Manchester, reconfiguring services into the HASU model has saved an average of 100 and 70 extra lives per year respectively and Northumbria has seen significantly improved patient outcomes. Evidence shows that stroke patients treated in HASUs are more likely to survive and recover more quickly because these units are fully staffed and equipped and set up to deliver specialist and effective care 24/7. This also helps to address the significant workforce shortages and challenges in stroke by concentrating specialist stroke skills and expertise under one roof.
Yet across the country, public and political opposition often stands in the way of reconfiguring stroke services into HASU models, leading to patchy progress.
Through the National Stroke Programme, work will also soon start to develop Integrated Stroke Delivery Networks (ISDNs) in all areas of England, bringing people and organisations together to create the best stroke pathway possible for local populations. Creating HASUs should be a top priority. It is proven to improve outcomes and we simply cannot afford to delay a process that will save lives.
Accessing game-changing treatments
Currently, only 10% of eligible patients have access to mechanical thrombectomy, a game-changing clot-retrieval treatment that reduces the severity of the disability that a stroke can cause. In some cases, thrombectomy also saves lives.
We want all eligible patients to access this transformative treatment as soon as possible, regardless of where they live. Again, we will only make real progress here once we get the basics right – properly and efficiently organised stroke services in each region delivered round the clock and enough stroke specialists trained up to carry out these complex procedures. A new national commissioning goal (CQUIN) to encourage thrombectomy training will also help and I hope to see many local health systems taking advantage of this.
It is good to see the Long Term Plan recognises how effective thrombectomy can be and the potential cost-savings involved. On average, each patient treated with mechanical thrombectomy saves the NHS nearly £50,000 over just five years.
Ending the ‘postcode lottery’ of stroke care
Standards of stroke care today vary enormously across the country, affecting your ability to survive and recover. It is simply not good enough that 45% of stroke survivors feel abandoned after they leave hospital and are not all able to access the rehabilitation and lifelong support that they need. Last month, another CQUIN was introduced, this time to increase the numbers of stroke survivors accessing vital six-month reviews. These will enable stroke survivors to access more personalised support and help to rebuild their lives after stroke.
Equity of access is key here. As James Green, who has lost three of his family members to stroke and now campaigns with the Stroke Association, explains:
“For me, the overriding priority for the new National Stroke Programme is reducing the postcode lottery of care for those who have had a stroke. We must have a level field for everyone no matter where you live or your wealth.”
Priorities for the future
NHS England’s goals for stroke are rightly ambitious and they will require sustained effort and real leadership to drive through improvement. The next five years should be about translating good intentions into action. Together, we must make sure there are tangible improvements for stroke survivors and their carers. We need to be bold and accept where things are not working and design services so that everybody can access world-class stroke care. Stroke survivors deserve a better deal than they are getting today and I and others will continue to push for stroke to be the priority it needs to be.
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