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National Audit Office

Clinical Articles, Featured

Progress in improving stroke care

The UK Department of Health’s strategy for stroke care has increased the priority and awareness of the condition and started to improve patients’ care and outcomes, concludes a report by the National Audit Office(1). Actions taken since 2006 have improved the value for money of stroke care; but improvements have not been universal and improvements in follow-up care have not matched those of acute care services.

The National Stroke Strategy is a comprehensive response to the concerns raised by the NAO in its 2005 report on stroke. The strategy has been underpinned by strong national leadership and performance indicators as well as £59 million of central funding over the first two years, £30 million of which was allocated to local authorities specifically to provide support services to stroke patients and their carers. With this clear focus from Ministers and the Department, the NHS is now starting to deliver better care from stroke services, and outcomes for patients are also improving. The NAO estimates that stroke patients’ chances of dying within ten years have reduced from 71 to 67 per cent since 2006.

Patients treated in a specialist stroke unit are more likely to survive, have fewer complications and regain their independence, and all relevant hospitals in England now have such a unit, although the services provided and time spent in the unit vary. Stroke patients should be immediately admitted to a specialist stroke unit; however in 2008 only 17 per cent of stroke patients reached the stroke unit within four hours of arrival at hospital. Brain imaging is also very important for stroke patients but many patients are not given a scan quickly enough and access at weekends and evenings is significantly more limited.

There is better awareness of the symptoms of stroke, and that it is a medical emergency, following the Department’s ‘Stroke: Act FAST’ advertising campaign, launched in February 2009. The number of calls categorised as being a suspected stroke during April to June 2009 increased by 54 per cent in comparison with the same period in 2008.

However, health and social care services are not working as well together as they could. A third of patients are not getting a follow-up appointment within six weeks and only a half of stroke survivors in the NAO’s survey said that they were given advice on further stroke prevention when leaving hospital.
Mr Amyas Morse, head of the National Audit Office, said “Care for people who have had a stroke has significantly improved since we reported in 2005. The publication and early implementation of the stroke strategy have begun to make a real difference and have helped to put in place the right mechanisms to bring about these improvements. There is still work to be done though: the poorer performers must be dragged up to the same standard as the best, so that the gains that have been made are sustained and value for money improved further. The Department should focus on ensuring that health, social care and employment services are working together much more effectively.”

References and Notes

  1. There are approximately 110,000 strokes per year in England and about 300,000 people in the UK are living with moderate to severe disabilities as a result of stroke.  It is one of the top three causes of death and the largest cause of disability in England and costs the NHS over £3 billion a year.
  2. Since April 2008, NHS performance has been managed against three tiers of “vital signs”. The Department has introduced two Tier 1 Vital Signs indicators for stroke care in the 2008-09 three-year NHS Operating Framework.
  3. In November 2005 the NAO reported on stroke care, which concluded that historically stroke had had a low priority within the NHS and that medical and technological developments which could improve patient outcomes were not being implemented widely. The report can be found on the NAO website at The Committee of Public Accounts then published a report in June 2006 and requested that the NAO produce a follow-up study on progress in improving stroke care.

Published on: February 26, 2010

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