The inability of some hospitals to recruit enough specialist stroke nurses has been identified as an area of “particular concern” by the latest national audit of services for the condition.
The latest national audit of how well stroke care in England is organised identified a lack of nurse staffing, particularly at weekends.
“We still have marked variation of services and patient outcomes across the UK”
Only 20% of acute hospitals are meeting the standard for weekend nurse staffing levels, according to the Sentinel Stroke National Audit Programme (SSNAP), which has published its 2016 findings today.
Its authors warned that there should be at least three registered nurses per 10 stroke beds on duty at all times during the day. Fewer than this at weekends was “associated with more hospital deaths”, stressed the auditors, highlighting a study from 2014 involving 103 stroke units across England.
“There have been substantial improvements in the proportion of patients being seen by a specialist stroke doctors and nurses within 24 hours of arrival in hospital over the past three year,” they said in their audit report – Mind the Gap!
“Despite these substantial improvements in early acute assessments, we are concerned by the current staffing levels of stroke consultant and nurse specialists,” the report authors warned.
They added: “SSNAP data have shown us that current nurse staffing levels are insufficient to provide good care for everyone who needs it, and as we implement the latest National Clinical Guideline for Stroke, it is clear that we will need more skilled nurses rather than less in the future.”
Overall, the 2016 SSNAP’s Acute Organisational Audit showed that the way that care was provided for people with acute stroke “continues to improve”, with more provision of weekend therapy and better access to early supported discharge teams.
All hospitals now have a designated stroke unit, 99% are able to provide access to thrombolysis 24 hours a day, seven days a week, and seven-day access to occupational and physiotherapy has increased to 31% and 40% of hospitals.
Additionally, 81% of hospitals have specialist early supported discharge available to them so patients can return home sooner and receive specialist post-acute care.
However, as well as nurse staffing problems, the report highlighted concerns about consultant numbers, with 40% of sites now with an unfilled stroke consultant post – up from 26% in 2014.
In addition, patient engagement was judged to be “inadequate”, with almost 40% of hospitals carrying out formal surveys of patient and carer experience of stroke services less than once a year or not at all, and nearly half of stroke strategy groups not having patient or carer representation.
Meanwhile, a lack of essential psychology provision was also identified. Just 6% of hospitals achieved the standard of one whole-time equivalent qualified clinical psychologist for every 30 stroke unit beds.
However, the report noted that there continued to be a “reassuring” increase in many areas of acute stroke organisation.
Lack of stroke nurses cause of concern, warns audit
The SSNAP is carried out by the Royal College of Physicians for the Healthcare Quality Improvement Partnership on behalf of NHS England.
Professor Pippa Tyrrell, associate director for stroke for the RCP’s clinical quality improvement department, said: “Stroke care has improved beyond recognition in the last 20 years. Thirty-day mortality has dropped significantly, and people leave hospital with less disability than they did in the past.”
“However, we still have marked variation of services and patient outcomes across the UK,” she said. “Some patients cannot access acute stroke units rapidly, and are therefore denied treatment such as thrombolysis or thrombectomy. Seven-day working is improving, but access to speech and language therapy at weekends remains extremely low.”
She added: “It is only by measuring the quality of our services that we know how well we are providing them, and we congratulate all of those dedicated staff who work so hard to provide and check data for both the organisational and clinical audits.”