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Review finds ‘significant improvements’ in NHS stroke care in England

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Patients are receiving significantly improved NHS stroke care, an independent report has concluded.

It stated that patients were getting much quicker access to the vital tests and treatment they needed when they had a stroke, which was greatly improving their chances of recovery.

“We recognise that there is a great deal more still to do”

Tony Rudd

Among the key indicators for good stroke care, it found significant quality improvements had been made in recent years, including on waiting times and specialist care.

It is the fourth Sentinel Stroke National Audit Programme (SSNAP) report, commissioned by NHS England and written by the Royal College of Physicians. It highlighted improvements made since the first one was published four years ago.

Improvements include that brain scanning times have improved with the numbers of patients scanned within 12 hours, with 93.5% scanned within 12 hours – up from 84.6%.

In addition, almost nine and out 10 of eligible patients are receiving thrombolysis, up from around seven in 10 two years ago. The numbers treated within one hour have risen from 53.2% to 62.3%.

Meanwhile, nine out of 10 patients received a joint health and social care plan on discharge in 2016-17, compared to only seven out of 10 in 2013-14, said the report – titled Rising to the challenge.

The report also highlighted that there had been “some heartening improvements in multidisciplinary care” over the last four years, which was “testament to the dedication and resourcefulness of many stroke teams”.

It stated that one of the key indicators that demonstrated good team working between nurses and therapists both at weekdays and weekends was whether a patient is seen by a stroke nurse and one therapist within 24 hours, and all other relevant therapists within 72 hours.

“This percentage has increased steadily over the last four years and probably reflects greater therapy weekend working,” said the report.

In addition, the report said the number of people receiving an initial swallow screen – to check whether they can swallow safely – had increased significantly over the last four years, though it noted that a quarter of applicable patients still do not have early swallow screening.

It said: “The initial screen is normally carried out by swallow trained nurses, and it’s very important that stroke service providers ensure that their nurses are appropriately trained in swallow screening and that there is always a nurse available on the ward capable of performing the screening assessment.”

Professor Tony Rudd, national clinical director for stroke at NHS England, said: “It is fantastic to see the excellent progress which has been made over the last four years.

“Real improvements have been made, not just in identifying and managing those with key stroke risk factors, but in waiting times for tests and new revolutionary treatments being provided,” he said.

But he added: “We are not complacent about stroke care – it remains the fourth biggest killer in England and we recognise that there is a great deal more still to do.

Royal College of Physicians

Dr Anthony Rudd

Tony Rudd

“The data published today provides us with a very high standard which we can continue to improve from to make stroke care even better for patients,” said Professor Rudd.

The NHS in England is working closely with the Stroke Association and others to develop a “very clear plan” to continue to improve stroke services, said the national body in a statement.

This will include joining up ambulance services, hospital services and community services to reduce the death rate, disability rate and increase the number of people that return to independent living.

NHS England also announced in April that it would commission mechanical thrombectomy to benefit 8,000 patients a year, which can significantly decrease the risk of long-term disability.

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