The UK lags behind other developed nations in stroke care and England is far from meeting its own targets, according to a report by The Health Foundation released today.
Stroke is the third biggest killer in the UK. In England alone there are more than 110,000 strokes each year. It is the leading cause of long-term severe disability in adults.
The report for the first time brings together data on performance with evidence of what works and the cost implications of stroke. In response, The Health Foundation will soon launch a programme with hospitals in the North West of England. This aims to increase by an estimated 30% the number of people in the region who could survive a stroke and make sure that many more stroke survivors could walk out of hospital without a long-term disability by 2010. This would see stroke care in the North West reach an unprecedented level for any English region. The programme is being run in partnership with the Stroke Association and the Royal College of Physicians.
The report shows that the UK lags behind other major western countries in cerebrovascular disease mortality – a disease of the blood vessels supplying the brain often leading to a stroke. The UK saw a 16% fall in mortality between 1997–2004, whereas Germany saw a 33% reduction during the same period. It draws on data which shows that only 43% of people in England are receiving a brain imaging CT scan within 24 hours of a stroke. National guidelines say this should be happening to all patients who have had a stroke.
The report also highlights the benefits of effective preventative programmes and food regulation. As many as 69% of strokes in inner London could be prevented by reducing hypertension, treating abnormal heart rhythms, stopping smoking and prescribing statins. Bread and cereal manufacturers could also prevent 8,000 strokes a year in England by reducing their salt content.
Stephen Thornton, Chief Executive of The Health Foundation, said: “This report shows that stroke services are still not good enough in England. We are confident that the stroke strategy is beginning to make important changes but it is clear that more needs to be done quickly. We are acting in the North West; the challenge is now for Government and the rest of the NHS to keep increasing the pace of change.”
Joe Korner, Director of External Affairs for The Stroke Association comments: “This report provides an important snapshot of the state of stroke care at the end of last year. Since then the Government has launched the National Stroke Strategy laying out a blueprint for improved stroke care. As a result we are now seeing a new dynamism around the country to make up for lost time and to radically transform all aspects of stroke care. However, as this report clearly demonstrates, we have a long way to travel before stroke services in England reach the standard boasted by many parts of the developed world.”
Notes to editors
The North West Stroke Collaborative
During the collaborative, all 31 hospitals in the North West that provide acute stroke care will be invited to participate in this programme. The collaborative will engage frontline teams from each organisation in the re-design of care. If successful, the teams will have the potential to significantly improve stroke outcomes. In pilot work, the investigators found that 30% more stroke patients survived than would be expected before the changes and fewer had long-term disability.
Their goal will be to implement a set of evidence-based interventions measured Royal College of Physician's National Sentinel Stroke Audit. Currently they achieve 65% success with these measures - our aim is that teams in the collaborative will improve to 90% compliance by 2010. To reflect this ambitious goal the investigators have named the collaborative 'Stroke 9010'.
At the start of the project, hospitals will be divided into two groups. Half will participate in the project immediately, the other half will have a delayed entry (at one year). This will allow them to be used as a control group against which the impact of collaborative participation can be evaluated. Teams will focus on improving systems of care to ensure reliable brain imaging, swallowing assessment and aspirin (if appropriate), all within 24 hours of a stroke. In year two all teams will work together in learning sets to accelerate the rate of progress even further.
Dr Maxine Power Director of Quality Improvement at Salford Royal Hospitals NHS Foundation Trust will lead the project, which has been designed as a result of her experience in the United States. It is the first time that an improvement programme for stroke has been attempted on this scale in the UK.
The Quest for Quality and Improvement
This research report forms part of The Health Foundation’s £2.5 million, five-year QQUIP (pronounced cue-kwip) research initiative which stands for the Quest for Quality and Improved Performance. QQUIP is led by a team of four internationally renowned academics, Professor Sheila Leatherman (University of North Carolina School of Public Health and London School of Economics and Political Science), Dr Kim Sutherland (Judge Business School, University of Cambridge), Professor Peter Smith (University of York) and Professor Gwyn Bevan (London School of Economics and Political Science).