State Of The Stroke Nation: Reorganisation Saves Lives, Staff Shortages Remain

Two reports published today from the Sentinel Stroke National Audit Programme (SSNAP) show that despite steady progress in the care of stroke patients in the UK, there are still major shortages of both nurses and doctors.  This is worrying because research shows that death rates are lower when stroke wards have higher numbers of nurses, and death rates for acutely ill patients are lower when there are more doctors available at nights and at weekends.

The audit is commissioned by the Healthcare Quality Improvement Partnership on behalf of NHS England as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP), and run by the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians (RCP).

The organisational component of SSNAP measures the staffing levels, resources and facilities available in every hospital that cares for stroke patients acutely, and also published today is the annual overview about the direct patient care element of SSNAP.  This continuously measures the care provided to patients and has reported every three months since February 2014 on the RCP’s website.

To coincide with the UK Stroke Forum beginning on 2 December, they are being published together to provide a full national and local picture of stroke care in the UK – The State of the Nation Report on Stroke services and care.

Headline results from the organisational audit – the Sentinel Stroke National Audit Programme (SSNAP) Acute Organisational Audit 2014:

• One in four hospitals has an unfilled consultant stroke physician post and there are not enough trainee doctors to fill them
• There should be 3 qualified nurses on duty at all times during the day per 10 stroke beds for stroke patients acutely. Currently only 50 out of 183 hospitals (27%) have this number on duty at 10am on weekends. Research shows that death rates are higher where there are fewer nurses
• The reorganisation of acute stroke services has been a great success, with a large increase in seven day working, enabling nearly all hospitals to provide 24/7 access to clot-busting drugs (thrombolysis)
• 3 out of 4 hospitals have access to stroke specific early supported discharge services (to enable patients to return home with the same level of expertise as they would have received in hospital), but this should be available to all stroke patients everywhere

Headline results from the overview of one year of the patient care audit – the Sentinel Stroke National Audit Programme (SSNAP), covering 74,000 patients treated between April 2013 to March 2014, provides answers to questions about the type of patient having a stroke, whether or not they are being treated quickly enough, receive enough therapy, where patients go for treatment including after their hospital stay, and whether they get the clot-busting drugs they require.  The report includes the context for the results including policy, research and patient perspectives:

• 1 in 7 stroke patients are under 60 years of age
• The average time between patients first getting symptoms and arriving at hospital is 2 hours and 25 minutes, with the quickest quarter of patients arriving in less than 1 hour 18 minutes, and the slowest quarter arriving after more than 7 hours
• 63% of patients arrived at hospital within 4 hours of first experiencing symptoms
• After arriving at hospital, the average time for a patient to have a brain scan was 1 hour and 22 minutes, to see a stroke nurse was 2 hours and 17 minutes
• Three quarters of eligible patients now receive clot-busting drugs (thrombolysis) which reduce disability
• 60% of patients who need support for mood or cognition after discharge receive the required support
• Whether patients get to a stroke unit within 4 hours of arrival varies not only according to the hospital but also within hospitals depending on the time of day and day of the week they arrive

Professor Tony Rudd, National Clinical Director for Stroke NHS England said:

It is fantastic having such high quality data available to the public and professionals describing the current state of stroke care.  Clearly care is improving but we must not be complacent.  There are still too many patients receiving sub-optimal care.  To correct these issues we need more stroke consultants and services that deliver treatment 7 days a week.