The whole problem here is measuring 'care' NOT RECOVERY! Until you get survivors in charge nothing will change for the better. SO, GET TO WORK AND TAKE OVER THE STROKE ASSOCIATION!
The only goal in stroke is 100% recovery, so start creating a strategy to GET THERE!
In-hospital stroke care provision has not improved enough over the last 10 years, says the Stroke Association
Thousands of stroke patients are missing out on lifechanging treatment and support as vital elements of in-hospital stroke care(NOT RECOVERY!) have declined over the last decade amidst increased waiting times, warns the Stroke Association.
Despite promising progress in some vital areas and the dedication of an overstretched workforce, the current healthcare ecosystem doesn’t appropriately support the 90,000 people who survive stroke every year to recover and live well afterwards.
The latest figures from the Sentinel Stroke National Audit Programme (SSNAP)1 reveal how both innovative treatments, such as thrombectomy, and basic care(NOT RECOVERY!) , such as hospital rehabilitation, are still being delivered inconsistently throughout the country.
SSNAP data found some basics in acute stroke care(NOT RECOVERY!) are now worse than they were 10 years ago. The number of people directly admitted to a specialist stroke unit within four hours of arrival at hospital stood at 46.7% in 2023/24 but 54.9% in 2019/20 before the pandemic and 58% in 2013/14. This time spent waiting dramatically increases the risk of stroke survivors facing long-term poor health and disabilities.
In addition, the number of patients spending more than 90% of their time on a specialist stroke unit when admitted to hospital has decreased in the last five years from 83.2% in 2019/20 to 75.9% in 2023/24 - which represents a drop of more than 4,400 patients. This specialist support is key to helping reduce mortality within the first 30 days and optimising stroke recovery.2
There has been an increase in people receiving integrated community-based rehabilitation, which is the preferred option for patients, and a key factor in NHS reform. However, the amount of time being spent delivering occupational therapy, physiotherapy and speech and language therapy has notably decreased over the last five years. Compounded by cuts to life-after-stroke support services, these types of care(NOT RECOVERY!) are vital to ensure stroke survivors can thrive throughout their recovery and beyond.
Although there have been significant improvements in moving patient rehabilitation from the acute sector and into the community, such support is still falling well below the 2023 National Institute for Health and Care Excellence (NICE) guidelines.3
The SSNAP data also comes alongside the latest figures from NHS England which reveal that ambulance response times for Category 2 calls, which includes stroke, increased to 42 minutes and 15 seconds in October from 36 minutes and 2 seconds in September. This is above the 30-minute target set out in the NHS England Urgent and Emergency Care Plan and at a time when the NHS experienced more pressure in October than ever before on record.
This is contributing to how people affected by stroke are taking longer to arrive at hospital from onset – the average time has increased by almost a third to nearly 250 minutes since 2013/14. Speedy treatment of stroke is crucial as 1.9 million brain cells die every minute that a stroke is left untreated, increasing the risk of serious long-term disability and even death.
Although the stroke community has improved the use of thrombectomy4 treatment - from less than 1% in 2015/16 when such data was first collated - SSNAP data shows that 3.9% of stroke patients had a thrombectomy last year. With NHS England’s target at 10% by 2027/28, this is still falling behind and there are continued regional disparities.
Similarly, thrombolysis5, a clot-busting drug, is underused. Around 20% of stroke patients are eligible for the treatment but only an average of 11.6% patients received the treatment in 2023/24 against the NHS England target of 20% by 2025 to achieve the best performance in Europe. There has been little or no variation over the last 10 years, but a sharp decline at the height of the pandemic.
The Stroke Association is calling on the Government for the 10 Year Health Plan to:
- Invest in stroke prevention, such as regular blood pressure checks, so many of the 100,000 strokes which happen every year can be prevented.
- Support the delivery of universal 24/7 access to an acute stroke unit and stroke treatments, such as thrombectomy and thrombolysis
- Support in-hospital and community rehabilitation services so that stroke survivors can live well after stroke.
Juliet Bouverie OBE, Chief Executive of the Stroke Association, said: “Despite a dedicated workforce with expert knowledge on how to help and support stroke survivors to make their fullest recoveries, the NHS stroke pathway has long been at crisis point. The recoveries of too many stroke survivors are being put at risk due to a lack of staff, spiraling waiting times and a lack of basic stroke care(NOT RECOVERY!) provision which compromises - rather than optimises - patient recovery.
“Patients have been battling what feels like a permacrisis in our healthcare which has been blighting NHS care(NOT RECOVERY!) for long enough – governmental change is long overdue, and the 10 Year Health Plan is an ideal opportunity to ensure everyone who has a stroke can survive and live well.”
The Stroke Association supports thousands of stroke survivors and their families by phone, at home, and in the community. Find out more at www.stroke.org.uk
Case Studies
Chloe Hodgkisson from Cambridgewas 37 when she had a stroke whilst on a holiday in Oxford with her husband, Ben, and their young family. She woke up early feeling faint, dizzy, and with an awful headache. She soon began experiencing sickness, reduced mobility, blurred vision, difficulty speaking and her face dropped on one side.
Ben called 111 and, following a telephone assessment, an ambulance arrived 10 minutes later. Chloe was taken to the John Radcliffe Hospital in Oxford where an MRI confirmed her diagnosis, and she had an urgent thrombectomy.
She said: “I instantly felt better after waking up from the surgery – I could speak, I could see, I could move my arms and legs – I was so relieved to have a conversation with my family again. Having a stroke stops your life completely and the recovery process gets the wheels moving again. It’s hard to explain to people who haven’t had a stroke or aren’t trained to understand it, but the trauma of it doesn’t ever go away.”
Phil Woodford, 53, from Preston had a TIA – a type of mini stroke – and full stroke the next day eight years ago. He was given thrombolysis, but he was unable to have a thrombectomy because his local hospital didn’t - and still doesn’t - provide the service on a weekend.
Phil said: "My life changed overnight. It took four months' rehabilitation in hospital and then another four months until I could return to work. My stroke caused musculoskeletal problems, permanent pain and weight gain because I'm less mobile now. I walk with a limp and my left arm sometime moves on its own and suffers from spasticity and cramps. Whilst there's no guarantee, if I had a thrombectomy, then I may well not have to be living with these disabilities."
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