It's damn simple! You create 100% recovery protocols, and you can't see that? Everyone in stroke must be a blithering idiot with no understanding of how to solve stroke! And she's the chief executive! Heaven help us poor stroke survivors!
What ICBs can do about the growing challenge of stroke
Someone in the UK has a stroke every five minutes. By 2035, the number of people having a stroke is set to increase by 60% and, as a result, the number of stroke survivors in the UK is expected to almost double to 2.1 million. While stroke is the fourth leading cause of death in the UK and advances in treatment and care have seen survival rates increase, it is still a leading cause of adult disability.
The huge burden of stroke is both understood and recognised and is why cardiovascular disease(WOW! No knowledge that Stroke has been called neurological disease by the WHO since 2006!)
prevention remains a key Government ambition for 2025/26 – even within their slimmed down set of priorities. But prevention alone isn’t enough. Reducing the number of strokes is critical but we must also prioritise ensuring every stroke patient can rehabilitate and recover well, as this is one of the biggest drivers of long-term health and social care costs today.
It is predicted that, by 2035, the societal costs of stroke to the Government will be £75 billion – an increase of 194% over 20 years. Our ageing population means that stroke is a demographic timebomb as, by 2035, two-thirds of adults over 65 are expected to live with multiple health conditions including stroke – with younger populations also increasingly at risk of stroke. That’s why ICB leaders need to prioritise stroke as a key and fundamental component of integrated care strategies – it’s very clear that the financial, health and workforce benefits make stroke a high-return investment.
Last autumn, the Stroke Association engaged with over 350 stroke survivors, professionals, researchers, and senior NHS leaders across England to ask them about their top priorities for stroke to help shape the Government’s 10 Year Health Plan. This valuable insight has formed the basis of the Stroke Association’s latest report – Unlocking potential – a bold vision for stroke care in England, launched in Parliament. The event was supported by NHS England’s Medical Director Stephen Powis and MPs including Uma Kumaran, whose husband had a stroke last year.
The report’s recommendations closely align with the shifts expected in the 10 Year Health Plan for England of sickness to prevention, better use of technology and moving care from hospitals to communities. It highlights prehospital video triage (PVT) as an example of how the NHS can use innovation and technology to better support diagnosis and treatment of stroke. At a time when ambulance services and emergency departments are severely stretched, technology which eases that strain is to be welcomed.
PVT connects ambulance teams on the scene with hospital-based stroke specialists via a video call to assess a patient’s condition and rapidly make a diagnosis of stroke or other conditions that mimic stroke. With severe staff shortages across the stroke pathway , this makes the best use of both generalist and specialist professionals’ skills and time. Patients can be conveyed to the nearest stroke centre and tests to confirm stroke, including CT scans, can be expedited on arrival so that patients are diagnosed quickly and get rapid access to specialist treatment and care in a stroke unit.
Multiple pilots funded by NHS England in areas including East Kent, London and the Midlands have shown that PVT is an effective intervention to speed up access to brain saving treatments and reduce unnecessary conveyance to hospital. When only people with a high likelihood of stroke are taken to stroke units, capacity is freed up to treat those who need it most. That means time-sensitive treatments, including thrombectomy and thrombolysis, can be administered faster to enable more stroke survivors to leave hospital on their feet instead of in a wheelchair.
This adds up in every way. Each thrombectomy saves the healthcare system £47,000 per patient over five years. In contrast, the cost of thrombolysis not being administered is high – for every 2,000 patients who do not receive thrombolysis, the NHS incurs £8.2 million in avoidable costs over five years. Not only does this make simple financial sense, but such treatments also reduce demand for recovery services and ensure the stroke patient has a better chance of living independently.
The human cost has to be considered too. Phil had a stroke on a Sunday – which meant he couldn’t have a thrombectomy as the service wasn’t available in his area on a weekend. Phil needed six months’ rehabilitation in hospital, an additional four months off work and he still lives with the various complex physical and mental side-effects today.
Yet such innovations are all too often entrenched in geographical inequality as swathes of the country are not yet consistently delivering evidence-based stroke care and so exacerbating health inequalities. Thrombectomy is one of the most effective treatments in modern medicine and should be available to all. In addition, interventions such as PVT, need to be supported to become the norm, not the exception, regardless of postcode.
PVT is just one way in which regional stroke teams have demonstrated pockets of innovation to support better patient care. There are others including virtual rehabilitation and digitally enhanced post-stroke support to allow recovery at home; and Early Supported Discharge (ESD) to reduce the length of hospital stays and support independent living.
Significant gaps remain in rehabilitation and long-term support for the thousands of stroke survivors who are left unable to work or live independently. ESD should provide stroke survivors with the same quality and quantity of rehabilitation they would receive in hospital but within their own home. Yet in 2023/24, only 55% of stroke patients received this. In addition, there’s huge regional disparities – in Greater Manchester 83% of patients received ESD, but in Kent and Medway only 36% did.
Without urgent action on stroke, the Government target to reduce stroke and cardiovascular deaths by 25% by 2035 will not be met. Whilst there is no denying that stroke is one of the NHS’s biggest challenges, it is also one of its greatest opportunities. By investing now in stroke prevention, treatment, and rehabilitation, ICBs can reduce pressure on acute services, maximise budgets, and – most importantly – save lives and improve recoveries and quality of life for tens of thousands of stroke survivors.
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