Professor Sir Stephen Powis: Fighting back against stroke - Healthcare Today

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Professor Sir Stephen Powis: Fighting back against stroke - Healthcare Today

The former National Medical Director of NHS England and current Maulin Group Advisory Board Member and Clinical Ambassador for the Stroke Association, talks about prevention, rehabilitation and unfinished business.

Having run NHS England between 2018 and 2025 as National Medical Director, and as the former executive lead for the NHS national cardiovascular disease, respiratory disease, stroke and prevention programmes, Professor Sir Stephen Powis has seen public health battle one health crisis after another. Now retired, he’s set his sights on effecting real change in stroke management.

Here, the Maulin Group Advisory Board Member and Clinical Ambassador for the Stroke Association talks about prevention, rehabilitation and unfinished business…

 

What drew you to stepping up as Clinical Ambassador for the Stroke Association after stepping down from your national post?

The National Stroke programme was part of my portfolio at NHS England when I arrived as National Medical Director in early 2018. 

In the acute stroke area, we set a particular ambition around mechanical thrombectomy – that’s the procedure where, for around 10% of patients, a radiologist can remove the clot causing the stroke. It’s one of the most effective procedures in the NHS.

We settled on a model with 24 major neuroscience locations in England as comprehensive stroke centres to deliver this service. The task was to get them running 24 hours a day, seven days a week, to hit that 10% target, and, while we have made some progress, the efforts were not enough. Workforce issues and a lack of interventional radiologists are constraints. As are financial issues and kit issues. 

The figure we’re currently at is around 5%, so we’re almost halfway towards our target. 

When I stepped down from NHS England last summer, I said to the Stroke Association that I would be happy to continue with this work. For me, it’s unfinished business. 

It also means I can do some work in Scotland, Northern Ireland and Wales. And I can give advice on a range of other issues, including prevention and rehabilitation. 

 

How well are integrated stroke delivery networks functioning in practice? Are they delivering the improvements that policymakers want?

The networks work well by bringing people together to collaborate and by having that system-level view. That’s really important in strokes. That entire pathway from ambulance to local stroke unit to thrombectomy centre has to work well and involves not just one organisation. 

A delivery programme that can bring all those constituent parts together into a single forum for optimising that pathway is really important, and that’s what networks do. 

Everywhere I go, people point out the value of having a network to take on that role. They’re relatively small teams performing a key role and I’m a big supporter of them.

 

“I’m a proponent of doing our best to support people in what are often relatively small teams.”

 

 

Given your experience at NHS England, is the NHS’s current approach to prevention of strokes, particularly around hypertension, atrial fibrillation, obesity and smoking, going far enough?

We have done pretty well on atrial fibrillation and we have met the ambition we had back in 2019. On high blood pressure, we’re part of the way there. In absolute numbers, they have been increasing because the number of people with potentially high blood pressure has been changing. On other risk factors like smoking, we have smoking cessation programmes. 

There’s a major conditions framework plan for cardiovascular disease, which will be the opportunity to look at how we’re doing on these risk factors. The key thing is that the risk factors are well known. It’s all around how you set up your health services to target those. 

I’m a proponent of doing our best to support people in what are often relatively small teams and I hope that they continue to be part of the overall way in which we improve.

 

Stroke Association research shows dramatic geographical and socioeconomic disparities; how do we shift the dial on that inequality? 

If you look back at where we were, we have made great advances. We have seen a steady reduction in smoking and a lot of the improvement has come from a sustained effort. 

We need to think of more innovative ways. If you use very targeted approaches, you can deal with the health inequalities issue. 

Through the determination of a practice and using a bunch of methodologies, you can make a difference in areas you think might be quite hard. With the right targeting and the right support, you can do it.

Rehabilitation remains a significant pressure point for stroke survivors. Where is the system failing? How could rehabilitation pathways be redesigned?

There is quite a variation in rehabilitation services. Sometimes we see excellent services; sometimes the services are struggling. The Stroke Association has been supporting improvement work in this latter area. 

Everybody’s rehabilitation needs are different. One of the things to think about is how you get that balance between a standard offering and a bespoke offering. There is some overlap with other rehabilitation services, and we are able to bring the rehabilitation teams from various speciality teams together. 

We have to make sure that we’re not working in silos on rehabilitation. And make sure that we are making the best use of a rehabilitation community. 

There’s an opportunity for innovation in how to get individual rehabilitation aligned with the standardised approaches that you inevitably end up with when you organise and commission these things. 

 

Is thrombolysis the answer to better treatment?

Thrombolysis is definitely effective and needs to be used where appropriate. That is something we focused on. Our message has been that none of these things should be used in isolation. 

If you are looking at improving thrombectomy, you need to be looking at improving your thrombolysis rates as well. All of this comes down to a really effective pathway. What we want is when somebody has symptoms of stroke, getting people to call early and ensuring the ambulance service gets there quickly. 

An innovation we are rolling out is video triage. We’re now using AI-supported software so stroke clinicians can see the CT scans and have AI-driven interpretation for decision support. That means that the clinician can be phoning the thrombectomy centre within seconds. All of these incremental changes are cumulatively making a difference. It’s not just about getting somebody to a thrombectomy centre. It’s about getting there quickly. 

 

“My role now is to be a critical friend with the Stroke Association.”

 

 

Looking back at your time as National Medical Director, what do you wish you could have achieved in stroke care(NOT RECOVERY!) but didn’t?

I wish we could have been further ahead. We did have the pandemic to deal with, and that put a dent in our progress, but I’m also proud of everything the NHS did to manage the pandemic. 

 

As Clinical Ambassador, where do you think the Stroke Association can most effectively influence national policy?

I’m keen that we involve our charity partners in policy development and implementation. The Stroke Programme board is co-chaired by the chief executive of the Stroke Association, and we need them to be our critical friends. 

My role now is to be a critical friend with the Stroke Association. The Stroke Association does this by supporting policy where it needs to, calling out where it thinks it needs to be different, recognising challenges, and helping when it can in overcoming those challenges. 

They do wonderful things supporting leadership development. It’s also around the Stroke Association, helping local services to overcome local challenges to deliver national policy. 

I’m confident that the government and NHS England will continue to involve the charity sector. Why wouldn’t you? There’s a huge amount of expertise and patient experience.