Published by NHS England and NHS Improvement: June 2019
Rolling out expert stroke teams across the country as part of the NHS Long Term Plan will ensure thousands more people ‘survive and thrive.'
Professor Stephen Powis, NHS national medical director, has revealed that the NHS has already saved hundreds more lives through the introduction of stroke networks across two major cities.
Speaking at the NHS Confederation conference, Professor Powis cited a major new study which found 170 extra lives are saved a year in London and Manchester alone thanks to the establishment of Hyper Acute Stroke Units (HASUs).
The units bring experts and equipment under one roof to provide world-class care and treatment around the clock, reducing death rates and long-term disability.
Working at the centre of a network of local hospitals, the units give patients faster access to specialist diagnosis and treatment, such as brain scans, clot-busting drugs and mechanical thrombectomy.
Patients treated at the specialist centres also spend less time in hospital, which is better for them and frees up staff and beds to care for more patients.
Professor Powis, who leads the NHS National Stroke Programme alongside the head of the Stroke Association, is expected to say: “Tackling killer conditions like stroke is a key part of our Long Term Plan for the NHS.
“Introducing quicker access to better treatment for stroke in London and here in Manchester has saved hundreds of lives and we now want to see them rolled out across the whole of the country.
“As clinicians and as leaders we have a responsibility to drive this forward and to make the case for change, because we know that the prize is so great: thousands more people surviving and thriving after stroke.”
The Stroke Association has backed the national roll-out, saying that the report showed centres of excellence can save more lives and speed recovery.
Juliet Bouverie, Chief Executive of the Stroke Association, said: “When stroke strikes, part of your brain shuts down. And so does a part of you. That’s because a stroke happens in the brain, the control centre for who we are and what we can do. The evidence shows that reorganising stroke services to create stroke centres of excellence saves more lives and enables survivors to leave hospital sooner to start their recoveries at home. That’s why it’s so important this is a key part of the NHS Long Term Plan.
“It’s a straightforward formula: get to the right hospital so that you are properly assessed and can receive the right treatment by the appropriate specialists round the clock. Time lost is brain lost. We cannot afford to delay this progressive approach, that is based on research and evidence.”
The NHS Long Term Plan committed to renewed action on the major killers such as stroke and heart attack including a joined-up network of stroke specialists providing emergency care 24 hours a day, seven days a week, followed by specialist rehabilitation, across the whole country.
The units have operated in London since 2010 and Manchester since 2015.
Prior to their introduction, patients were taken to the nearest hospital A&E department in the capital to receive immediate care, followed by treatment on a general ward.
An independent analysis into the change showed that patients are now more likely to receive the right treatment sooner, and are therefore more likely to survive and recover faster.
The recent study from University College London, funded by the National Institute for Health Research, reviewed data from 500,000 hospital admissions for patients between 2008 and 2016 and compared the rate of stroke survival and the time patients spent in hospitals in London and Greater Manchester compared with other urban areas in England.
Chief Investigator, Professor Naomi Fulop (UCL Department of Applied Health Research), who led the UCL evaluation, said: "Our research provides robust evidence for centralising acute stroke services in urban areas. This may mean that patients are taken by ambulance past their local hospital to a specialist centre in order to save lives. We have also shown that it is possible to sustain improvements over time. These findings mean that other urban areas should seriously consider adopting a similar model.”
The latest insight follows an analysis of specialist care in Northumbria, which found patients received brain scans and thrombolysis medication 25 minutes faster than before the changes to services, while across the three units stroke patients were able to reduce their stay in hospital by five days.
Professor Powis will also point to the necessity of NHS action to help more people to avoid having a stroke in the first place, by taking a more proactive approach to identifying those with cardiovascular problems and helping them to manage their condition before it gets worse.
More than three in five strokes could be prevented if major risk factors were managed effectively, such as treating high blood pressure and high cholesterol through lifestyle changes and medication.
The NHS Long Term Plan aims to cut strokes and heart attacks by identifying and treating people who have atrial fibrillation, high blood pressure and high cholesterol – significant causes of cardiovascular disease and stroke.
As part of this, a new £9m programme has been launched to target and provide tailored support to 20,000 people living with heart problems in 23 areas with the highest rates of stroke.
The scheme will see specialist nurses and clinical pharmacists identify those who have been diagnosed with atrial fibrillation but aren’t receiving treatment, so that they can be offered a personalised treatment plan developed with their GP.
NHS bosses expect that this proactive approach, based on a successful pilot scheme in south London, will help prevent around 700 strokes, saving an estimated 200 lives, and provide a model for the rest of the country to follow.