5 November 2009 By Clare Lomas
Fewer than 40 per cent of acute and specialist trusts are achieving the required standards of stroke care.
Stroke care was one of 13 national priority performance indicators in the Care Quality Commission’s annual health check for the first time this year. All acute and specialist trusts where the indicator applied were measured on their performance.
Challenging financial times mean focusing on major priorities, but managers need to recognise the importance of stroke care and ensure it is not overridden
Analysis by HSJ of the CQC’s ratings for 2008-09, published last month, reveals only 37 per cent of the 150 acute and specialist trusts measured achieved the stroke target. Forty-seven per cent “underachieved” and 16 per cent failed.
The acute stroke indicator is assessed using eight standards from the Royal College of Physicians’ national sentinel stroke audit 2008 (see box).
Trusts must also have at least 60 per cent of stroke patients spending 90 per cent of their hospital stay on a stroke unit.
NHS East of England had the worst regional performance rating with more than 70 per cent of the 17 acute and specialist trusts measured in the region not achieving the stroke indicator.
National clinical director for stroke Roger Boyle said trusts “still have some way to go” to achieve the world class services set out in the national stroke strategy, published in December 2007.
“Striking the right balance between providing good local infrastructure and the benefits of a centralised 24/7 stroke unit can take time to implement,” he said.
“The NHS needs to continue developing robust systems for direct admission to a stroke unit whenever appropriate and work across boundaries to implement early supported discharge arrangements.
“With better bed management we could see significant improvement in performance,” he added.
NHS East of England head of service and development Sally Standley said “considerable improvements” had been made since the 2008-09 audit was undertaken, but admitted attention “still needs to be focused more fully” on stroke care.
“One of the big issues we identified is that patients in accident and emergency are not always recognised as needing to get into a stroke unit,” she said. “We need to incentivise trusts to move faster, identify stroke patients early and route them [to a stroke unit] as swiftly as possible,” she added.
NHS East of England has set a target that, by 2010-11, 90 per cent of patients admitted to hospital with a stroke will be transferred to an acute stroke unit within four hours.
In the North West, Aintree University Hospitals Foundation Trust was one of just seven trusts to achieve the required standard. Lead consultant for stroke Anil Sharma said “clear, seamless” patient pathways and more investment in stroke and radiology services were required to improve care.
“Challenging financial times mean focusing on major priorities, but managers need to recognise the importance of stroke care and ensure it is not overridden,” said Dr Sharma.
In London, where Healthcare for London is establishing eight hyper-acute stroke units, 43 per cent of trusts met the standard.
King’s College Hospital in south London, designated a hyper-acute stroke unit this July, now sees 90 per cent of stroke patients spend 90 per cent of their hospital stay on the unit.
But Bromley Hospitals Trust and Queen Elizabeth Hospital Trust failed the stroke indicator, and Queen Mary’s Hospital in Sidcup was classed as underachieving. In April 2009, the three trusts merged to form South London Healthcare Trust, which should significantly improve stroke services, chief executive Chris Streather told HSJ.
Trying to run three separate units had meant a diluted workforce, with clinical staff spread too thinly to be able to become experts in stroke care, he said.
“We also need improvements in leadership so stroke care is given the same priority as heart disease and cancer,” he said.
An NHS West Midlands spokesperson said the five trusts out of 15 that achieved the stroke indicator had redesigned the patient pathway.
Next year the Care Quality Commission is to review stroke patient pathways in England.
Stroke indicator 1
Eight aggregated elements taken from Royal College of Physicians national sentinel audit 2008
- A swallow screen within 24 hours of admission
- A brain scan within 24 hours of stroke
- Aspirin within 48 hours of admission
- Physiotherapy within 72 hours of admission
- Patients to be weighed during admission
- Occupational therapy within four working days of admission
- The patient’s mood to be assessed on discharge
- Rehabilitation goals to be agreed
Stroke indicator 2
Achieved
Greater than or equal to 60 per cent of patients on stroke unit spending more than 90 per cent of their hospital stay on the unit
Underachieved
Greater than or equal to 40 per cent of patients on stroke unit spending more than 90 per cent of their hospital stay on the unit
Failed
Less than 40 per cent of patients on stroke unit spending more than 90 per cent of their stay on the unit
SHA performance on stroke care
SHA / Number of specialist or acute trusts assessed / % that achieved indicator
South West / 17 / 53
North East / 8 /50
London /26 / 43
East Midlands / 8 / 37
Yorks and the Humber / 14 / 36
South Central / 9 / 34
South East Coast / 12 / 34
West Midlands / 15 /34
North West / 23 / 31
East of England / 17 / 29
