Press Release - Reducing Brain Damage: Faster
access to better stroke care
16 November 2005
Sir John Bourn, head of the National Audit Office, reported
today that the priority afforded to stroke care by the Department
of Health and the wider health service can be increased, given its
impact and cost. Sir John’s report shows that notable progress has
been made from a low starting point. It recommends further
improvements in preventing, treating and managing stroke patients,
in line with recent evidence. These improvements would reduce the
number of deaths, improve recovery rates, increase NHS efficiency
and lead to significant financial savings.
Stroke costs about £7 billion a year. The direct cost to the NHS
is about £2.8 billion a year – more than the cost of treating
coronary heart disease – and annual costs to the wider economy
associated with lost productivity, disability and informal care are
around £4.2 billion. Stroke is one of the top three causes of death
in England and a leading cause of adult disability. Approximately
110,000 strokes and a further 20,000 Transient Ischaemic Attacks
(‘mini strokes’) occur in England every year. There are at least
300,000 people in England living with moderate to severe
disabilities as a result of stroke.
The report’s conclusions and recommendations target
areas needing attention and action:
- A fast response to stroke, including rapid access to brain
scanning, reduces the risk of death and disability. However,
Ambulance Trusts, Accident and Emergency departments, Radiology
departments and stroke teams rarely provide an effective,
integrated emergency response to stroke.
- The clinically optimal model of stroke care is care delivered
in a specialised stroke unit, and 63 per cent of patients are
accessing a stroke unit at some point in their hospital stay.
However, what constitutes a stroke unit varies considerably between
hospitals and stroke units are of insufficient size.
- Without a brain scan, treatment cannot commence safely.
Research shows that scanning all stroke patients immediately is the
most cost-effective strategy. Although most hospitals have the
capacity to provide CT scans within 24 hours of admission, in 2004
most patients waited more than two days.
- Thrombolytic (clot busting) drugs can improve patients’ chances
of recovery after a stroke, but are rarely part of acute stroke
care in England. Achieving rates of thrombolysis in England in line
with those being achieved in leading Australian hospitals could
generate net savings to the health service of over £16 million a
year, with more than 1,500 patients fully recovering from their
strokes each year who would not otherwise have done so.
- Early access to rehabilitation can restore movement, improve
recovery and reduce delayed discharges. However, access to
professionals such as psychologist, physiotherapists, occupational
and speech therapists and social workers can be patchy.
- Hospitals said that around half of patients receive
rehabilitation services that meet their needs in the first six
months after discharge, and this falls to around a fifth of
patients in the 6-12 months after discharge. There is also a
serious impact on carers which is not being addressed adequately.
The lack of clarity about how responsibilities are divided between
health and social care services is a barrier to the delivery of
patient-centred care.
- Many people still do not realise that strokes are largely
preventable and cannot list the main risk factors, or how to manage
them. Over three times as many women died of stroke than of breast
cancer in England and Wales in 2002, but 40 per cent more women
mentioned breast cancer than mentioned stroke when asked what the
top causes of death were.
- The new GPs’ contract has improved stroke prevention. Nearly
all the desired GP activities, such as measuring and controlling
blood pressure and cholesterol in those people who have had a
previous stroke or TIA will soon be achieved, except, however, the
very low referral rate for scans for people who have had a stroke
or TIA.
- Some scans and interventions are being carried out after the
time when they would have been of benefit. Around £1.2 million a
year is being inefficiently spent on scans for patients with TIA
after the critical time-period has passed. Providing carotid
surgery within two weeks to eligible patients could prevent around
250 strokes, and result in a net saving to the health service of
around £4 million, each year.
- All patients with suspected TIA should be assessed and
investigated within seven days. However, only a third of people
with TIA are seen in a TIA clinic, and the median waiting time is
14 days.
Sir John Bourn said:
"Stroke services in England have been improving and
there are pockets of excellent practice on which to draw, but many
patients are still denied fast and effective treatment and
rehabilitation services. At £7 billion a year, stroke imposes
significant economic costs. By giving stroke the attention and
status it deserves, the Department will be able to make financial
savings to the NHS and the wider economy. The NHS can help prevent
more strokes and improve treatment, care and outcomes by
re-organising services and using existing capacity more wisely.
Much can be done to achieve real improvements in patients’
prognosis, treatment and rehabilitation and to reduce the toll that
stroke takes on individuals and their families."
Notes for Editors
Definitions:
-
Carotid surgery – is performed on the carotid
arteries (the arteries in the front of the neck which make up two
of the four main blood vessels supplying the brain) to ease blood
flow to the brain.
GP contract – the General Medical Services
contract for General Practitioners, issued by the Department of
Health, stipulates the rewards available for the achievement of
certain criteria or indicators in treating patients.
TIA – Transient Ischaemic Attack, where blood
flow to the brain is temporarily disrupted, causing symptoms of
stroke but they pass quickly (often within minutes). Can be a
warning of a more severe stroke to come.
Thrombolysis / thrombolytic treatment –
clot-dissolving treatment (appropriate for ischaemic strokes only)
is given directly into a vein and currently must be administered
within three hours.
- Press notices and reports are available from the date of
publication on the NAO website at www.nao.org.uk.
Hard copies can be obtained from The Stationery Office on 0845 702
3474.
- The Comptroller and Auditor General, Sir John Bourn, is the
head of the National Audit Office which employs some 800 staff. He
and the NAO are totally independent of Government. He certifies the
accounts of all Government departments and a wide range of other
public sector bodies; and he has statutory authority to report to
Parliament on the economy, efficiency and effectiveness with which
departments and other bodies have used their resources.
Press Notice 58/05
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