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Charity calls for major reorganisation of stroke care

Stroke Association says small units must close to focus care in centres of excellence

Mark Gould

Monday, 06 February 2017

The Stroke Association says that dozens of small stroke units should be shut and the service reorganised into fewer centres of excellence in order to improve care. Juliet Bouverie, the charity’s chief executive, says the the NHS should follow the highly successful example of the NHS in London in centralising stroke treatment at a much smaller number of hospitals which has increased survival rates and reduced risk of long-term disability.

Ms Bouverie says that while reconfiguration is controversial, patients and their families generally understand that travelling longer distances to get a higher standard of care and reduce the risk of dying is worthwhile.

“At the moment there are 126 hospitals in England which routinely admit stroke patients. That number needs to be reduced to somewhere between 75 and 100. But progress on that is very variable across the country and so unnecessary costs are being incurred and unnecessary mortality is happening,” she said.

She urged the NHS to learn from studies showing that scores of lives are being saved every year by the reorganisation of stroke units in London over a decade ago. “Previously there were more than 20 hospitals providing acute care in London and there was strong evidence that actually reducing the number of acute stroke units and creating a hub and spoke model [of bigger hospitals supporting smaller ones] on stroke would not only save lives but it would also save the NHS money.

“The Stroke Association says evidence shows that each year more than 100 patients extra are saved as a consequence of these changes and that a similar reorganisation is happening in Manchester, with equivalent numbers of lives saved.

“Centres of excellence would offer better care by having larger numbers of patients and would tackle the shortage of specialist doctors and nurses by concentrating them in fewer places. They could then offer patients clot-busting drugs and, potentially, 35 to 50 could undergo a new surgical procedure called mechanical thrombectomy, in which even large blood clots in the brain can be enclosed in a stent. Many more hospitals than the current handful should be offering the £7,000-a-time “game-changer” operation, said Bouverie.

Ms Bouverie says that hospitals’ self-interest is “stalling” what should be an NHS-wide drive to improve stroke care. “Too many hospitals are protecting their own interests and not doing what is in patients’ best interests. No hospital wants to give up some of those life-saving treatments, but it’s not in patients’ interests for these smaller hospitals to be delivering services.”

Bouvrie added that too many of the Sustainability and Transformation Plans being drawn up across England do not include clear ways of reorganising stroke care, despite evidence that fewer units reduce the risk of death and disability.

Tony Rudd, the national clinical director for stroke at NHS England, says: “The changes to stroke services in London have saved lives, proving it is right to concentrate expertise in selected centres. One advantage of the local planning arrangements is they can identify where there are opportunities to provide this more focused care for stroke patients.”

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