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Stroke therapists must offer seven-day working

Report says there is too wide a variation in availability of stroke services

Mark Gould

Thursday, 06 December 2012

A national review of stroke services has called for a substantial increase in the number of stroke therapists so that they can offer a full six or seven day service.

While there has been rapid growth in the number of NHS services offering six- or seven-day working for acute stroke therapy, the number of therapists has not changed substantially according to the Sentinel Stroke National Audit Programme (SSNAP) acute organisational audit.

It found that there has been little increase in staff numbers since the report’s predecessor – the National Sentinel Stroke Organisational audit (2010) – and shows wide variation between hospitals.

But the audit also speaks of ‘encouraging developments’ since 2010, including:

  • an increase from 50% to 90% in 24/7 provision of thrombolysis; be it on-site or in collaboration with neighbouring sites
  • 99% of sites (100% of trusts) providing neurovascular clinics for management of transient ischemic attacks (mini strokes) with the median waiting time reduced to two days (from 12 days in 2006) for high risk TIA patients
  • a 44% to 66% increase in services providing early supported discharge after stroke
  • a dramatic change in stroke unit admission policy, with very few units now operating exclusion policies based upon age, stroke severity, pre-existing dementia, or patients being assessed as having ‘no rehabilitation potential’ or needing end of life care.

But it also spotlights areas of concern, for example too few patients are being admitted directly to a stroke unit. The audit found that two thirds of sites (129) still use medical assessment units (MAU) on occasion and 19% of sites have a policy of directly admitting their patients to an MAU rather than a stroke unit.

“This is not good practice as the quality of care stroke patients receive on an MAU is substantially lower than that received by patients admitted directly to a stroke unit,” the audit concludes.

SSNAP recommends that seven-day working for therapists is to be encouraged, “but should happen in a way that ensures overall service quality does not fall and does not come at the expense of care in normal working hours”.

There has been an increase in seven-day working, with 25% of sites having physiotherapy on seven-day rotas (up from 12% in 2010), while the average length of a patient’s stay has reduced.

The number of therapists has not changed, suggesting patient contact time with therapists is decreasing. Care therefore needs to be taken not to reduce the patient’s quality or quantity of therapy following a stroke.

The audit was commissioned by the Healthcare Quality Improvement Partnership (HQIP) and carried out by the Royal College of Physicians’ Clinical Effectiveness and Evaluation Unit (CEEU).

Professor Tony Rudd, associate director, Royal College of Physicians’ CEEU, and chair of the Intercollegiate Stroke Working Party said:

“Many aspects of stroke care in England, Wales and Northern Ireland have improved dramatically over recent years showing the success of the national stroke strategies. There is however still a lot to do to ensure that all patients receive the highest quality of care, not just in the early days after a stroke but also for the months and years that follow. Much more attention now needs to be paid to solving the problem that patients do not receive sufficient rehabilitation either in hospital or in the community, to ensure that they achieve the best possible outcomes.”

Karin Bishop, interim head of professional practice at the College of Occupational Therapists, agreed that there was a need for “much greater access to this vital support”.

“There have been some welcome improvements in Occupational Therapy stroke care including a 12% increase in hospital provision across England, Wales and Northern Ireland. Importantly, Occupational Therapy is now available in all Early Supported Discharge (EDS) services, reducing the time people spend in hospital following a stroke,” she added.

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