While there has been rapid growth in the number of NHS services offering 6 or 7 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.
Access the full reports now on the SSNAP Acute Organisational Audit page
The study finds 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.
SSNAP, commissioned by the Healthcare Quality Improvement Partnership (HQIP) and carried out by the Royal College of Physicians’ Clinical Effectiveness and Evaluation Unit (CEEU), recommends that 7 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 7 day working, with 25% of sites having physiotherapy on 7 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.
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.
Commenting on the audit, Karin Bishop, interim head of professional practice at the College of Occupational Therapists, said:
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. Occupational Therapy improves recovery from stroke by helping people to manage daily life, overcome barriers to practical tasks and take part in the leisure activities they enjoy. We need to see much greater access to this vital support.
The SSNAP audit also shows 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.
However there are still areas of concern, for example too few patients are being admitted directly to a stroke unit. This 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.
For further information, please contact Linda Cuthbertson, head of PR, on +44 (0)203 075 1254 / 0774 877 7919, or email Linda.Cuthbertson@rcplondon.ac.uk
- The SSNAP acute organisational audit looks at the organisation of acute stroke services and not patient data. The report is now available online.
- This audit is part of the Department of Health-funded national audit programmes (commissioned by HQIP) and managed by the RCP’s CEEU. Data were collected within trusts using a standardised method.
- The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). Their purpose is to engage clinicians across England and Wales in systematic evaluation of their clinical practice against standards and to support and encourage improvement in the quality of treatment and care. The programme comprises more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. More information can be found at www.hqip.org.uk.
- This acute organisational audit report is the first report published under the auspices of the new Sentinel Stroke National Audit Programme (SSNAP). The CEEU in the RCP first conducted the National Sentinel Stroke Audit (NSSA) in 1998 and subsequently a total of seven rounds have been undertaken with 100% participation achieved since 2006.
- The audit is based on standards agreed by representatives of the Colleges and professional associations of the disciplines involved in the management of stroke.
- There is 100% participation of eligible trusts (151) in England, Wales (Health Boards) and Northern Ireland. Guernsey and the Isle of Man also participated but Jersey declined.