Stroke in the UK: Mind the Gap!

The third annual SSNAP report, Mind the Gap!, launched today (Tuesday 29 November), reveals that despite stroke care continuing to improve year on year, much more work is still required to ensure that all patients have access to high quality care regardless of where they live or when they are admitted to hospital.

SSNAP measures both the processes of care (clinical audit) provided to stroke patients, as well as the structure of stroke services (organisational audit), including staffing levels against evidence-based standards. The overall aim of SSNAP is to provide timely information to clinicians, commissioners, patients, and the public on how well stroke care is being delivered so it can be used as a tool to improve the quality of care that is provided to patients. You can access the latest results on SSNAP's website.

Written with patient representatives, stroke clinicians, and stroke research professionals, this annual report uses results from both the clinical and organisational audits run by SSNAP to show what aspects of stroke care are improving or getting worse over time. Both important acute interventions like scanning and clot busting treatment (thrombolysis) and the services that are available to patients after leaving hospital are covered in this report.

In addition SSNAP data have also been used and published in scientific journals to provide evidence for how the processes and structure of stroke care could be organised to provide better quality of care to people with stroke and improve chances of recovery. This report illustrates the power of SSNAP data and demonstrates how it can be used to influence future practices of healthcare for stroke patients, policy decisions, and decisions on the future direction of stroke within the NHS. This report, coupled with our National Clinical Guideline for Stroke 2016, could also inspire researchers to identify some key questions on stroke that still need to be answered. You will be able to access Mind the Gap! from 7.30am on 29 November 2016.

Important headlines from this annual report for 2016 include:

• There have been remarkable improvements in stroke care since we first produced guidelines for stroke and audited stroke services against them nearly 20 years ago.
• There have also been improvements in stroke care evident since SSNAP began collecting patient data in January 2013.
• Brain scanning times have improved (47.5% of people are now scanned within an hour of arrival in hospital, compared to 41.9% in 2014), and more than 90% scanned within 12 hours of arrival.
• Average (median) door to needle times for thrombolysis has improved to 55 minutes in 2015/16 compared to 58 minutes in 2013/14. The faster thrombolysis is administered the better the chances of recovery for patients.
• Patients are being assessed by stroke consultants and nurses faster than in previous years. This is encouraging as it allows rapid delivery of important treatments that patients need.
• Only 16.6% of patients are having intermittent pneumatic compression applied, which has been shown to reduce the frequency of deep vein thrombosis, which is a much lower than expected uptake.
• There are concerns that 40% of acute trusts report at least one vacant stroke consultant post.
• There is a concern that not all units have enough specialist nurses to ensure high-quality care for all patients.
• While more therapists are working at weekends, very few sites (6%) have availability of speech and language therapists 7 days a week. These specialists are needed not just to provide advice about communication problems, but are vital for the management of swallowing difficulties after stroke.
• There remain significant regional variations in the services that people receive following discharge from hospital. Early supported discharge, a highly valued service which reduces length of stay in hospital, is not available throughout the country and only a minority of patients are being assessed at 6 months after stroke (29.9%) to review recovery progress and decide if further care is needed.

Since SSNAP started collecting patient level data in January 2013 more than 235,000 patient records have been reported on. Over 95% of expected stroke cases are being entered to SSNAP by providers in England and Wales, with case ascertainment in Northern Ireland now steadily improving. There was also 100% participation in this year’s acute organisational audit. This means that the data presented in this report from both of these complementary audits are complete and robust.

SSNAP is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme (NCA). The audit is led by the Royal College of Physicians Clinical Effectiveness and Evaluation Unit on behalf of the Intercollegiate Stroke Working Party. It covers over 95% of all stroke admissions in England, Wales, and Northern Ireland and involves all stroke units.

Professor Pippa Tyrrell, professor of stroke medicine and consultant stroke physician, Salford Royal NHS Foundation Trust, said:

It is heartening to see the continued improvement in stroke services in the NHS and the SSNAP audit provides us with so much data on nearly everyone admitted to acute stroke services that we can now show how improved care saves lives and reduces disability. There is still a great deal to be done to ensure that everyone with acute stroke gets the evidence-based care that they need, and that they and their carers feel well supported.

Please see also the RCP media release Are stroke services in the NHS still improving? covering the Sentinel Stroke National Audit Programme (SSNAP) 2016 Acute Organisational Audit – which also launches today.