Guidance to the national health service on stroke care is contained in the national stroke strategy. In addition, stroke is a priority area for the NHS and there is a Tier 1 Vital Sign covering the time stroke patients spend in a stroke unit and the percentage of higher risk transient ischaemic attack patients who are treated within 24 hours.
This Vital Sign is a new data collection. Following the first two quarters of data and at the request of the NHS, the vital signs guidance was revised to help improve data accuracy. This included aligning the International Classification of Diseases codes with the Sentinel Audit and clearer definitions. This revised Guidance was made available to the NHS on 27 March 2009 and a copy has been placed in the Library.
Stroke is included as a priority for the national health service in the operating framework. The stroke strategy recommends that everyone who can benefit from urgent stroke care should be transferred to an acute stroke centre that provides 24-hour access to scans and specialist stroke care. All hospitals now provide computed axial tomography scanning and most provide magnetic resonance imaging and carotid doppler too. The Department published an imaging guide in 2008, to help ensure that imaging services develop in line with the quality markers in the national stroke strategy. A copy has been placed in the Library. The guide has been welcomed by the profession. The latest National Sentinel Audit of stroke from the Royal College of Physicians shows that the number of stroke units providing thrombolysis is increasing. However, provision of these services out of hours remains a challenge. Local stroke networks have been established to assist in reviewing and organising the delivery of improved stroke services. This includes ensuring access to scanning and the provision of thrombolysis where appropriate.
Stroke is included as a priority for the national health service in the operating framework.
Those with a suspected stroke or transient ischaemic attack (TIA or minor stroke) should immediately be referred for appropriate, urgent, specialist assessment and investigation including access to imaging and necessary treatment. The stroke strategy recommends that local referral protocols should be agreed between primary and secondary care to facilitate the timely assessment of people who have had a suspected TIA. The Department published an imaging guide in 2008, to help ensure that imaging services develop in line with the quality markers in the national stroke strategy. The guide has been welcomed by the profession. A copy has already been placed in the Library.
The strategy also recommends that people with suspected acute stroke should be transferred immediately by ambulance to a receiving hospital that provides hyper-acute stroke services including expert clinical assessment, timely imaging and intravenous thrombolysis over 24-hours. Local stroke networks have been established to assist in the reviewing and organising of the delivery of improved stroke services across the pathway.
This includes assessment, imaging and appropriate follow up treatment.
Ensuring that people have access to appropriate stroke services is a matter for the national health service locally. In rural areas, this could include the development of tele-radiology and tele-medicine. We have set up the Stroke Improvement programme and local stroke care networks to support the NHS to deliver world class stroke services.