The following information is from Professor Anthony Rudd, National Clinical Director for Stroke NHS England; Professor of Stroke Medicine, Kings College London; and Stroke Programme Director Royal College of Physicians, London. It is in response to a request for information on where else hyper acute stroke services have been established and a challenge that the evidence does not support changes in rural areas like Kent and Medway.
The first point I would make is that stroke patients living in rural areas are exactly the same as those living in urban areas and deserve the same quality of care. The only difference in terms of process will be the travel times that may be longer for some people in Kent compared to London.
However what matters to the patient will be the ‘stroke to treatment’ times and we know from national audit data that larger, better equipped and staffed hospital treat patients more quickly than smaller units; so what may be lost in time getting to the HASU may be saved by more efficient management at the hospital.
The areas that have centralised care into larger units are:
- London – started 2010
- Manchester phase 1 (about 2010) and phase 2 (2015/16)
Both of these have data showing improved mortality and better processes of care. The Manchester data from Phase 2 as well as lots of information from London will shortly be available on the NIHR website. Phase 1 Manchester and the London data are already available in peer reviewed articles.
Northumbria reconfigured about 3 years ago centralising from 3 hospitals to one and there will be data published soon in the journal Clinical Medicine to show that this reconfiguration resulted in improved processes and outcomes as well.
- Grimsby ceased treating acute stroke about 5 years ago with all now being managed effectively in Scunthorpe.
- Scarborough patients are now managed in York.
- Royal Victoria Infirmary Newcastle now manage all patients from Newcastle and Gateshead.
- Northampton has been taking most of the acute stroke from the Kettering area and have delivered ‘SSNAP A’ care (highest standard) over the last year; compared to the two units separately previously seriously under-performing.
- Guildford ceased admitting acute stroke in 2017 and all patients now go to St Peters Chertsey and Frimley and are getting excellent care.
Planned changes: include centralising HASU care in South and Mid Essex in Basildon; Harrogate may cease admissions with patients going to Leeds; Whitehaven patients will in future probably go to Carlisle; North Devon will probably be managed in Exeter.
There are several other examples and my view is that there are likely to be further centralisation of care in coming years to enable rapid access to thrombectomy across the country.
There are lots of reasons why it makes sense to focus stroke care in a smaller number of units not least the fact that we have a major shortage of stroke specialist doctors and this is leading to major differences in care that people receive depending on the time of day and day of the week they have their stroke.