​A ticking time-bomb for stroke care

New figures show that the number of stroke professionals across most of the UK is at a worryingly low level. This puts thousands of lives at risk and leaves many more stroke survivors under threat of a lifetime of severe disability, according to the Stroke Association.

The charity highlighted the new findings from the Sentinel Stroke National Audit Programme’s (SSNAP) Acute Organisational Audit Report⁽ⁱ⁾. The report reveals that there is large variation in access to the services that stroke patients need. This is common throughout hospitals in England, Wales and Northern Ireland.

Stroke is the fourth biggest killer and a leading cause of adult disability in the UK. According to these figures, nearly half (48%) of all hospitals have had at least one stroke consultant post unfilled⁽ⁱⁱ⁾ (up from 40% in 2016⁽ⁱⁱⁱ⁾) for their stroke units for at least 12 months. With these gaping holes in staffing levels of experienced stroke professionals, people’s recoveries from stroke are being jeopardised.

The charity’s Chief Executive, Juliet Bouverie, said: “Unless these workforce issues are urgently addressed, we are hurtling our way to a major stroke crisis in the next few years. The highest standards of stroke treatment and rehabilitation must be available to all. Stroke happens in the brain, the control centre for who we are and what we can do. The progress in stroke treatment and care over the past 10 years run the risk of being wasted without experienced doctors to deliver world class stroke services.

“The lack of senior doctors and also of trainees to fill these gaps is worsening and is a ticking time-bomb for an already stretched health service. The stroke skills gap threatens the sustainability of many services and puts increased pressure on local hospitals. There are over 100,000 strokes every year in the UK and this is estimated to rise to 150,000 over the next five years^(iv), which will increase the pressure on stroke wards further.

“Nearly half of the hospitals in England, Wales and Northern Ireland have under-staffed stroke wards and the problem has grown since the last report published in 2016. In England, we are working with NHS England to ensure that stroke is a priority, and we want to see positive change in their forthcoming People Plan to solve this long overdue issue.

“We are deeply concerned by the rate at which highly qualified stroke doctors are leaving the profession and the slow uptake of stroke medicine by new doctors. Stroke happens in the brain and therefore requires highly expert and specialist knowledge. Training new doctors is vital to giving stroke patients the best chance of survival, but it’s also essential that other stroke professionals such as specialist nurses and therapists are also recruited and trained to ensure that stroke patients get the best possible care through their recoveries.

“This report makes some welcome recommendations to address the challenges. Government; NHS England and its arm’s length bodies and health and social authorities across the UK must act now to ensure that stroke survivors get the world-class treatment and care they deserve. We support the recommendations made last year by the British Association of Stroke Physicians^(v) around how to meet the big challenges the stroke workforce faces. At the Stroke Association, we will also play our part by providing high quality emotional, practical and social support services to help people to rebuild their lives after stroke.”

In the report, Professor Martin James, Clinical Director of the King’s College Stroke Programme, said: “This year’s audit also highlights some areas in need of urgent corrective action, including aspects of services that have deteriorated in the last three years. The most striking of these is the worsening situation with trainee and senior medical (consultant) staffing in many centres, with nearly half of all acute sites now carrying at least one consultant vacancy for a median of 12 months. This is already jeopardising the sustainability of many services and forcing service reconfiguration, and even if decisive corrective action were taken now to improve the pipeline of doctors training in stroke medicine this would come too late to remedy the situation for some services.”

Professor Tom Robinson, outgoing President of the British Association of Stroke Physicians and Professor of Stroke Medicine at the University of Leicester, said: “With more than 100,000 strokes in the UK each year, we must urgently address the lack of professional stroke staff to ensure that patients have access to the best treatment as quickly as possible.

“Great advances have been made in the medicines and procedures available to patients, but to offer these treatments to as many patients as possible, we need more doctors to be trained in stroke medicine. Improving stroke care and modernising the stroke workforce is a key part of the NHS Long Term Plan, and we look forward to working with NHS England and others to help give everyone affected by stroke the best possible care.”

Other key findings in the SSNAP report include:

• Only one in 14 (7%) hospitals have enough clinical psychology staff
• A rise of 7% in the number of hospitals that provide two of either physio, occupational or speech therapies on weekends, although the physical effects of stroke are only one half of the picture.

For more information about the Stroke Association’s work on the National Stroke Programme visit www.stroke.org.uk/strokeprogramme.