Improving care for stroke patients in the UK

UCL research led by Professor Naomi Fulop has changed to the way UK hospital stroke services are organised, improving care for 20,000 stroke patients and saving 68 lives each year.

Stroke patients who get better care are not only more likely to survive but will also make a better recovery, improving the quality of their lives afterwards. Professor Naomi Fulop (UCL Department of Applied Health Research) has led a major NIHR-funded research project to study the effects of centralising hospital stroke services in urban areas on patient survival, quality of care and value for money.  

The research analysed national data on hospital admissions, deaths and stroke care; it also used interviews with staff, patients, and carers to learn how such changes are planned, carried out and sustained. The research compared two urban areas which had centralised stroke care services in 2010 but used different approaches: London, which gave all stroke patients access to its specialist units, and Greater Manchester, which restricted access to those who reached hospital within four hours of their stroke.  

Specialist units deliver high quality care 

Findings revealed that both areas reduced patient hospital stays more than the rest of England, but only London reduced patient deaths significantly more than in other urban areas. While both centralisations offered value for money, the research showed that this was down to more lives being saved in London, and shorter hospital stays in Manchester.

By having no restrictions on which stroke patients could access specialist units, London’s services were clearly understood, resulting in more stroke patients getting specialist care. London’s services had to meet quality standards, which meant specialist units were more likely to deliver high quality care. Additional support from London’s stroke networks helped ensure the services met these standards quickly. 

One piece of evidence – that up to 50 patient deaths could be avoided in Greater Manchester each year by opening up access to all stroke patients – directly spurred further centralisation of stroke services in Greater Manchester, and was central to the publicity campaign that won local support for further change in stroke care.  

After Greater Manchester further centralised their stroke services in 2015, 86% of stroke patients were treated in a specialist unit. This resulted in 68 fewer deaths per year and improved care for 20,000 stroke patients up until 2020. 

Greater Manchester and London’s stroke services are now among the highest performing in England, regularly achieving national stroke audit ‘A’ or ‘B’ ratings, which indicate world class care. Professor Fulop’s evidence on the benefits of sustaining centralised stroke care have helped convince commissioners to continue funding London’s system, which is now seen as an aspirational model for improving stroke care in other areas.  

Implementing changes across the UK 

The UCL work has influenced planning of stroke services both locally and nationally. In local regions, the findings have influenced 15 ‘case for change documents’ across the English NHS and now three stroke services across South and West Yorkshire and North Cumbria have been centralised. In addition, the findings were used by change leaders in Kent and Medway during a judicial review of their plans to centralise local stroke services; the judicial review ruled in favour of the changes in early 2020.    

Nationally, the UCL work has informed NHS England’s Five Year Forward View and clinical guidelines for stroke, the National Clinical Strategy for Scotland and proposals to reorganise stroke services in Northern Ireland. The team’s findings on stroke outcomes was cited in the NHS Long Term Plan, and helped secure greater resources for development of stroke services across the whole of the English NHS over the coming years. 

The research team also included Professor Steve Morris, Dr Angus Ramsay and Rachel Hunter. 

Links

• Professor Naomi Fulop’s academic profile 
• Professor Steve Morris’s academic profile 
• Dr Angus Ramsay’s academic profile 
• Rachael Hunter’s academic profile 
• UCL Department of Applied Health Research 
• UCL Institute of Epidemiology and Health Care 
• UCL Faculty of Population Health Sciences 
• UCL Faculty of Population Health Sciences REF 2021

Image 

• Image credit: Flickr/ emergency_vehicles