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Stroke treatment in England varies widely by location

December 17, 2014

*HSCIC must be quoted as the source of these figures

*Regional data is available within this report

New figures released today show that the treatment of stroke patients in England varies widely depending on where patients live2.

Of the 68,8003 patients admitted to hospital with stroke during 2013-14, 41,200 (60 per cent) were admitted to an acute stroke unit within four hours of arrival at hospital. This figure varied by clinical commissioning group (CCG), from 22 per cent of patients in NHS Wyre Forest CCG to 85 per cent of patients in NHS Hillingdon CCG.

In 71 of the 2114 CCGs across the country, less than 55 per cent of patients were admitted to a stroke unit within four hours of admission to hospital and in 13 CCGs, this figure was less than 40 per cent. No CCGs were able to ensure that 90 per cent5 or more of their patients were admitted to a stroke unit within four hours of admission to hospital.

Today's report, CCG Outcomes Indicator Set, December 2014, shows two further indicators which examine stroke at CCG level - people who have had an acute stroke who receive thrombolysis6 and people who have had an acute stroke who spend 90 per cent or more of their hospital stay on a stroke unit7.

The report also shows that in 2013-14:

  • Nationally 84 per cent of people spent 90 per cent or more of their stay on a stroke unit and this was exceeded in more than half of CCGs (53 per cent)
  • In three CCGs8, less than 70 per cent of patients spent 90 per cent or more of their stay on a stroke unit
  • NHS Corby CCG had the lowest rate of stroke patients spending 90 per cent or more of their stay on a stroke unit (66 per cent), whereas NHS Ealing CCG had the highest rate (95 per cent).

pdf icon People with stroke admitted to an acute stroke unit within four hours of arrival to hospital(9). [628kb]


Today's report also shows further indicators on hip fracture and mental health:

  • hip fracture: incidence
  • hip fracture: timely surgery
  • unplanned readmissions to mental health services within 30 days of a mental health inpatient discharge in people aged 17 and over
  • percentage of adults in contact with secondary mental health services in employment.

HSCIC Chair Kingsley Manning said: "Today's report shows that different elements of care for stroke patients vary widely between CCGs across England.

"It is important that patients suffering a stroke receive appropriate care as soon as possible. I'm sure health professionals and those responsible for delivering care for stroke patients will use this report to identify how improvements in treatment can be made, such as how quickly patients are admitted to a stroke unit. The other new indicators in the report on hip fracture and mental health will also be helpful to CCGs in forming their commissioning plans."

You can view the full report at: http://www.hscic.gov.uk/pubs/ccginddec14

ENDS


Notes to editors

  1. The Health and Social Care Information Centre (HSCIC) was established on April 1 2013 as an Executive Non Departmental Public Body (ENDPB). It is England's trusted data source, delivering high quality information and IT systems to drive better patient services, care and outcomes. Its work includes publishing more than 220 statistical publications annually; providing a range of specialist data services; managing informatics projects and programmes and developing and assuring national systems against appropriate contractual, clinical safety and information standards.
  2. Data are sourced from the Royal College of Physicians (RCP) Sentinel Stroke National Audit Programme (SSNAP). The SSNAP contains national and hospital level findings on the organisation of stroke services, in particular acute care organisation, specialist roles, staffing, Transient Ischaemic Attack (TIA, also known commonly as 'mini stroke') services, communication between staff groups and with patients and carers, and pathway at discharge. Using the patient's home postcode, the data has been mapped to provide figures at CCG level. CCGs are responsible for commissioning health services to meet the needs of their patients. The location (CCG) for which figures are reported does not necessarily reflect the location at which the care was delivered.
  3. Counts of figures under 10,000 are exact. Figures over 10,000 are rounded to the nearest 100. Percentages are rounded to the nearest whole number.
  4. Data is suppressed for five CCGs in this indicator due to small numbers; this is where there are either less than 20 cases recorded in the audit or where less than 50 per cent of cases in the audit have a matching record in Hospital Episode Statistics. More information can be found at: http://www.rcplondon.ac.uk/projects/sentinel-stroke-national-audit-programme
  5. The aim for 90 per cent or more of patients to be admitted to a stroke unit within four hours of arrival at hospital is an aspirational marker of performance that has been agreed by clinicians and is measured in the audit.
  6. Patients with suspected stroke are admitted directly to a specialist acute stroke unit and assessed for thrombolysis, receiving it if clinically indicated. Thrombolysis is a clot busting drug which can be a very effective way of treating ischaemic strokes (caused by blood clot) however it is not suitable for all patients. There is no absolute rate of thrombolysis which is suitable. It is not appropriate to simply have a high rate, as the procedure carries significant risk and is not suitable for every patient.
  7. Treating people who have had a stroke on a stroke unit is recognised as best practice, as set out in the NICE Quality Standard on Stroke; an aspirational marker of performance is for people who have had stroke to spend 90 per cent or more of their stay on a stroke unit.
  8. The indicator on people who spend 90 per cent or more of their stay on a stroke unit includes transfer of patients who have had a stroke whilst already admitted to hospital for another condition. It is recommended that stroke patients should spend 90 per cent or more of their stay on a stroke unit; in three CCGs this was achieved for less than 70 per cent of stroke patients: NHS Corby CCG, NHS South Worcestershire CCG, NHS Lincolnshire West CCG.
  9. The bandings used in the map are set by the SSNAP, and are accepted by the clinical teams that submit SSNAP data, as aspirational markers of performance.
  10. For media enquiries please contact media@hscic.gov.uk or 0300 30 33 888.
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