PCT stroke spending at odds with outcomes

NHS Westminster and NHS Newham both spent more than £8m on stroke care in 2008-09 – the highest of any PCT in the capital – but have different outcome profiles, according to analysis by Commissioning Support for London.

Westminster spent £8.3m and had a stroke mortality rate of 61 per 100,000 among those aged under 75 during 2006-08 – the most recent period for which data is available. This compares to Newham which spent £8.7m but had a premature stroke mortality rate of 129 per 100,000 – more than double that of Westminster.

The data is contained within individual “stroke pathway profiles” compiled for each PCT, which include 28 clinical and financial indicators.

NHS Bexley and NHS Kingston spent the least on stroke per head of population. Kingston spent £1.9m and had a premature mortality rate of just 39 compared with Bexley, which spent £1.5m and had a mortality rate of 100.

NHS Kensington and Chelsea had the lowest premature mortality rate at 40 per 100,000 – spending £3.4m. Average spend across all 31 PCTs in London was £4.3m.

A spokeswoman for NHS Newham said: “Since the data was collected and published there has been a reconfiguration of hyper acute stroke services in London. Having clear pathways to hyper acute care means that more people are getting the specialist care they need in time.

“Newham residents with acute stroke symptoms are now taken directly to the Royal London NHS Hospital Hyper Acute Stroke Unit; meaning earlier diagnosis, treatment and reduced length of stay. A service to support early discharge of people who have had a stroke will start on 17 January 2010.”

Primarily designed to aid commissioners, Commissioning for London also said the stroke profiles could potentially be used to monitor the impact of London’s stroke strategy, including the new hyper-acute stroke units.

The Department of Health last week published the first NHS Atlas of Variation in Healthcare, revealing dramatic differences in wellbeing, health outcomes, spending and service provision across England.

Among its indicators, the atlas includes percentage of patients admitted to hospital following a stroke who spend 90 per cent of their time on a stroke unit by PCT. It showed the lowest rates were in Ealing, Brent, Lewisham, Greenwich and Hammersmith and Fulham.