Published: 01/04/2004, Volume II4, No. 5899 Page 6 7

The government has come under fire over claims that it is close to achieving success against key targets for stroke services.

Older people's czar Professor Ian Philp told HSJ that he expected at least 94 per cent of hospitals to achieve the end-ofyear target to have their own specialist stroke service.

This would represent a massive improvement on performance from last September when, according to Department of Health figures, just 70 per cent of services had met the target, part of the national service framework for coronary heart disease.

But Professor Philp, national director for the care of older people, said the low September figure was rooted in a 'misperception' among the service about how a specialist service was defined.

Many trusts had presumed they needed to set up their own service to achieve the target, whereas all they were required to do by yesterday's deadline was provide regular access to 'roving' specialist teams.

Professor Philp said he now expected the service to 'at least' achieve forecasts from local development plans suggesting that 9496 per cent of trusts would meet the March 2004 target.

He told HSJ that earlier figures were based on 'a misperception about what people had to achieve'.

'People were being aspirational, ' he said.

Professor Philp gave an example of five community hospitals in Devon, which all provide stroke care.He said that a requirement for each hospital to have its own service 'would be an inflexible model'.

Instead, 'what you have is a peripatetic team, who'll visit the hospital and provide stroke care, and That is consistent with the target'.

But leading experts on stroke services said many in the service had assumed the target required them to establish their own service.

Dr Helen Rodgers, chair of the British Association of Stroke Physicians' service development and quality committee, suggested that for some trusts, success on the target amounted to no more than 'getting a label'.

She said she had presumed that the NSF requirements meant that every hospital required to have its own 'physical' centre: 'My understanding was that it needed to be a geographical unit.'

BASP president Dr Anthony Rudd, lead on stroke for the Royal College of Physicians, said he did not know whether the DoH had altered its interpretation of the target. But he said within the service he had heard 'tales of gaming, and that there has been some moving of the goal posts'.

Dr Rudd said there was a clear evidence base to prove that geographically based units produced better outcomes than 'roving' ones.

Professor Philp acknowledged there was a 'strong lobby' against the roving model of care: 'If You have got a rural community, being taken 60 or 70 miles to the nearest acute stroke unit as opposed to being in hospital that is closer to home, you can imagine the pros and cons of that.'

The NSF target has also come under attack for not spelling out how many beds a service requires, and not measuring how long patients are given access to the service.

Stroke Association chief executive Margaret Goose said: 'At the last audit [2001-02] only 36 per cent of stroke patients got access to that service at all, and only 27 per cent of people spent most of their time there.'

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