- 126 stroke units may be cut to 80, research suggests
- Stroke Association CEO says reconfigurations “will save lives”
- Plans may face resistance from clinicians, the public and politicians
A planned major reorganisation of stroke services could see the number of acute units in England cut by more than a third, with patients going to more specialised centres, HSJ understands.
Experts have said this will reduce the number of deaths and disabilities from the condition.
The NHS long-term plan said it wants “sustainability and transformation programmes and integrated care systems to reconfigure stroke services into specialist centres” within the next five years.
No numbers were attached to the proposals, but the Stroke Association charity, which supports and is involved in development of the plan, told HSJ that independent modelling suggested the number of stroke units should be cut from 126 to around 80 “hyper acute” and specialist units. These would be composed of around 30 neuroscience centres and 50 hyper acute stroke units (see box below).
Funded by the National Institute of Health Research, the research findings would likely leave the majority of the population facing travel times of up to 45 minutes. But it would also cut the current post code lottery of access to the best stroke treatments.
NHS England’s long-term plan said: “Areas that have centralised hyper-acute stroke care into a smaller number of well-equipped and staffed hospitals have seen the greatest improvements [in patient care].”
NHS England did not comment on the scale of centralisation being planned, but HSJ has seen documents that suggest its national clinical director of stroke, Professor Tony Rudd, has been supportive of the modelling work in his clinical/academic work in south London.
The NHS plan said reconfiguration will help it boost the number of people receiving life-changing thrombectomies from one per cent to 10 per cent of stroke patients by 2022. It also said it will help deliver “amongst the best performance in Europe for delivering thrombolysis” by 2025.
However, reconfiguring stroke services has proved challenging in the past, as they often come up against political and public resistance. In 2014, NHS England talked of plans to replicate the London and Greater Manchester models across England, but the ambition has yet to be realised.
Juliet Bouverie, who is chief executive of the Stroke Association and was also involved in the long-term plan, said: “It is a significant reconfiguration [but] given the delays and non-starters over the last few years in attempts at reconfiguring stroke care, we would want this plan implemented quickly.”
She pointed to improvements in care for other conditions such as trauma and cardiac care through centralisation, and added: “We know changes to or reductions in numbers of units can sound worrying but evidence tells us it will save lives by ensuring more people are able to access the treatment they need.”
Professor Rudd said: “The long-term plan for the NHS will give 100,000 people better access to stroke care, with services designed around individual communities to be agreed as part of local implementation plans in the coming months.”
Eight new neuro science centres
HSJ understands the reconfiguration of stroke units will have two aspects.
Firstly, NHS England wants to increase the number of neuro science centres (which include specialist stroke care) in England from the current 24. This would help ensure greater access to mechanical thrombectomies, a life changing treatment that can remove blood clots from the brain of stroke patients and prevent lifelong disabilities.
The independent modelling led by researchers at the University of Exeter suggests these would need to increase to 30 to allow for equitable access. The 18 centres outside of London would likely remain with the six located in London dropping to four.
No final decision has been made on the location of the additional eight centres.
Secondly, NHS England wants to reconfigure the remaining 102 stroke units into hyper acute stroke centres. The modelling suggests around 50 HASUs would be needed with each admitting at least 600 patients a year. The remaining 52 units would be either decommissioned, repurposed for rehabilitation or used for less intensive acute care.
Currently, stroke is the fourth biggest killer in England, leaving almost two-thirds of survivors with a disability.
NHS long-term plan; Stroke Association; interviews
- Accountable care systems/organisations
- Acute care
- Acute care
- BARKING, HAVERING AND REDBRIDGE HOSP NHS TRUST
- Health charities
- KING'S COLLEGE HOSPITAL NHS FT
- Long-term conditions
- NHS England (Commissioning Board)
- NHS long-term plan
- Policy and regulation
- STPs NHS England
- Stroke care
- Sustainability and transformation plans (STPs)