Experts have called for centralisation of stroke care in large specialist units.
A study done by University College London has found that the change in services in London with eight centres offering focused care was saving around 96 lives annually. Comparatively, less far-reaching adjustments in Greater Manchester has had less impact.
Professor Tony Rudd, England’s national stroke director, said the research indicated that centralisation of care should be implemented in all urban areas. The method used for emergency care has become a pressing issue in health services.
During last year, NHS England proposed the creation of a network of major centres to offer the most complex care. This action has already commenced for strokes within London and Greater Manchester where reorganisation has been ongoing.
Since 2010, stroke sufferers in London are taken to one of the eight 24-hour specialist units instead of the closest unit at one of the city’s 30 hospitals. Patients are immediately assessed, given brain scans and clot-busting treatment, if required.
The units were chosen to ensure that no Londoner was placed no more than a 30-minute ambulance ride away. Most of the other units still offer rehabilitation, but five of them do not provide stroke care at all.
The Greater Manchester service allows for stroke patients who have been seen within four hours of the development of symptoms to be taken directly to one of its three specialist stroke centres. Other patients are taken to one of the 10 district centres. Only one specialist centre operates 24 hours a day and none of the hospitals have stopped offering stroke services as a result of the centralisation.
The researchers who were commissioned by the National Institute for Health Research, a government-funded body, studied stroke survival in these two areas prior to and after reconfiguration. These results were compared to performance across the rest of the country.
It was found that the patient survival rate increased by 1.1% in London, or 96 lives per year, but this was not the case in Greater Manchester. The length of time patients required in hospital reduced in both areas. It reduced by 7% in London and 9% in Manchester.
The co-author of the study, Professor Naomi Fulop, said that although it may appear counter-intuitive for an ambulance to drive a patient who is in critical condition past the closest hospital, it saves lives.
She said the work indicated benefits to centralisation and other regions should consider implementing a similar approach.
Professor Rudd agreed with her.
The Stroke Association’s Dr Shamim Quadir said that for a long time it has been known that fast, specialist medical treatment for stroke sufferers saves lives and reduces NHS costs. He said that the centralisation of stroke care in hospitals in other large British cities could save thousands of lives.
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