Major changes in stroke care can save lives

It’s the fourth biggest killer in the UK, and a leading cause of disability.  Not only this, but stroke comes at a huge price, costing NHS and social care around £1.7 billion a year in England. With England’s National Stroke Strategy due to come to an end this year, we need to drive forward much-needed changes to stroke services that could save money and lives.

The reconfiguration of stroke services is a topic that continues to drive public and political debate. But the evidence is clear that centralising stroke treatment at a much smaller number of hospitals has considerable benefits. The London Hyper Acute Stroke Unit (HASU) model, which operates 24 hours a day, seven days a week, saves £5.2 million each year. That’s equivalent to £811 per NHS patient. Evidence from the National Audit Office also suggests that faster access to tests and specialist treatment, and the associated efficiencies, have improved outcomes for stroke patients and helped to save the NHS an estimated £456 million between 2007 and 2014.

Clearly, this is not just about saving the NHS money. Reconfiguration has also been shown to deliver an absolute reduction in mortality of 3%, and enables an additional 6% of people to achieve independent life at home after a stroke. More than 95 extra lives are saved every year in London alone as a result of concentrating specialist stroke care in eight hyper-acute units. And this isn’t just the case for stroke treatment. Reorganising some services for heart attack patients, for example, has led to lower death rates.

Creating centres of excellence would address the critical shortage of specialist doctors and nurses by concentrating them in fewer places. This move would also ensure patients have access to rapid diagnosis and treatment, including thrombectomy; the latest revolutionary stroke treatment which has recently been approved by NHS England. It’s a shocking fact that currently, the stroke treatment people receive – including access to brain scans and the clot busting drug thrombolysis – depends on where they live.

But despite the evidence that HASUs save lives, improve people’s recoveries and make vital savings to the NHS, reorganisation is not happening at a quick enough pace across the country.

As a result of London’s centralisation of stroke services in 2010, five acute stroke units were closed down – and these closures can provoke emotive campaigns from local communities, as people rally to protect local services in their area.

Initially, local people may oppose the closure of their nearest stroke unit. Our challenge is to explain that travelling a little further to a well-staffed and better equipped unit will mean that stroke treatment can be given more quickly, and lives will be saved.

The Stroke Association is working with NHS RightCare and a wider group of stakeholders, including Anthony Rudd, NHS England’s National Clinical Director for Stroke, to develop a stroke pathway which will help sustainability and transformation partnership areas and clinical commissioning groups focus on vital opportunities for improvement, and develop plans to tackle the unwarranted variation in stroke care and treatment.

We are also working with regions across England to help stroke patients understand why reorganisation is needed, and make sure that they and their carers remain at the heart of any changes to stroke services.

In Kent and Medway, for example, we have been involved in discussions around reorganisation of acute stroke care and redesign of the stroke pathway, providing essential local knowledge and insight. The charity also supports community engagement days, which are crucial in communicating the benefits of reorganisation.

We want to see more sustainability and transformation partnerships focusing on the benefits of reconfiguration without delay. Stroke care and treatment is a life and death issue, and the longer we wait for major changes to stroke services, the more lives are at risk.

The Stroke Association has more than 30 years of experience working with stroke survivors, carers and clinicians. We can provide knowledge and expertise across the whole pathway, which could help every sustainability and transformation partnership to ensure that stroke survivors and carers get the support they need across the whole pathway. For more information about our work, visit

Juliet Bouverie

Juliet has been chief executive of the Stroke Association since June 2016. Prior to joining the charity, Juliet worked at Macmillan Cancer Support for 16 years in roles including head of planning and policy, director of corporate development and executive director of services and influencing. In this last role she led a staff team of over 800 people, managed a budget of £150m and oversaw a programme of award-winning innovations and service design across the UK. She also secured important government commitments to improve patient experience and post-treatment support through the 2015 Cancer Strategy for England.

Prior to Macmillan, Juliet worked at the British Red Cross in strategy and service evaluation, the Community Development Foundation in fundraising and a political consultancy. She was a trustee of the Long-Term Conditions Alliance and chaired the Cancer Patient Experience Board for University College London Hospital (UCLH) from 2011 to 2014.

Juliet has a degree in modern languages from Oxford and a postgraduate diploma in management.

One comment

  1. Haydn Canter says:

    FAST has been a major success in raising effective first aid. 54% of strokes are related to high blood pressure.KYBP AWARENESS is so important. High blood pressure is so easy to diagnose and inexpensive to treat. Prevention is so much better than having to treat this devastating condition. There are very few symptoms to high blood pressure so forewarned is so important. Bleeds are usually more extreme and fatal, as the damage is usually greater.As a stroke survivor I know how much it effects myself and my family. If I had known how dangerous hypertension is I would have got it checked out. Many people worry about cancer and heart attacks, but I wonder how many even think about the possibility of having a stroke. Awareness could save many deaths, survivors and their families have to live with result. It would also save £billions and ease the massive burden on the BHS as re-hab is a long-term issue.