Jacqui Young: NHS celebrates progress in heart and stroke services in England

A conference held in London this week, titled “Celebrating clinical leadership in heart and stroke care,” looked at what has been achieved over the past decade in heart and stroke services under the leadership of Roger Boyle, who retires this month after 10 years as England’s national director for heart disease and stroke.
Bruce Keogh, medical director at the Department of Health, told the conference: “He is a shining example of what can be achieved by good leadership. He has made a bigger contribution to the management of cardiovascular disease and stroke than any other individual working in this field.”
Professor Boyle said, “Over the last decade we have seen a transformation in heart services across England. The national service framework outlined what needed to be done, and the NHS has delivered almost every aspect laid out in March 2000.”
The conference, organised by NHS Improvement, heard examples of major improvements in heart and stroke services.

Paul Guyler, a consultant stroke physician at Southend Hospital, told the conference that an audit of stroke services in 2004 showed that Southend was at the very bottom of the pile. But the past five years had seen dramatic improvements. For example, between 2006 and 2009 the mortality rate among people who had had a stroke halved, from 23% to 12%. And the proportion of people going home independent after a stroke almost doubled, from 32% to 62%.
Dr Guyler said that the hospital had made several initiatives, such as promoting the public’s awareness of stroke symptoms through posters in hairdressers’ salons and at bus stops. Staff members had also worked to get the message across to general practice receptionists so that suspected stroke patients phoning in are immediately directed to call 999. The hospital also promoted awareness among paramedics, who now alert the hospital about the imminent arrival of a patient with a probable stroke.

Dr Guyler said, “Our default position is to give thrombolysis to all patients with acute ischaemic stroke unless there is a good reason not to.” In September 2008 the Essex Acute Strategy was agreed to provide thrombolysis to all patients in Essex who needed it in “hyper-acute” stroke units in their nearest hospital.

Damian Jenkinson, the clinical lead on stroke improvement at NHS Improvement, said, “Up to 2005 there was a steady evolution in stroke services, but in the last five years there has been a remarkable revolution.”

He said that examples of innovative practice included paramedics delivering suspected stroke patients directly to computed tomography units. Telemedicine is now used by 30% of hospitals in England to help clinicians make decisions about thrombolysis. Dr Jenkinson also praised the success of the FAST (“face, arms, speech, time”) campaign, which highlights the warning signs of stroke and encourages people to seek help immediately.
Janet Williamson, director of NHS Improvement, told the conference: “The role of the clinical networks has been key in improving heart and stroke services.”

However, it is still unclear what will happen to clinical networks as a result of the current NHS reorganisation, although they look likely to stay. The health department has accepted the NHS Future Forum’s recommendations, which emphasised that “a range of professionals play an integral part in the clinical commissioning of patient care, including through clinical networks and new clinical senates hosted by the NHS Commissioning Board.”
The Future Forum recommended that networks such as the stroke networks should have a strong role in the new system.
For examples of good practice and further resources see www.improvement.nhs.uk.