Stroke is a preventable and treatable disease; however, it is one of the leading causes of death in the UK and the largest single cause of severe disability. One in eight strokes are fatal within the first 30 days, with one in four strokes fatal within a year[1]. Stroke is a major health problem in the UK, with over 100,000 people having a stroke in the UK every year, with many more experiencing the warning condition of a transient ischaemic attack (TIA). The latest 5 year average age-standardised mortality rate for stroke is 61.7 deaths per 100,000 and 1.2 million stroke survivors have significant disabilities[2]. Across the coastal area of West Sussex in 2019/20, there were 989 Stroke recorded admissions on the Sentinel Stroke National Audit Programme (SSNAP); if nothing is done, this number could rise to 1446 over a similar period. Complete 2021/22 SSNAP data is awaited but July-September 2021 data now publicly available indicates 260 stroke admissions during that 3 month period to the 2 West Sussex acute stroke units, Worthing and St Richard’s Hospital (SRH) Chichester.
A review of the stroke services at Worthing and St Richard’s Hospitals identified a number of areas where the service is not currently meeting national standards. These are:
- The staffing levels within the current stroke wards do not meet the standards expected in an ASC for provision of a 24/7 acute and hyper acute stroke care.
- Consultant on-site review is not available 7 days per week.
- TIA services (including therapy) are provided 5 days per week and not 7 days per week.
- Some aspects of their services, such as proportion of patients admitted to Stroke Ward within 4 hours and ensuring thrombolysis given within 60 minutes, require improvement.
- The National Clinical Director for Stroke has cited 600 patients per annum as a minimum number for ASC/CSCs. Individually both units see below 600 patients per annum.
- There is a lack of access to early supported discharge and stroke survivor 6 month reviews.
The aim of the West Sussex Stroke Transformation programme is to ensure the end to end pathway across West Sussex offers high quality stroke care; evidenced by being fully compliant with national standards, to achieve high levels of performance enabling delivery of improved outcomes for patients.
[1] Stroke Association (2018) State of the Nation: stroke_association_annual_report_2018.pdf Stroke statistics (online). Available at: Stroke statistics | Stroke Association
[2] Monthly mortality analysis, England and Wales – Office for National Statistics (ons.gov.uk)