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Funding stroke guidelines; heeding words of caution
- Nigel Dudley (7 August 2008)
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Nigel Dudley, Consultant in Elderly / Stroke Medicine St James's University Hospital, LEEDS. LS9 7TF
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The words of caution from stroke experts Helen Rodgers and Mark Sudlow about the overemphasis on acute treatment and acceptance of consensus recommendations that may be detrimental to care perhaps come a little late.[1] It has been clear for some time that this focus on acute stroke has been the Department of Health’s priority as was made clear from its response to the public consultation on the draft National Stroke Strategy (NSS) [2]; in the document “Consultation Response and Analysis: A National Stroke Strategy”, published in December 2007 at the same time as the NSS and Impact Assessment, it was stated that , “It is recognised that the consultation document has focussed on the acute pathway for stroke and TIA patients. This is because the acute pathway has the potential to improve the whole care pathway and raise the profile of stroke services.” That statement looks to be accurate in terms of raising the profile given reports in the media about clot - busting treatment and the need to improve acute stroke[3,4]. However, the warnings of Rodgers and Sudlow should be taken on board by those in SHAs and PCTs responsible for delivering stroke services; these mirror some of the concerns raised in the responses to the draft NSS and it is clear that the £32 million central funding for demonstration sites to implement the NSS in the next three years is for just the TIA and scanning and thrombolysis aspects of the pathway[5]. It can also be calculated that for the first three years of implementing the stroke unit recommendation alone it will cost £114.3 million and for ESD (early supported discharge) it will require another £44.9 million. Where are the PCTs going to find this funding as there appears to be no new central funding for therapists or other essential elements of stroke services? According to the NICE guidelines, therapists will be needed in the first few days after stroke to assess swallowing and nutritional needs. The key to the successful delivery of the whole stroke care pathway and stroke guidelines is to fund all aspects of the pathway. This is not, as has been claimed in one BBC news report[3], just a matter of requiring a “radical restructuring of health services”. New central funding is required to implement the NICE stroke guidelines; the Department’s own economic analysis work rather contradicts the Royal College of Physicians' reported view that “We do not necessarily need any more resources … just better organisation of what we have already”[4]. PCTs and SHAs have been given sensible warnings by Rodgers and Sudlow that should not simply be ignored and brushed aside. [1] Rodgers H, Sudlow M. Commentary: Controversies in NICE guidance on acute stroke and transient ischaemic attack. BMJ 2008;337:a833 [2] Department of Health (2007). Consultation Response and Analysis: A National Stroke Strategy. Department of Health. [3] BBC News. Poor stroke care “still common”. Tuesday, 22 July 2008. http://news.bbc.co.uk/1/hi/health/7519775.stm (accessed 04/08/2008) [4] Laurance J. Fast treatment for strokes urged to prevent disability. Wednesday, 23 July 2008. The Independent. www.independent.co.uk/life-style/health-and-wellbeing/helth-news/fast- treatment-for-strokes-urged-to-prevent-disability-874863.html (accessed 04/08/2008) [5] Dudley N. Responding to the stroke strategy. British Geriatrics Society Newsletter, August 2008. www.bgsnet.org.uk/aug08/1_stroke.html (accessed 07/08/2008) Competing interests: None declared |
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