Community services for people who have had a stroke are “patchy,” says watchdog

BMJ 2011; 342 doi: (Published 17 January 2011) Cite this as: BMJ 2011;342:d246
  1. Helen Mooney
  1. 1London

Patients in England who have had a stroke are subject to varying quality of care after they leave hospital, depending on where they live, a new review has found.

The review, carried out by the Care Quality Commission, found that some people have no access to specialist rehabilitation stroke services in the community and that the support needed to enable them to be discharged from hospital as early as possible after a stroke was available in just over a third of primary care trusts.

The commission reviewed the performance of all 151 primary care trusts in England and found gaps in rehabilitation services such as physiotherapy.

It found that patients who have had a stroke often faced delays in being seen by all types of rehabilitation services, while in some areas no services were provided at all.

The review highlights the fact that only two thirds of primary care trusts have commissioned specialist stroke physiotherapy and that less than 40% of areas provide stroke patients with good access to psychological therapy or stroke counsellors.

Cynthia Bower, the commission’s chief executive, said, “The regional variations across the country are enormous . . . For people who have had a stroke it is the difference between a return to normal life in their communities—a return to work, for example—and a life of disability.

“I think it is very worrying. There is a lot of information about what represents good services for people who have had a stroke, and you see places in the country where people have really got their act together in terms of local authorities and health services working together . . . particularly issues about support carers, counselling for people who have had strokes, and returning to work for people. These are things that are well understood, and it is unacceptable that those services are not available for everyone across the country.”

The review found that almost half of patients who have been treated in hospital for a stroke have to wait at least two weeks before getting speech and language therapy in the community. Similarly, only 37% of primary care trusts provide stroke survivors with the rehabilitation they need to help them return to work.

England’s health secretary, Andrew Lansley, admitted that there was still “a lot of work to do to ensure that people get the right support once they leave hospital.”

He added, “We need a more integrated approach to stroke that covers hospital and home care. Recovery from stroke isn’t over when a patient leaves hospital: rehabilitation and ‘re-ablement’ are an integral part of the journey.”

Commenting on the review, Joe Korner of the Stroke Association said, “This important report shows that thousands of people don’t have access to specialist stroke services in the community when they leave hospital. In many areas essential treatments such as physiotherapy, occupational therapy, and psychological support are not available to stroke survivors.

“It is estimated that 50 000 people are left with a long term disability due to a stroke in the UK every year. We are at risk in some areas of the standard of post-stroke care regressing to that before the national stroke strategy was launched. This comes at a time when evidence suggests more not less investment is needed to help stroke survivors in the community with their recovery.”


Cite this as: BMJ 2011;342:d246


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