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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.
[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)
Funding stroke guidelines; heeding words of caution
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
Competing interests: No competing interests