Committee of Public Accounts


Publication of the Committee's 26th Report, Session 2009-10

Edward Leigh MP, Chairman of the Committee of Public Accounts, today said:

"One in four of those who suffer a stroke die and stroke is also the leading cause of adult disability in England. However, since 2006 when we concluded that stroke services in England were poor, there have been demonstrable improvements in the acute hospital response. Underpinning this is a recognition of the crucial importance of the speed with which patients arriving at hospital are given an immediate brain scan to determine the kind of stroke. The Department is also to be congratulated for its excellent stroke awareness media campaign.

"Not so good is the variation that remains between hospitals in the timeliness of scans and quality of specialist stroke care provided. It is totally unacceptable that the likelihood of receiving a timely brain scan or accessing specialist care depends on where and when you have a stroke. In 2008, of all patients with suspected stroke, only three-fifths had been scanned within 24 hours. It is also worrying that, despite every hospital having a specialist stroke unit, too many stroke patients fail to be admitted to units quickly enough or spend enough time on the units.

"Improvements in hospital care are also not being matched by progress in providing post-hospital support, with too many patients, once they have been discharged from hospital, facing a postcode lottery when seeking follow-up support and rehabilitation services. On top of that, the Department does not have evidence for which types of support and long-term care are most effective."

Mr Leigh was speaking as the Committee published its 26th Report of this Session which, on the basis of evidence from the Department of Health (the Department), examined how to sustain and improve still further the standards of services for all stroke patients across the whole stroke care pathway and what lessons could be learnt from its experience in developing and implementing the stroke strategy.

Stroke is one of the top three causes of death and the largest cause of adult disability in England, costing the NHS at least £3 billion a year in direct care costs, with wider economic costs of around £8 billion. In July 2006 our first report on this important subject highlighted serious shortcomings across the whole stroke care pathway, concluding that the human and economic costs of stroke could be reduced by re-organising services and using existing capacity more wisely.

We welcome the demonstrable improvements in stroke care which the Department has achieved since our first report. The Department and NHS have increased the priority given to stroke, particularly the speed of the acute hospital response. We also congratulate the Department on the excellent Stroke€”Act F.A.S.T. media campaign and the impact this has had on raising staff and public awareness.

However, improvements have not been universal. We find it totally unacceptable that the likelihood of receiving a timely brain scan or accessing specialist care is dependent on where and when you have a stroke. For example, if you have a stroke in London, it is much more likely that you will get a scan within 3 hours and certainly within 24 hours€”but in Grimsby in Lincolnshire, too many patients have to wait up to 48 hours€”increasing the likelihood of complications and long term disability. Similarly, the proportion of patients treated on a specialist stroke unit, although improving, is still well short of the Department's target of 90%, with some regions showing extremely wide variations.

The improvements in hospital care are not yet matched by progress in delivering more effective support once stroke survivors leave hospital. Many patients discharged from hospital continue to struggle to obtain follow-up care and access to community rehabilitation services remains a post-code lottery. There is also a risk that the current level of services will not be sustained once the funding provided by the Department to help implement the strategy ends next year.

There are a number of systemic problems restricting further development of stroke services, such as a lack of effective joint working between health and social care and limitations in out-of-hours hospital care. There is an opportunity for the Department to consolidate its experience from implementing this strategy and its efforts to improve the quality of care in other disease areas to ensure that these challenges are overcome.