Written Statement - Stroke services in Wales

Together for Health – Stroke Delivery Plan, published in December 2012, sets out what the people of Wales can expect from stroke care by 2016.  

There is wide recognition that, since the Royal College of Physicians’ Audit in 2006 and subsequent health committee inquiries into stroke, patient care and outcomes have improved significantly across Wales.

Patients today have a greater chance of surviving a stroke and strokes are now assessed, diagnosed and treated more promptly than ever before. Survival rates from cardiovascular disease have also increased progressively for both men and women.

New drugs and technologies have been introduced and new treatments, such as 24/7 thrombolysis, have been introduced throughout Wales and are contributing to better outcomes for people who have suffered a stroke.

Multi-professional service planning and delivery structures are in place in health boards to provide more personalised, co-ordinated care at home or close to home. These systems now need to grow and mature.

Over the last few years, stroke performance in Wales has been measured against four bundles of care. While these give a good indication of the quality of stroke care, which patients receive, these now need to be realigned to reflect the higher standards of care in the new Sentinel Stroke National Audit Programme (SSNAP).

The NHS in Wales is working towards achieving the new SSNAP standards, which are more rigorous than the four bundles of care against which we have previously measured stroke services. The Royal College of Physicians acknowledges that nowhere else in the world has set such stringent standards.

Audit is a fantastic tool intended to stimulate improvement and drive change and health boards recognise we must pick up the pace of improvement to ensure Welsh patients get the best possible care. Over the coming years the SSNAP audit will provide patients and healthcare professionals with unprecedented levels of information on the services being provided and it is essential we use this information to drive forward improvement.

The latest clinical audit results demonstrate we still have a significant way to go and health boards must consider how we can ensure there is demonstrable improvement every quarter.

As we all know strokes require prompt treatment. Often the crucial intervention may be performed before a patient reaches hospital. However, we currently only measure what happens when a patient reaches hospital.

I want to ensure all stroke patients get the best possible care from the point at which they ask for help. I have therefore asked Cwm Taf University Health Board and the Welsh Ambulance Services NHS Trust to carry out a pilot project to improve emergency responses to suspected and confirmed stroke patients.  

This pilot will monitor the entire patient journey, from the time of call to admission to a stroke bed, joining up the available data to ensure patients are receiving the best clinical practice – this will include a CT scan; thrombolysis, if appropriate, and access to a stroke unit bed.

This work marks the start of the development of new clinically-led outcome measures for stroke for the NHS in Wales.

This is a transitional year, as we trial new measures, which will result in better outcomes for all patients. We will continue to retain existing targets and our focus will be to improve performance against these while developing new clinically-led and meaningful outcome measures.

I am committed to sharing the results of the pilots and will hold a public discussion about the findings before making any decisions about the future measures.

Research is critical to effective stroke care and the NHS must respond to the latest evidence in the planning and delivery of its services. Stroke research in Wales is also vital in attracting investment and first class NHS staff.

The Stroke Delivery Plan is clear about how important the role of NHS Wales is in leading collective efforts to tackle stroke. It is deliberately designed as a framework to enable and empower leadership from NHS Wales. Health boards and their partners have developed and published plans to improve stroke services to meet the needs of people at risk of or affected by stroke within their local areas.

The stroke implementation group, led by Adam Cairns, which is tasked with overseeing the plan’s implementation, has identified three priority areas of work focusing on atrial fibrillation, hyper-acute services and community rehabilitation.

I have also recently announced we will be appointing a new clinical lead for stroke and interviews for this post will take place in the next few weeks.

These developments will be reflected in the second all-Wales annual report on stroke, which will be published later this year. I will ensure this is made readily available to Members.