Patchy stroke services may harm patients' recovery, nurses warn

Stroke nurses say inconsistent stroke services, revealed by an audit across England, Wales and Northern Ireland, could cause patients anxiety and mental health problems

An audit of post-acute stroke services across England, Wales and Northern Ireland has found wide variations in standards – with ‘too many areas failing to commission comprehensive care’, according to the authors.

Leading stroke nurses say the lack of services in certain areas could hinder some patients’ recovery and lead to increased anxiety and mental health problems.

Nearly half (47%) of 223 clinical commissioning groups (CCGs) in England and three of six health boards in Wales do not commission assessments of patients six months after they leave acute hospital. These assessments are a requirement of the National Stroke Strategy for England. In Northern Ireland, assessments are commissioned by all five local commissioning groups (LCGs).

About one in five of England’s CCGs commission no supported early discharge services, and there is a similar lack of services in two health boards in Wales and in two of Northern Ireland’s LCGs.

Problems also exist in community rehabilitation, with 35 CCGs in England and two health boards in Wales failing to provide these services.

The Royal College of Physicians collected the data on behalf of the Sentinel Stroke National Audit Programme (SSNAP).

Clare Gordon, chair of the National Stroke Nursing Forum and consultant stroke nurse at Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, said: ‘Everywhere should have an early discharge team with nurses, physios, doctors and other health professionals, but the team members vary, and sometimes nurses are not even in them. These nurses can help patients with things such as continence, and give advice on secondary prevention or handling relationships with other people.

‘If you don’t do a six-month assessment, then you won’t pick up on patients who are missing out on certain services. It can also mean some patients develop mental health problems that are not detected.’

A nurse consultant in stroke care, who did not wish to be named, said: ‘It is a serious concern that some patients are missing out on community rehab. They can become angry and frustrated.

‘Patients are leaving hospital quicker than before, so early discharge services are important. Nurses play an important part in co-ordinating care and providing advice.’

The Royal College of Physicians is concerned that some patients discharged to care homes are missing out on some rehabilitation services – such as physiotherapy – that they would have in an acute hospital. The authors of the audit report recommend that commissioners consider joint health and social care partnerships to improve the provision of emotional and psychological support for patients.

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