Where is the best place in Europe to have a stroke? According to professor Tony Rudd, a stroke consultant and NHS England’s national clinical director for stroke, it’s in the UK, where he believes stroke services have made “fantastic progress over the past 20 years”.

In a recent report looking at the quality of stroke services in hospitals across England, Wales and Northern Ireland, 50 out of approximately 130 hospitals received an A rating (= first class service). By comparison, in 2013 no hospitals were rated A.

A key difference is that today specialist stroke units are available in all hospitals that can accept a suspected stroke, giving patients quick access to specialist treatments and care. Hospitals are also getting better at discharging people as soon as they are medically fit, to continue rehabilitation at home and supported by specialists. UK stroke services have also become very good at capturing and sharing data, so experts like professor Rudd can understand what a ‘good’ service should look like.

But, with the majority of hospitals still falling short of categorisation as ‘world class’, it is clear that more can be done, and according to professor Rudd, this can be across the whole stroke care continuum. Among the changes he would like is greater use of technologies such as thrombectomy – which in certain stroke patients is used to suck out the blood clot blocking blood flow to the brain. But, “we are a nation of therapeutic nihilists,” he says, describing some clinicians’ attitudes to using this emerging technology.

General wards staffed by a high quality multidisciplinary team would also be welcome, he says, to bring skills in identifying and managing the damage caused by a stroke, and in optimising a stroke patient’s general wellbeing to support faster recovery. With the gift of a magic wand he would also improve longer term rehabilitation. “We keep people in hospital far too long due to lack of community services,” he says, to huge economic and societal costs when patients and their families are prevented from returning to full productivity.  In his view, local commissioning, which can result in huge variations in community service provision, does little to redress this situation.

And, finally, he’d also like to see patients empowered to take more of a role in their own stroke care, including by embracing healthy lifestyle messages and well man/woman checks that potentially, could reduce the incidence of stroke by as much as 60-70 per cent.

Because stroke is painless, some people don’t see it as an emergency. But time is of the essence: some stroke treatments are only effective within the first four hours of a stroke occurring.

Should a stroke occur, professor Rudd would like to see more acknowledgement of the need to act FAST -

F: Face drooping on one side;
A: Arm weakness;
S: Speech difficulty;
T: Time to call 999.