Stroke Services in London and Manchester – A successful example of centralisation?

150,000 people suffer a stroke each year in England, of which 40,000 die. Although it is the 3rd largest cause of death, it is also the largest cause of disability because of the paralysis or brain damage it can cause. Due to centralisation of stroke services in London and Manchester in recent years, more patients can be treated quickly, helping to reduce brain injury.

What is a stroke?

A stroke occurs when the blood supply to the brain is compromised and there are two ways this can occur. The most common stroke is an ischaemic stroke (80% of cases) and this is caused by thrombosis (a blood clot). The other type of stroke is known as a haemorrhagic stroke and this is caused when a weak blood vessel bursts and bleeds directly into the brain or into the space surrounding the brain tissue. There is also a ‘mini-stroke’ known as a transient ischaemic attack (TIA) where the supply of blood to the brain is temporarily compromised.

Think F.A.S.T.

Due to the recent attempts at educating people on the symptoms of strokes, many people are familiar with the FAST acronym. The acronym details three key symptoms of stroke and if all three are present, the person should be taken to hospital.

F = Face – face may be dropped to one side (usually left), may be unable to smile
A = Arms – may not be able to lift their arms above their head, may have numbness in arms
S = Speech – speech may be unclear or slurred, may not be able to speak at all
T = Time – time to call 999 or take the person to hospital

There are other symptoms that may not be covered in the acronym such as blurred vision, dizziness and balance problems. Risk factors for strokes include poor diet, lack of exercise, smoking, excessive alcohol consumption, high blood pressure and diabetes.

Centralisation of Stroke Services

A study by UCL, the University of Manchester, King’s College London and the Guy’s and St Thomas’ NHS Foundation Trust and published in the BMJ concluded that around 96 more lives are being saved each year in London through the centralised system compared to standard hospital treatment. The study also found that the time spent in hospital is reduced by an average of a day and a half in London and two days in Manchester. In Manchester however, there has been no decrease in mortality.

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Since 2010, eight hyperacute stroke units (HASU’s) have been opened in London and anyone that suffers a stroke is taken to one of these units rather than the closest hospital. The units are equipped with specialist stroke staff and a range of brain imaging machines to effectively treat the stroke and are open 24 hours every day. The HASU’s are no longer than 30 minutes away from every individual in London and there are 24 stroke units in hospitals to provide rehabilitation. In comparison, Greater Manchester has 3 HASU’s, only one that is open 24 hours every day, and only patients that developed symptoms less than four hours previously are taken to the HASU’s.

The results of the study show that the system in London is effective at reducing mortality rate and it is estimated that if the same system was in place in Greater Manchester, approximately 50 more deaths could be avoided each year. They study also showed a 7% decrease in hospital stay in London and a 9% decrease in Greater Manchester.

Although the idea of centralised services is controversial, this study proves that in the case of a stroke it is effective and should be considered in other parts of the country.

Bethany

Relevant Articles:

It’s Never Lupus? Think again…

The Boy in the Bubble: The Story of David Vetter

Suspended Animation: Science Fiction or Just Science?

References

University College London (2014) UCL News [Online] http://www.ucl.ac.uk/news/news-articles/0814/060814-Centralised-stroke-services-save-lives

NHS (2014) NHS Choices [Online] http://www.nhs.uk/Conditions/Stroke/Pages/Symptoms.aspx

Grant, R (2014) How can closing stroke units improve survival rates? [Online] http://www.theguardian.com/science/occams-corner/2014/aug/06/closing-stroke-units-improve-survival-london-manchester

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