30.10.19
Improving stroke care training – British Association of Stroke Physicians (BASP)
Source PSE: Oct/Nov 2019
Nicholas Evans, deputy chair of the trainee committee at the British Association of Stroke Physicians (BASP), explains why vital training expansion is needed to tackle one of the UK’s leading causes of death and disability.
Improving stroke care and modernising the stroke workforce is a key part of the NHS Long Term Plan and to make that a reality we are calling for key joint actions to increase undergraduate and postgraduate exposure to stroke medicine, and enhanced training and career opportunities.
Stroke is the fourth biggest killer in the UK, and the largest cause of complex disability. Yet despite the prevalence of stroke and its potentially life-changing impact, there is a worrying shortfall of stroke professionals in the UK. New findings from the British Association of Stroke Physicians (BASP) show that an additional 226 full-time stroke consultants – an increase of 33% on current levels – are required to meet the current needs of patients in the UK.
This deficit risks leaving UK stroke services unable to keep pace with advances in stroke care, something we cannot risk. We can introduce strategic system change through, for example, greater exposure to stroke at medical school, incorporating stroke training in associated specialities, increasing the proportion of PA time allocated to stroke, and working with other multi-disciplinary professionals across the stroke care pathway.
Specialist stroke units within hospitals are crucial. Here, patients with stroke are treated by a wide range of professionals to support their recovery. This includes doctors, nurses, physiotherapists, occupational therapists, and speech and language therapists. In these units patients undergo rehabilitation therapy, as well as investigations into why the stroke happened in order to prevent another one. Those cared for on specialist stroke unit are more likely to be alive and living independently after one year, compared to those on non-specialist wards.
The sooner someone receives specialist treatment, the less damage is likely to happen, and the more likely people are to recover well. Swift access to procedures such as intravenous thrombolysis and mechanical thrombectomy, which remove clots and restore blood flow to the brain, can significantly decrease the risk of disability and save millions of pounds in health and social care costs.
We must therefore increase the proportion of NHS time committed to stroke medicine and change stroke consultants’ job plans (Direct Clinical Care programmed activities) to reflect this across the country. Departmental shifts could see existing stroke consultants rebalancing their job plans by increasing the proportion of stroke medicine programmed activities. BASP’s latest report finds a Stroke Unit admitting 600 patients a year will require 40 Direct Clinical Care programmed activities to meet the current national care quality indicators and standards.
Additionally, medical education must shift to encourage a greater understanding of stroke amongst future professionals. There is currently very limited exposure to stroke medicine in medical schools and amongst doctors in the first few years of training. We are calling for increased exposure of medical students to acute stroke patients as part of increased promotion of stroke medicine at undergraduate level. Comprehensive stroke medicine training should also be included within the teaching curriculum of parent specialities – including acute medicine, geriatric medicine, neurology and rehabilitation medicine. By encouraging many more people to become stroke specialists in our NHS, we will help to ensure that every stroke patient and survivor has the best possible treatment, care and support.
Being a stroke specialist is hugely rewarding; supporting people through one of the most difficult times of their life is a challenge but also a privilege. Our work is hugely varied – from racing against the clock to give immediate treatment to those who have just suffered a stroke, through to rehabilitative care for patients in recovery. There are more than 100,000 strokes in the UK each year, and the cost of stroke to society is around £26bn a year, including lost productivity, disability and informal care.
Working together as an NHS we can look at altering policy and departmental practice around stroke so that we can provide treatment to the best of our ability and capacity to stroke patients now and in the future.
FOR MORE INFORMATION
Tw: @british_stroke
W: www.basp.ac.uk