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<p>Since the publication ofthe National Stroke Strategy, diagnosis and treatment of
stroke has improved in a number of areas:</p><br /><p>- access to immediate brain
scanning has improved with 46% of patients being scanned within one hour of hospital
arrival and 90% within 12 hours;</p><br /><p>- stroke patients do better when they
are treated on a stroke unit. 83% of stroke patients now spend more than 90% of their
time in hospitalon a stroke unit;and</p><br /><p>- clot busting drugs give a certain
cohort of stroke patients a better chance of regaining their independence. Almost
12% of all stroke patients admitted to hospital receive these drugs – a rate that
is higher than most other developed countries.</p><br /><p>Since publication of the
strategy, the National Institute for Health and Care Excellence has published technology
appraisal and interventional procedures guidance on a number of new technologies to
treat or prevent stroke and transient ischaemic attacks. Further information is available
at:</p><br /><p><a href="http://www.nice.org.uk/guidance/conditions-and-diseases/cardiovascular-conditions/stroke-and-transient-ischaemic-attack"
target="_blank">www.nice.org.uk/guidance/conditions-and-diseases/cardiovascular-conditions/stroke-and-transient-ischaemic-attack</a></p><br
/><p>The strategy has also encouraged the development of specialist care for stroke
both in the acute phase and during rehabilitation. This combined with the Stroke Research
Network (and subsequently the Clinical Research Network),funded through the National
Institute for Health Research, has led to a huge increase in the number of people
with stroke taking part in research, particularly randomised controlled trials.</p><br
/><p>In terms of improvements in rehabilitation, there has been a significant growth
in availability of services such as early supported discharge and community neuro-rehabilitation
teams over recent years. For example, recent data shows that 74% of hospitals had
access to stroke specific early supported discharge and 72% to specialist community
rehabilitation teams.</p><br /><p>Although these figures are encouraging, there is
more to do. NHS England recognises this and, in collaboration with the Royal College
of Physicians stroke programme and the Strategic Clinic Networks, is working with
clinical commissioning groups to support areas where improvement is needed.</p><br
/><p>The strategy remains valid and implementation of it continues.There are, therefore,
no current plans to renew the national stroke strategy. Action is being taken to ensure
the progress made on stroke continues. This includes:</p><br /><p>- ongoing work in
virtually all parts of the country to organise acute stroke care to ensure that all
stroke patients, regardless of where they live or what time of the day or week they
have their stroke, have access to high quality specialist care;</p><br /><p>- publication
of the Cardiovascular Disease (CVD) Outcomes Strategy in 2013, which includes many
stroke specific strategic ambitions;</p><br /><p>- a CVD expert forum, hosted by NHS
England, to coordinate delivery of the work which was initiated in the CVD Outcomes
Strategy; and</p><br /><p>- NHS England’s National Clinical Director for Stroke works
with the Strategic Clinical Networks, CCGs, voluntary agencies and individual providers
to support better commissioning and provision of stroke care.</p><br /><p>More generally,
the NHS Five Year Forward Viewrecognises thatquality of care, including stroke care,
can be variable and that patients’ needs are changing and new treatment options are
emerging. The Five Year Forward View sets out high level objectives to address these
issues.</p><br /><p>NHS England uses a wide variety of mechanisms to inform thinking
about the clinical priorities for the NHS, including public involvement (such as through
the NHS citizen process) and analysis of the clinical challenges and opportunities
to deliver improvement which exist. In addition, the recommendations of Parliament
and the National Audit Office are key considerations.Final decisions about the priorities
for the NHS are determined through the Government’s Mandate to NHS England.</p>
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