Stroke care in 
 
England, Wales and Northern Ireland  
 
This report is for stroke survivors and their families Based on patients treated between August - November 2017  

## Table Of Contents

 Glossary……………………………………………………………………………………………………………5 
Introduction to the SSNAP Easy Access Version Report 
...................................... 6 
How to read this report 
...................................................................................... 8 
Understanding the results .................................................................................. 9 
1. Brain Scanning 
........................................................................................... 12 
2. Stroke unit 
................................................................................................. 14 
3. Clot Busting Treatment (Thrombolysis) ..................................................... 16 
4. Specialist Assessments .............................................................................. 18 
5. Occupational Therapy (OT) 
........................................................................ 20 
6. Physiotherapy ........................................................................................... 22 
7. Speech and Language Therapy .................................................................. 24 
8. Team Working ........................................................................................... 26 
9. Standards met by Discharge ...................................................................... 28 10. Discharge Processes ................................................................................ 30 
Interactive Maps .............................................................................................. 32 
Further information on stroke care for patients and carers ............................. 35 
Useful contacts and websites ........................................................................... 36 
 


## Glossary

| Atrial fibrillation (AF)                             | an abnormal heart beat which can result in the           |
|------------------------------------------------------|----------------------------------------------------------|
| formation of blood clots                             |                                                          |
|                                                      |                                                          |
| Cognitive Screening                                  |                                                          |
| as  memory  and  concentration.                      |                                                          |
|                                                      |                                                          |
| A plan to help a patient increase their control over | Continence Plan                                          |
|                                                      |                                                          |
| bowel and bladder function                           |                                                          |
|                                                      |                                                          |
| A  condition  which  is  caused  by  not  having     | Malnourishment                                           |
|                                                      |                                                          |
| enough  of  or  the  right  nutrients.               |                                                          |
|                                                      |                                                          |
| Occupational Therapy                                 | Therapy  to help  patients  relearn  activities of       |
| everyday  life.                                      |                                                          |
|                                                      |                                                          |
| Physiotherapy                                        |                                                          |
|                                                      |                                                          |
| Speech and Language Therapy                          | Therapy to help patients recover from                    |
| communication  or  swallowing  difficulties.         |                                                          |
|                                                      |                                                          |
| Thrombolysis                                         | The  use  of  medicine  to  break  down  a  blood  clot. |

 
This is a **report** about a project called the 

## Sentinel Stroke National Audit Programme. (Ssnap)

This information is written in a way that is **easy** to understand. You may want someone to **help** you when you read this report. 

## What   Is   Ssnap?

 
SSNAP measures stroke care.  It does this to improve the quality of stroke care. SSNAP collects information from hospitals about the care provided to stroke patients from the time they **arrive at hospital** up until 6 months after their stroke. This means that SSNAP can report on **both** the early stages of stroke care in hospital and later stages of care in the **community**. The aim is that the information and results from the audit are used to improve care for stroke patients. The report shows how well hospitals treated stroke patients. The information is about the care given between **August - November 2017**. This report can help people to talk about their **stroke care** with local hospitals. We will write this report every  4 months. 

 
The **Royal College of Physicians** (RCP) runs SSNAP.  
NHS England and NHS Wales pay for SSNAP. The Stroke **Working Party** guides SSNAP.   
This includes  

- 
people who work in stroke   
- 
charities such as the Stroke Association 
- 
stroke survivors 
 
Thank you to 

- 
Speakeasy, a charity based in Bury, which supports people with aphasia 
- 
The **South London Stroke Research Patient and Family Group** 
- 
The **stroke survivors** on the stroke working party 
They helped to make this report **easy to read**. 

 

## For **Regional Easy Access Version Reports**

https://www.strokeaudit.org/results/Clinical/Regional-Results     

## For More Detailed Reports

https://www.strokeaudit.org/results    

## For Interactive Maps

https://www.strokeaudit.org/results/Clinical-audit/Maps  

## How To Read This Report

This report gives information about **10 aspects of stroke care.**   
 
There are **standards** within each aspect of care. 

 
Each hospital must do well in **all standards**. In this report we explain: 
What should be done? How quickly it should be done? 

 
Why it should be done? 


These boxes give a summary of national performance for each aspect of stroke care. 

 

## This Box Will Highlight The **Aspects Of Care** That Are **Performing Well**.

 
 
This box will highlight the **aspects of care** where improvements **are needed**. 


## Understanding The Results National Maps These Show How Well Hospitals Have Performed In England, Wales,

and Northern Ireland. 

## Ssnap Level

Source: SSNAP Aug-Nov 2017 There is a box beside each map. It shows which **shapes** are for each **level from A - E**.  
  
A is the **best** level and E is the **worst**.  


The black cross shows which hospitals did not submit information about enough of their patients to be included in the results for this period. 

|          |                                 |          |                   |                | Shape    | Level    | Each area of care    |
|----------|---------------------------------|----------|-------------------|----------------|----------|----------|----------------------|
| Hospital | meets                           |          | highest standards | for almost all |          | patients |                      |
| A        |                                 |          |                   |                |          |          |                      |
|          |                                 |          |                   |                |          |          |                      |
| B        |                                 |          |                   |                |          |          |                      |
|          |                                 |          |                   |                |          |          |                      |
| C        |                                 |          |                   |                |          |          |                      |
|          |                                 |          |                   |                |          |          |                      |
| D        |                                 |          |                   |                |          |          |                      |
| Hospital | does not meet highest standards | for many |                   |                |          |          |                      |
| E        |                                 |          |                   |                |          |          |                      |
|          |                                 |          |                   |                |          |          |                      |
|          |                                 |          |                   |                |          |          |                      |
| patients |                                 |          |                   |                |          |          |                      |

## Hospitals Included In This Report

This report includes 28,698 s**troke patients** admitted to hospital between  
August - November 2017. 228 hospitals in England, Wales and Northern Ireland are included in this report. Most of these teams submitted more than 90% of their stroke patients to SSNAP. We want all hospitals to send in their information so that they can use the results to **improve care** for patients. 

 

## Ssnap Participation 1. Brain Scanning

 
What should be done? 
All patients with stroke symptoms should have a **brain scan** 
How quickly should this be done? 
Patients who are **very sick** should have a scan **within 1 hour** of 
arriving at hospital. All patients should have a brain scan **within 12 hours** 
Why should this be done? 
To show the doctor what **treatment** the patient **needs**.  
Fast treatment can **reduce** the **damage** caused by stroke. 


## Brain Scanning

Source: SSNAP Aug-Nov 2017 (Patient Centred)
 

 
 
Stroke patients have **better access to scanning** than ever before. Over 9/10 stroke patients are scanned **within 12 hours**. Fewer stroke patients are scanned at **weekends** and at **night time** than during the week. 

## 2. Stroke Unit

 
 
What should be done? 

Patients should get to a **stroke unit** very quickly. 
 
Patients should spend at least 90% **of their time** in hospital on a 
stroke unit. 
 

## How Quickly Should This Be Done?

Patients should get to a stroke unit **within 4 hours** of arriving at 
 
hospital. 
Why should this be done? 
Stroke units give the **best care** to stroke patients. 

This can save lives and reduce disability. 


## National Results Stroke Unit

 

 Direct admission to a stroke unit is **very important**. Almost all patients spend **some** of their **time** in hospital on a **stroke unit.** Almost **2 out of 5** patients are **not taken** to a stroke unit **immediately**. This needs to be **improved** urgently. 


## 3. Clot Busting Treatment (Thrombolysis)

 

## What Should Be Done?

Between 15-20% of patients should receive **a clot-busting drug**.   

 
 
Patients who have a stroke caused by a **clot** and who get to 
hospital quickly can be given this drug. These patients should receive clot busting treatment at the 
earliest possible time after arriving at hospital.  

 
How quickly should this be done? 
It should be given up to **4 and a half hours after a stroke.**  
 

 
Why should this be done? 

## Clot-Busting Drug Treatment Can **Reduce Disability.**


## National Results Clot Busting Treatment (Thrombolysis)

 
 
National Summary 4 out of 5 stroke patients who **should** be given **clot busting drugs** are given them. This is **highe**r than nearly **every other country**. Some hospitals do not provide this treatment **at all times**. It often **takes too long** for patients to get to hospital and so it is too late for this treatment to be effective. 


 

## 4. Specialist Assessments

 
 
What should be done? 
Patients should 
 
- see a **stroke consultant** 
- see a **stroke nurse**  
- be **screened** for swallow safety 
- have a **swallow assessment** if needed 
How quickly should this be done? 
 
 
Within 4 hours: swallow screen Within 1 day: **stroke nurse** and stroke consultant Within 3 days: **swallow assessment** 
 
Why should this be done? 
Stroke specialist professionals give patients the care they need.  
This will **improve their recovery**.    

 Swallow screening checks if the patient can swallow food and 
drink safely and therefore reduce the risk of choking.  

## National Results Specialist Assessments

Source: SSNAP Aug-Nov 2017 (Patient Centred)
 
 
National Summary Hospitals are **performing well** in providing **swallow assessments** to patients who need them. More patients are being provided with **swallow screenings** and **assessments** in recent months. There are **too many** patients who are not being assessed to find out what kind of **swallowing** difficulties they have rapidly. 1 out of 5 patients are **not seen** by a **stroke consultant** within **24 hours** of admission. 


## 5. Occupational Therapy (Ot)

 
What should be done? 

 All **patients** (who are well enough and need it) should get 
 
- at least **45 minutes** of occupational therapy - on at least **5 days a week**  
- for the duration of their stroke care. 
Why should this be done? 

Occupational therapy helps people to re-learn everyday activities and skills following a stroke. 

 
 
This may include **tasks** such as getting dressed or **hobbies** such as painting.   


## National Results Occupational Therapy (Ot)

Source: SSNAP Aug-Nov 2017 (Patient Centred) National Summary This aspect of care is being **performed well**. Almost all stroke patients who **need** it are **assessed** by an occupational therapist during their hospital stay. 

 
It is **encouraging** that so many patients are assessed at **weekends**. Many patients **needing** an assessment **do not** receive one **within 3 days**. More minutes of **therapy** should be given on more **days** to patients who need it. 


## 6. Physiotherapy

 
What should be done? 

 All **patients** (who are well enough and need it) should get 
 
 
- at least **45 minutes** of physiotherapy 
- on at least **5 days a week**  
- for the duration of their stroke care. 
Why should this be done? 

Physiotherapy helps people to overcome or adapt to weakness on one side of the body.   

 
It also helps people to **improve** their **balance** and **movement**. 


## Physiotherapy (Pt)

 
 
National Summary This aspect of care is being **performed well**. It is **encouraging** that so many patients are assessed at **weekends**. More minutes of **therapy** should be given on more **days** to patients who need it. 


## 7. Speech And Language Therapy

 
What should be done? 
 
 
All **patients** (who are well enough and need it) should get 
- at least **45 minutes** of speech and language therapy - on at least **5 days a week**  
- for the duration of their stroke care. 
Why should this be done? 
Speech and language therapy helps people to recover from 
 
communication problems following a stroke. 
 

## Speech And Language Therapy (Salt)

 
National Summary Most patients who require an **assessment** for **communication difficulties** receive one during their hospital stay. Fewer patients are being assessed at weekends by **speech therapists** than the other therapies. More minutes of **therapy** should be given on more **days** to patients who need it. 

 

## 8. Team Working

 
What should be done? 
Patients should  
 
 
- see a **stroke nurse**  
- be **assessed** if needed by all relevant therapists  
(for example a speech and language therapist) 
- agree **rehabilitation goals** with the staff 
How quickly should this be done? 
Within 1 day: **stroke nurse** and at least **1 therapist**  
Within 3 days: **all relevant therapists**. 
Within 5 days: all rehabilitation goals agreed 
Why should this be done? 
Each member of the **stroke team** can give patients the care that they need to **improve** their **recovery**. 


## Team Working

Source: SSNAP Aug-Nov 2017 (Patient Centred)
 
 
National Summary Nearly all patients who need it are **assessed** by a **physiotherapist** and occupational **therapist** within **3 days of admission to hospital**. More patients are agreeing **rehabilitation goals** within **5 days** than 1- 2 years ago. 1 out of 10 patients are **not assessed** by a **speech therapist** within **3 days**. 

## 9. Standards Met By Discharge

 
What should be done? 
If needed, before leaving hospital a patient should 
 
 
- be **screened for nutrition** and seen by a dietitian  
- have a **continence plan** drawn up. This should be done 
within 3 weeks of arriving at hospital 
- be **screened for mood and cognition** 
How quickly should this be done? 
 
By discharge: nutrition screening Within 3 weeks: continence plan By discharge: mood screening 
Why should this be done? 
 
Nutrition screening checks if the patient is at risk of malnourishment. Patients say **continence management** is one of the most important areas of care. Mood screening identifies feeling of distress or lack of 
confidence. Cognitive screening identifies difficulties thinking, concentrating or **remembering** after a stroke. 

## National Results Standards By Discharge

Source: SSNAP Aug-Nov 2017 (Patient Centred)
 

 There have been **consistent improvements** in these aspects of care as reported on SSNAP: 

- continence planning - mood and cognition screening - assessments by dietitians 
 Too many **hospitals** are **still failing** to meet these standards for all patients. There is **no excuse** for **not treating patients** in these important aspects of care. 


## 10. Discharge Processes


## What Should Be Done?

When leaving hospital, patients should  
 
- have received a **joint health and social care plan**  
 
- be given the name of a **person they can contact** 
 
 
Some patients may be well enough to leave hospital early.  
 
These patients should be **provided with further rehabilitation** 
at home if they need it.  


An **Early Supported Discharge (ESD)** team can provide this 
rehabilitation. About **40% of patients** could benefit from ESD. Patients with an **irregular heartbeat** should be given medication 
to prevent blood from clotting. 
 

## Why Should This Be Done?

Health and social care services should work together in a way that best suits the needs of patients. 
 
 
Rehabilitation in the community means getting treatment including **rehabilitation** in a home environment. It can improve **recovery**. 
 
Blood clotting medication **improves blood** flow.  
It reduces the chance of another stroke occurring. 

## National Results Discharge Processes

Source: SSNAP Aug-Nov 2017 (Patient Centred)

 There have been **improvements** in these aspects of care: 

- joint health and social care planning - giving patients and carers a named person to contact when leaving 
hospital  
 Almost all patients with an **irregular heartbeat** are given suitable **medication**. 

 
You can view the information in this report using interactive maps on the internet. To see the maps go to: 
 
www.strokeaudit.org/results/Clinical-audit/maps  
 

- These maps are **easy to read** 
 
- They include **all hospitals** treating 
stroke patients in England, Wales, 
and Northern Ireland 
- Results are also presented using 
graphs and pie charts 
 
- The maps will be updated every 4 
months with up to date results 
 These maps **enable patients and carers to**: 
 

- **Identify** areas where care is good 
and where improvements are needed 
- **Compare** aspects of **stroke care** 
within and across hospitals 
- **Compare** hospitals' performance 
over time 
 
 
- **Search** for **specific information** you 
are most interested in 
- **Save and print** the information  

## Rising To The Challenge. Ssnap'S Fourth Annual Report

You can view the SSNAP Annual Report on our website:  
www.strokeaudit.org/AnnualReport  

- This report is written by doctors 
- It gives an overview of how good stroke 
care is across England, Wales and Northern Ireland. 
- The information in this report is from        
2015 and 2016   
- This report is patient friendly 
- It uses **patient experiences** of stroke 
care 
- The report uses **maps and graphs** to 
show information 

## Www.Strokeaudit.Org/Results 1) Public Report

- This report contains **national level results** across 
the stroke pathway. 
- It compares national stroke results **over time**.  
 
-  The report has **commentary** from the doctor 
who leads SSNAP   
 
- The report gives **recommendations** for 
improving stroke care 
 
- The report has colour coded tables showing  
the results for each hospital  

## 2) Summary Results

- This report gives a **summary of performance** 
for individual hospitals. 
 
- It is a **starting point** for understanding how 
good a hospital is at treating stroke patients. 
 
- Each **aspect of stroke care** is covered. 
 
- Hospitals are given a **level from A-E** for each 
aspect of stroke care. 

## 3) Full Results

- This is a **very detailed**  report 
 
- It contains national and hospital level 
results for **every stroke measure** collected by SSNAP 
 
- It allows readers to look further into 
specific aspects of stroke care 

- This booklet is a **shorter version** of the 'National Clinical **Guideline** for 
Stroke' (2016).   
- It is written for **stroke survivors and their carers** but is also useful for 
anyone who has an interest in stroke care and management.    
- It gives **information and advice** on the **care and treatment** of adults 
after a stroke or TIA (mini stroke). 
- It also has listings of **organisations and support groups** who can help 
stroke patients and their families or carers. 
- The patient version of the **Guideline** is available here: 
https://www.strokeaudit.org/Guideline/Patient-Guideline.aspx  


Disabled Living Foundation Helpline: 0300 999 0004 (Mon-Fri, 10am-4pm) helpline@dlf.org.uk www.dlf.org.uk Stroke Association Helpline: 0303 3033 100 
Textphone: 18001 0303 3033 100 stroke.org.uk   
info@stroke.org.uk  
Mind / Mind Cymru (England and Wales) Infoline: 0300 123 3393 Text: 86463 
info@mind.org.uk  
www.mind.org.uk Chest Heart & Stroke Scotland Advice Line: 0808 801 0899 
www.chss.org.uk  
adviceline@chss.org.uk Northern Ireland Chest Heart & Stroke Helpline: 028 9032 0184 
www.nichs.org.uk  
mail@nichs.org.uk Niamh Mental Wellbeing (Northern Ireland Association for Mental Health) Enquiries: 028 9032 8474 
info@niamhwellbeing.org  
www.niamhwellbeing.org  
Different Strokes (run by and for younger stroke survivors) Helpline: 0845 130 7172 
www.differentstrokes.co.uk    
info@differentstrokes.co.uk Scottish Association of Mental Health (SAMH) 0141 530 1000 
enquire@samh.org.uk     
www.samh.org.uk NHS **Choices** (Medical advice and information on health services) NHS non-emergency number: 111 
www.nhs.uk Age UK England: 0800 169 2081 Northern Ireland: 0808 808 7575 Scotland: 0800 4 70 80 90 
Wales: 08000 223 444 
www.ageuk.org.uk Royal National Institute of Blind People (RNIB) Helpline: 0303 123 9999 
helpline@rnib.org.uk  
www.rnib.org.uk  
Headway (Charity for people who have had a brain injury) Helpline: 0808 800 2244 (Mon–Fri, 9am–
5pm) 
www.headway.org.uk  
helpline@headway.org.uk Brain and Spine Foundation Helpline: 0808 808 1000 
www.brainandspine.org.uk  
helpline@brainandspine.org.uk   
Alzheimer's Society (Information and support on all types of dementia) Helpline: 0300 222 1122 
enquiries@alzheimers.org.uk  
www.alzheimers.org.uk 

## We Hope You Found This Report Helpful And Useful

There is more information about SSNAP on the Royal College of Physicians website. www.rcplondon.ac.uk/ssnap If you have any questions about this report please contact the Stroke Programme at the Royal College of Physicians: Tel: 020 3075 1318 or **020 3075 1383** Email: **ssnap@rcplondon.ac.uk** 

## 

We want to know…… What do you think of this report? Have you found it useful? 

 
Please email ssnap@rcplondon.ac.uk and let us know.