Hyperacute stroke care and NHS England's business plan

Abstract

Computer simulation, coupled with high quality data, can help in decision making NHS England’s refreshed business plan identifies the reconfiguration of hyperacute stroke services as a priority. NHS England aims to develop the case for major reconfigurations in two further geographical locations by April 2015.1 This priority follows the centralisation of London’s acute stoke care in 2010, in which 30 local hospitals receiving stroke patients were reduced to eight hyperacute stroke units, each within a maximum ambulance travel time of 30 minutes. In a before and after study,2 the thrombolysis rate increased from 5% to 12%, the survival rate increased from 87.2% to 88.7%, and centralisation achieved an estimated 90 day cost saving of more than £5m (€6.1; $8.4m) a year. Improvements have continued, with 2013 audit data for London reporting a thrombolysis rate of 17% and median door to needle times ranging from 29 to 48 minutes compared with an English average of 12% and median 59 minutes, respectively.3 Given London’s success, an important question arises for many NHS commissioners: would such a reconfiguration be just as effective outside the major conurbations? Central to this question is the exquisitely time sensitive …