Abstract

Background: the National Service Framework for Older People requires every general hospital which cares for stroke patients to introduce a specialist stroke service by 2004.

Objective: to describe the organisation and staffing of specialist hospital‐based stroke services in the UK.

Design: a national postal survey of consultant members of the British Association of Stroke Physicians (BASP) seeking details of the provision of neurovascular clinics, acute stroke units (ASUs), stroke rehabilitation units (SRUs), and the organisation and staffing of these services.

Results: the response rate was 91/126 (72%). Fifty‐four neurovascular clinics, 40 ASUs and 68 SRUs were identified. Neurovascular clinics used a number of strategies to maintain rapid access and 30 (56%) were run by a single consultant. Only 50% ASUs usually admitted patients within 24 h of stroke. As the number of beds available on ASUs and SRUs did not reflect the total number of stroke in‐patients, 21 (53%) ASUs and 45 (79%) SRUs had admission criteria. Training opportunities were limited: 37% ASUs and 82% SRUs had no specialist registrar. The therapy sessions (1 session=half a day) available per bed per week on a SRU were: physiotherapy 0.8; occupational therapy 0.6; speech and language therapy 0.25.

Conclusions: significant development is needed to achieve the NSF target for hospital‐based stroke services as few Trusts currently have all components in place and even when available not all stroke patients have access to specialist care. Stroke specialists will be required to run these services but training opportunities are currently limited. Stroke unit therapy staffing levels were lower than was available in randomised controlled trials.

Address correspondence to: Helen Rodgers, School of Population and Health Sciences (Epidemiology and Public Health), The Medical School, Newcastle Upon Tyne NE2 4HH, UK. Fax: (+44) 191 2226461. Email: helen.rodgers@newcastle.ac.uk
†HR, MD, DC, AR initiated the project and designed the questionnaires. HR undertook the analysis and drafted the paper and is the guarantor. All authors participated in discussing results and writing the paper.

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