What is stopping timely stroke care in the UK?

An Editorial in this week's Lancet looks discussed the recent report from the UK Vascular Society and the Royal College of Physicians which states patients in the UK are waiting too long for vascular surgery after symptoms of stroke or transient ischaemic attack (TIA).

The UK National Institute for Health and Clinical Excellence (NICE) guidelines recommend no longer than a 14-day delay between symptoms and operation, and the 2007 National Stroke Strategy set a target of 48 h, to be achieved by 2017. The recent data show that only 3% of patients had the operation within 48 h, and about a third met the 14-day guideline.

Two years ago, an audit by the same organisations showed more than a third of patients were waiting 12 weeks or more for their operations. A public awareness campaign followed that 2008 audit, alongside reorganisation of services for TIA and stroke care. The new audit has shown some improvement, with reductions in delays at all stages of the process from presentation to surgery, but work remains to be done. Delayed referral (40%), scarcity of staff or operating theatres (18%), and delayed patient presentation (18%) were the main causes of waits longer than 14 days.

The Editorial concludes: "The persistence of delays in presentation and referral shows the continued importance of awareness campaigns. Improved identification and urgent referral of patients at high risk will need to be coupled with further reorganisation of services to ensure availability of specialist staff and facilities. Renewed efforts are needed if the UK is to meet a 48-h or seven 2-week deadline for all patients."