Dudley Strategy for Tackling Health Inequalities 2010-15

Timely ResponseTimely access to treatment for stroke/TIA is dependent on:Public knowledge and awareness of signs, symptoms and speed of responseAmbulance response times and use of validated tools to diagnose stroke/TIAAccess to timely diagnostics and treatmentPublic knowledge and awareness of the symptoms and need to call 999 for stroke islow. The national F.A.S.T campaign was introduced in 2009 and evaluation of thiswas carried out in May 2009 by Central Office of Information on behalf of theDepartment of Health (Central Office of Information, 2009), and has shown somepositive results. Pre and post awareness levels were measured and showedincreases in the need to call 999 from 58% to 70% amongst the general population(52% to 62% amongst the black Caribbean and South Asian populations),awareness of early detection being beneficial from 53% to 66% in the generalpopulation (42% to 51% for black Caribbeans and South Asians) and in recognitionof symptoms from 79% to 89% in the general population (67% to 83% for blackCaribbeans and South Asians). The lower levels of awareness within key Black andMinority Ethnic communities needs to be addressed since they are at higher risk ofstroke. Lower levels of awareness has also been found for the over 65s (The StrokeAssociation, 2007). Local data for awareness in Dudley is not available; howeverone can assume a similar pattern of awareness. There have been a number of FASTcampaigns in Dudley which have been aimed at the general population, particularlyin lower income areas. There are currently no targeted campaigns for older people orBME communities.For those who call 999, thrombolysis can be an effective treatment for stroke ifdelivered within 3 hours of the on-set of symptoms, thus the patient needs to bediagnosed using FAST, receive a category A ambulance response (8 minuteresponse) with rapid referral to hospital for imaging within one hour and subsequentdrug administration. TIA patients that are of a high risk of stroke are also required tobe identified using the ABCD2 score and imaged within 24hours. The NICE qualitystandard measures the proportion of total stroke and TIA screened by ambulancestaff and transferred to a stroke unit within one hour. This is a new metric, and the 4months data for 2010 shows a slow increase to 25% in May 2010 against a target of100%.TIA and Stroke Diagnostics and ServicesThe accelerating stroke programme and associated targets was only recentlylaunched in March 2010 hence the metrics, and data collection processes andservice developments are relatively new. Table 3 gives a snapshot of Dudley‟sposition against April 2011 targets. Data available in most cases is just 4 months.The table indicates the month 4 position (May).89