Speed and use of the most effective best-practice treatments


Stroke – where a blockage cuts off the blood supply to the brain, or a blood vessel bursts within or on the surface of the brain – is a major cause of death and disability.

About 85% of patients leave hospital alive after a stroke, with about a third of those returning home. Close to 10% are discharged to a care home, of whom 65% are being sent to a home for the first time and about 80% are expected to become permanent residents. The proportion of people who become permanent residents in care homes is an important measure – at 7% in 2016, it has decreased from about 10–15% in 2013.

High quality care for people with stroke involves rapid diagnosis and specialist hospital treatment, as well as early assessment by therapists to provide essential care and begin rehabilitation. The Sentinel Stroke National Audit Programme grades NHS stroke services in England, Northern Ireland and Wales on how well they perform on delivering all these different aspects of care. Figure 8 shows that in England, Northern Ireland and Wales, the NHS made substantial progress in improving care from 2013 to 2016, with more clinical teams achieving a grade of ‘first-class’ or ‘good or excellent in many respects’, and a decrease in services where substantial improvement is needed.

Figure 8: Percentage of patients receiving stroke services that meet quality standards in England, Northern Ireland and Wales, July–September 2013 and August–November 2016

Source: Sentinel Stroke National Audit Programme, 2017

The latest data, from August to November 2016, suggest that 93.7% of patients who have had a stroke have a brain scan within 12 hours of arrival at hospital and 50.7% within 60 minutes. Over 88% of patients who have had a stroke and can be treated with ‘clot-busting’ drugs receive this treatment, two-thirds within one hour of arrival at hospital. 58.5% of patients are admitted to a specialist stroke unit within four hours of arrival at hospital, with over 80% seen by a stroke specialist within 24 hours.

Approximately 90% of patients see stroke specialist nurses, occupational therapists, physiotherapists and speech and language therapists within 72 hours, who provide essential care and help improve outcomes – for example, they reduce the chances of patients becoming ill with pneumonia by making early swallow assessments.

However, many patients are not receiving the amount of therapy they need – particularly speech and language therapy, which is rarely available seven days a week. Fewer than a third of patients received a six-month follow-up assessment and, in a 2016 survey by the Stroke Association, over 45% of stroke survivors reported feeling abandoned after leaving hospital.

Figure 9 shows that the UK lagged behind OECD countries for stroke mortality in 2008: 17 per 100 people died within 30 days of hospital admission for ischaemic stroke in the UK, compared with an average of 12 per 100 people in OECD countries. But advances in the treatment of stroke have led to a substantial reduction in deaths, and Figure 9 shows that the UK had made rapid improvement to virtually close the gap by 2013.

Figure 9: Mortality following admission to hospital for stroke and acute myocardial infarction, OECD average vs UK

Source: OECD, 2015

Heart attack

Heart attack, also a major cause of death, is caused by the blood supply to the heart being suddenly interrupted.

For the most serious form of heart attack, primary percutaneous coronary intervention (PCI) has been established as the best treatment to re-open blocked heart vessels that cause heart attack. In 2015, 99% of patients in England who could benefit were treated with PCI.

In 2015, 88.6% of all patients in England and Wales were treated with PCI within 90 minutes of arriving at hospital, up from 52% in 2005. This was a slight deterioration from 92% in 2014, but it is unclear if this is normal variation or the start of a downturn in quality. The time from the 999 call to treatment gives an indication of the quality of care provided by the ambulance service and in hospital, as well as the transition between the two. 77% of patients were treated within 150 minutes of a 999 call in 2015, a decrease since 2014 (82%). 90% of patients were discharged from hospital with the appropriate medication.

Heart attack mortality in 2008 was worse in the UK than in OECD countries: 12.0 per 100 people died within 30 days of hospital admission for heart attack in the UK, compared with an average of 11.0 per 100 people in OECD countries. Performance has improved and, although progress has since levelled off, Figure 9 shows that the UK overtook the OECD average by 2013, when 9.1 per 100 people died within 30 days compared with an average of 9.5 per 100 people in OECD countries.


In the 2015 National Cancer Patient Experience Survey, participants were asked to rate the overall quality of their care on a scale from zero (very poor) to 10 (very good) and gave an average rating of 8.7, with 94% rating their care as seven or higher.

Breast cancer is the third most common cause of cancer death in the UK, with around 11,400 deaths in 2014. The UK performs very well on breast cancer screening, with an average of 75.9% of women aged 50–69 screened in 2013 compared with the OECD average of 60.3%. Survival for people with breast cancer in the UK is improving over time, as with most cancers. One-year survival rates improved by 14% between 1971 and 2010, from 82% to 96%, while five-year survival rates improved from 53% in 1971 to 87% in 2010. The latest available international comparisons of five-year survival rates suggest the UK remains worse than the average for OECD countries. But Figure 10 suggests the UK has gained some ground in the past decade, with a 7.6% improvement in rates between 1998–2003 and 2008–2013, compared with a 5.5% improvement in the average for OECD countries over the same period. Breast cancer mortality rates have decreased by 32% in women in the UK since the early 1970s, but despite this they are currently the 14th highest in Europe.

Figure 10: Breast and bowel cancer five-year relative survival rates, OECD average vs UK

Source: OECD, 2015

With around 40,000 new cases registered every year, bowel cancer is one of the most common cancers in the UK and the second most common cause of cancer death. Around half (57.9%) of people in England who are invited for bowel cancer screening are screened with a definitive usable result within six months of invitation, although uptake rates vary between different parts of the country. There have also been marked improvements in the quality of care delivered by the NHS for patients with bowel cancer. Shorter stays in hospital following major bowel surgery indicate improvements in terms of other treatments like chemotherapy, better decisions on who would benefit from surgery, and advances in care of people after operations. Median time in hospital following major surgery for bowel cancer has almost halved from 13 days in 2004 to seven days in 2015, although the ambition is to reduce this further to five days. It is difficult to compare bowel cancer mortality over time due to changes in how data have been collected, but there is a general trend of improvement, with 90-day mortality following major surgery declining steadily from 5.4% in 2010 to 3.8% in 2015.

Figure 10 shows that the UK’s five-year survival rate for bowel cancer remained below the average for OECD countries in 2008–13. While the UK was above the average for OECD countries for age-standardised mortality rates for bowel cancer in 2003–13, it remained behind France, Australia, Switzerland, Germany and Spain. The UK mortality rate for bowel cancer in 2012 was the tenth lowest in Europe, with five-year survival in men (51%) and women (52%) in England below the average rates for Europe (both 56%).

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