National Institute for Health and Clinical Excellence (NICE)
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Health organisations working to incorporate NICE recommendations into NHS care to benefit thousands of patients who have had a stroke

An NHS workforce and resource impact statement published yesterday (17 July 2019) highlights the work being done by national partners to integrate changes recommended by NICE in its updated stroke guideline into routine NHS patient care.

The statement is the result of a collaboration between NICE, NHS England and NHS Improvement, NHS Clinical Commissioners, and Health Education England. It is designed to help commissioners and trusts understand the potential impact on the NHS workforce and resources of implementing specific NICE guidelines.

Stroke affects around 230 people per 100,000 each year, with over 80,000 people hospitalised per year in England. It is the single biggest cause of disability in adults, with an estimated annual cost to the NHS of £2.98 billion per year. A further £4.55 billion per year is estimated to be spent on social care for people who have had a stroke.

The workforce and resource impact statement estimates the costs to the NHS of increasing the provision of thrombectomy - a procedure to remove the blood clot causing the stroke - will be around £3.7 million in the first year, rising to £18.5 million in year 5. However, it is likely that these will be offset by cost savings for NHS and social care services of around £15.4 million in year 5 as a result of shorter hospital stays and reductions in future NHS supportive care and social care costs.   

The potential increased costs of additional MRI requests for patients suspected of having a ‘mini-stroke’ – a transient ischaemic attack (TIA) - will be offset by savings gained through no longer routinely offering CT brain scanning to everyone with a suspected TIA. The net impact of these recommendations is estimated to be a cost saving of around £800,000 in year 5.

Overall, implementation of the guideline in England will cost around £18.6 million in 2023/24, although this will be offset by NHS and social care cost savings of around £16.2 million. 

The statement also highlights the initiatives underway both within and across organisations to put the NICE guideline recommendations into practice, including support by NHS England specialised commissioning for the implementation of a thrombectomy service specification across the country. These initiatives will ensure the provision of the most effective, up-to-date treatments and in doing so will improve patient care.

Health Education England will work with the medical Royal Colleges and others to develop new training programmes for hospital consultants to offer mechanical thrombectomy.

In addition, the newly established Stroke Delivery Board (as part of the NHS Long Term Plan) includes a focus on increasing rates of thrombectomy, as well as improving the delivery of hyper-acute stroke pathways. Delivery and performance will be monitored and supported regionally by NHSE and the Getting it Right First Time (GIRFT) Stroke Programme.

The statement published yesterday was developed by a guideline resource and implementation (GRIP) panel, comprising members from NICE, Health Education England, NHS Clinical Commissioners, and NHS England and NHS Improvement.

The GRIP panel has been set up to focus on NICE guidelines that are most likely to have a substantial resource impact on the NHS - either where the total cost of implementing a guideline is likely to be more than £5 million per year, or where the cost of implementing a single recommendation within the guideline is likely to exceed £1 million per year. 


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