The National Stroke Strategy,1 published in 2007, outlined a “National Ambition for Stroke” where every patient with stroke or transient ischaemic attack (TIA) receives timely and evidence-based stroke care from the moment of symptom onset. The recent publication of the NICE guideline on diagnosis and initial management of acute stroke and TIA2 provides clinicians, service providers and commissioners with the evidence to support acute and hyperacute care following a neurovascular episode. The challenge is now to implement the evidence in every acute and primary care trust across the country. Stroke clinicians are working alongside their cardiological colleagues now in managed clinical “cardiac and stroke” networks to develop systems of care that will implement the new evidence so that every patient, wherever and whenever they present, can have equal access to high-quality services.

ACUTE STROKE

The guideline emphasises the importance of early recognition of stroke symptoms, and recommends a validated diagnostic tool such as Face Arm and Speech Test (FAST). This will require a community awareness programme involving the public and front-line healthcare workers. The Stroke Association and Department of Health launched a national awareness programme in the spring of 2009 to develop awareness of FAST and encourage patients to seek urgent paramedic attention. Paramedics need to have clear protocols for the management of “FAST-positive” patients, and clinical networks have a vital role to play in ensuring that the right services are available in the right place and at the right time. This may involve transporting patients to designated “stroke centres” rather than to a local district hospital, if this means more ready availability of urgent assessment and treatment. A number of different stroke centre models are being developed across the country, depending on local geography …