Complete guide to NHS stroke services in the UK — SSNAP audit performance, thrombolysis and thrombectomy targets, hyperacute stroke unit (HASU) care, stroke rehabilitation, and stroke software.
100,000 people have a stroke in the UK each year. Thrombolysis rates are 12-15% against the 20% target. Thrombectomy is at 2-3% against the 10% target. SSNAP performance varies significantly across NHS trusts.
NHS Stroke Pathway
- Face-Arm-Speech-Time (FAST): Public recognition campaign for stroke symptoms
- 999 call: Ambulance dispatched as Category 2 (18 min target)
- Pre-alert: Ambulance pre-alerts HASU for rapid handover
- HASU admission: Direct admission to Hyperacute Stroke Unit (bypass A&E)
- Brain imaging: CT/CTA within 1 hour of arrival (target: immediate)
- Thrombolysis: If eligible, alteplase within 4.5h of onset (door-to-needle < 60 min)
- Thrombectomy: If large vessel occlusion, mechanical thrombectomy within 6h
- Stroke unit: Transfer to stroke unit within 4h of arrival
- Early therapy: Therapy assessment within 24h, therapy within 72h
- Discharge: Early supported discharge, community rehabilitation
- 6-month review: Comprehensive 6-month assessment
SSNAP Key Metrics
| Metric | Target | National Average |
|---|---|---|
| Brain imaging within 1h | 95% | 85% |
| Thrombolysis rate (eligible) | 20%+ | 12-15% |
| Door-to-needle time | < 60 min | 55-70 min |
| HASU admission within 4h | 90% | 75% |
| Stroke unit admission within 4h | 90% | 80% |
| Specialist therapy within 72h | 85% | 70% |
| 6-month assessment | 80% | 60% |
| Discharge to usual place of residence | 80% | 75% |
HASU Requirements
- 24/7 stroke consultant: Consultant available 24/7 (on-site or telemedicine)
- 24/7 thrombolysis: Ability to thrombolyse at any time
- 24/7 imaging: CT/CTA available 24/7 with immediate reporting
- Stroke nurses: 1:2 nurse-to-patient ratio in hyperacute phase
- Stroke unit: Transfer to stroke unit within 4 hours
- Thrombectomy service: Direct or transfer to thrombectomy centre
- Early therapy: Physio, OT, SALT within 24-72 hours
- Swallow assessment: Within 4 hours of admission
Frequently Asked Questions
- What is SSNAP?
- SSNAP (Sentinel Stroke National Audit Programme) is the national clinical audit for stroke care in England, Wales, and Northern Ireland. It measures stroke care against evidence-based standards: time to brain imaging, thrombolysis rate, HASU admission, specialist therapy, and 6-month outcomes. All NHS trusts must participate.
- What is the NHS thrombolysis target for stroke?
- The NHS target is to thrombolyse 20%+ of eligible ischemic stroke patients. The national average is 12-15%. Thrombolysis must be given within 4.5 hours of symptom onset ('time is brain'). Door-to-needle time target: < 60 minutes. Each 15-minute delay reduces good outcome odds by 4%.
- What is mechanical thrombectomy?
- Mechanical thrombectomy is a procedure to remove blood clots from large brain vessels in acute ischemic stroke. It can be done up to 6 hours (sometimes 24 hours) after symptom onset. NHS England targets 10% of stroke patients to receive thrombectomy — currently only 2-3%. Thrombectomy improves functional independence by 50%.