Written evidence submitted by the Stroke Association (PHA0014)

Stroke Association’s evidence to Health and Social Care Committee inquiry into Pharmacy

The Stroke Association welcomes the opportunity to provide evidence to the Health and Social Care Committee’s inquiry into pharmacy services as they have an important role in detecting and managing stroke risk factors like atrial fibrillation (AF), high blood pressure and high cholesterol. Pharmacists also play a role in supporting stroke survivors who may use medication to manage their condition and reduce their risk of having a second stroke.  

About the Stroke Association 

The Stroke Association is the UK’s largest charity for people affected by stroke. We're here to support people to rebuild their lives after stroke. We provide specialist support, fund critical research and campaign to make sure people affected by stroke get the very best care and support to rebuild their lives. 

There are over 100,000 new strokes every year, and over 1.3 million stroke survivors in the UK today. And these numbers are only set to grow. Stroke is the fourth biggest killer in the UK. And the cost of stroke to our society is around £26 billion a year. Sadly, we know stroke causes a greater range of disabilities than any other condition. Almost two-thirds of stroke survivors leave hospital with a disability. However, thanks to improvements in stroke care, you are now twice as likely to survive a stroke compared to 20 years ago.   

Our vision is for there to be fewer strokes, and for people affected by stroke to get the help they need to live the best life they can.  

In summary

• Pharmacy should be a key system partner for detecting stroke risk factors like atrial fibrillation and high blood pressure.
• The UK Government needs to go further to educate the public on the level of services available at pharmacies and the role they can play in keeping people well and preventing strokes.
• The UK Government needs to build on the commitments in the NHS Workforce Plan by engaging with the pharmacy sector to improve retention of its workforce long term.
• Pharmacy needs to adopt the Stroke Specific Education Framework (SSEF) in its training practices.
• The UK Government needs to invest in innovations which can detect stroke risk factors like atrial fibrillation to reduce the number of strokes. 

1. What does the future of pharmacy look like and how can the Government ensure this is realised? 

1.1.             In the future pharmacy services should be seen as crucial in detecting and managing stroke risk factors like AF, high blood pressure and high cholesterol.

1.2.             British Heart Foundation found that nearly 100,000 more people with cardiovascular disease including stroke have died in England since the start of the pandemic.[1]

1.3.             Last year the NHS set out its plans for cardiovascular disease prevention recovery which includes a system-wide response.[2] Pharmacy services can help to reduce the health and economic burden of cardiovascular disease through initiatives that improve the detection of stroke risk factors like atrial fibrillation.

1.4.             AF remains chronically underdiagnosed with an estimated 500,000 people in the UK unaware that they have this condition.[3] However, pharmacies can also use CVDPrevent data to look into their local rates of AF and hypertension prevalence and treatment and use this to identify groups of people to target and co-design community-based projects to improve rates of cardiovascular disease.[4]

1.5.             Pharmacies play an important role in their communities and should be forming strong relationships, which will reduce the number of strokes and reduce health inequalities. This will progress the aims within the NHS Long Term Plan to prevent 150,000 strokes, heart attacks and dementia cases over the next 10 years as well as reduce the burden on GPs and urgent and emergency health services.

1.6.             The Government should prioritise encouraging the public to make use of their pharmacy services and encouraging them to visit pharmacies for health check-ups. This could be done through public awareness campaigns and signposting to pharmacies to check for conditions like AF and high blood pressure so that people are aware of what is available.

1.7.             At the same time pharmacists should ensure they are acting in line with NICE guidance to carry out pulse checks whenever they carry out a blood pressure check.[5] AF increases people’s risk of stroke by around 5 times.[6] Furthermore, AF related strokes tend to be more serious with more damage to the brain and worse long-term effects.[7] 

1.8.             Therefore, it’s imperative that pharmacy professionals are ensuring that they optimise the contact they have with members of the public to look for common stroke risk factors and then work with other system partners such as GPs and the voluntary sector to provide a plan and guidance for their patients in managing their conditions as necessary. 

1.9.             Pharmacists should also be used as a key resource to improve medicine adherence and the Government could facilitate this by reviewing the exemptions list for prescriptions to include long term conditions such as stroke. This would remove one of the barriers to stroke survivors not taking their medicines which is cost in the middle of a cost-of-living crisis.

1.10.         The Stroke Association’s 2019 Lived Experience of Stroke report showed that a significant proportion of stroke survivors ended up worse off, with 37% of stroke survivors saying they saw their income go down as a result on their stroke.[8] This would improve patient outcomes and quality of life and reduce the likelihood of costly interventions.

2. What are the challenges in pharmacy workforce recruitment, training and retention, and how might these best be addressed? 

2.1.             Current challenges in the pharmacy workforce staff shortages are much like other areas of the NHS. The NHS Workforce Plan promises to increase the number of pharmacy training places by nearly 50% by 2031/32.[9] However, there is little mentioned about how to retain pharmacy staff once they’re in place.

2.2.             The UK Government needs to work with the pharmacy sector on a plan to retain staff and ensure employers are as focused on improving the morale of the pharmacy workforce as it is on recruiting them.

2.3.             The Stroke Association often hears from stroke survivors that there is a need to improve health professionals’ knowledge and awareness of the signs of stroke and its impact on survivors.[10] Pharmacies need to adopt the Stroke-Specific Education Framework, especially the elements on “Long-term care” and “Professional behaviour and values” and use it within their training so that they can engage with stroke survivors and understand their needs.

2.4.             Stroke survivors may need to interact with pharmacists when taking their medications, especially if they have questions or concerns so it’s important for medication adherence to ensure that pharmacists are appropriately trained.    

3. What innovations could have the biggest impact on pharmacy services and why?  

3.1.             Innovations which can help with detecting and managing stroke risk factors like AF and high blood pressure could have a massive impact on pharmacy services. The Stroke Association supports the use of proven technologies, to support the detection and self-management of AF where appropriate.

3.2.             A systematic review and Meta -analysis found that blood pressure monitors and non 12-lead electrocardiography (ECGs) are more accurate in detecting AF compared with manual pulse checks.[11]

3.3.             Remote technology for AF diagnosis and monitoring and smartphone apps can also be used to screen for AF. A 12-lead ECG would still be needed to confirm diagnosis, but these technologies could be used appropriately by pharmacies to support detection of AF.[12]

3.4.             Pharmacies could also promote smartphone apps like the Stroke Risk-o-meter to their patients so that they could assess their risk of stroke in the next five or ten years and how they can reduce that risk.