Action after inquiry needed on stroke services in Wales

BMA representatives have given evidence this morning to the Assembly’s Health, Wellbeing and Local Government Committee inquiry into Stroke Services in Wales. Several other groups with an interest in this area have also given evidence, along similar lines to ours, so here’s hoping the committee listens and acts on the recommendations of the majority.

A stroke can be devastating condition and is the third most common cause of death in the UK; 11,000 people have a stroke in Wales each year.

Strokes leave one third of patients permanently dependent on the help of others and is the biggest cause of severe acquired disability in the UK.

The treatment and management of stroke is now supported by a good body of quality evidence and we have witnessed a number of medical advances in recent years. As a result acute stroke is increasingly becoming a treatable condition.

That’s one of the reasons why BMA Cymru Wales welcomes the Welsh Assembly Government’s decision to make improving stroke services a priority - as a result the last few years have seen improvement in stroke care across Wales. However so far, this has not gone far enough. In almost every area of stroke care Wales lags behind that of England and Northern Ireland. There are pockets of good practice but the patchy provision of services across the country indicates that much more needs to be done.

If we are to see real improvement in the treatment and services available to stroke patients across Wales, the WAG needs to take act on the points listed below;

• A Wales-wide doctor recruitment and retention strategy, with an emphasis on specialist stroke physicians and neurologists.

• Everyone in Wales should have access to a stroke unit within 30 minutes travelling time of their home and the units should;
* Offer round-the-clock care with access to thrombolysis and scanning equipment
* Be adequately staffed (doctors, nurses, physiotherapists, occupational therapists, speech and language therapists, dieticians, psychologists, social workers)
* Have adequate bed capacity
* Have strong links with rehabilitation and support services

• The new LHBs should:
* Make it someone’s responsibility to lead the team and champion the improvements within their areas and offer local solutions;
* Greatly increase the number of whole time equivalent medical hours allocated to stroke treatment and management;
* Work closely with local authorities and others to create multi-disciplinary care partnerships ensuring joined up working and continuous care provision;
* Interpret national guidance into effective local delivery by considering what is best to meet the challenges of that particular area. In this way national guidance should be broad and flexible;
* Facilitate research and data gathering through, for example, local clinical research networks - working with other LHBs to take a Wales-wide view of stroke services;
* Utilise the new Professional Forums and Stakeholder Reference Group as a mechanism to highlight stroke issues.
* Facilitate public awareness and education campaigns.

• Given the importance in receiving treatment immediately after a stroke, people should be directed straight to hospital, ambulance staff should be specially trained in the early treatment of stroke victims, and information should be sent to GPs to support direct referral.

• A national public awareness campaign is needed to highlight the prevalence and severity of stroke, how to recognise the symptoms, and that it requires a 999 response. The FAST (Face, Arms, Speech, Time) campaign did some good work in relation to this but needs to be built on – for example, the ways to recognise transient ischaemic attacks (TIA), the risk factors such as high blood pressure and diabetes, high cholesterol, smoking, excess alcohol intake and recreational drug use should also be highlighted. Many people still do not realise that strokes are preventable, do not know the symptoms or risk factors, or how to manage them.

• A training programme should be developed for stroke treatment across the multi- disciplinary teams working within the primary and secondary care sector to ensure efficiency and confidence when treating or managing stroke. Training should also be extended to carers.

• The long-term impact of stroke on families and carers needs to be looked at and their views sought.

• Current policy on Stroke - the National Service Framework for Older People, the Stroke Improvement Programme and the Stroke Pathway – are useful but we also support the development of a Stroke Strategy for Wales accompanied by a solid and achievable Action Plan.