Some Good News on World Stroke Day

You might have read elsewhere that today is World Stroke Day. And that to mark the day, its been announced that an NHS initiative to speed up the treatment of stroke victims is being rolled out across Wales.

A very welcome development.

BMA Cymru recently gave evidence to the National Assembly’s Health Committee on stroke services in Wales as part of the professions ongoing campaign to improve what is one of the worst performing areas of the NHS in Wales. In almost every aspect of stroke care Wales lags behind the rest of the UK.

The new NHS initiative, overseen by the All Wales Stroke Services Improvement Collaborative, has been created over the last twelve months. It is about creating new ways of working to ensure that all stroke patients in Wales have access to automatic emergency care, and receive faster relevant treatment.

In Wales 11,000 people have a stroke each year, it’s the leading cause of disability and the country’s third biggest killer - yet for some reason Stroke hasn’t quite hit the radar of Joe Public as a major health concern.

Perhaps it’s because traditionally stroke has been seen as something that only happens to older people. That’s no longer the case – stroke can and does affect anyone.

Or perhaps it’s because in the past stroke was not considered a medical emergency. But now it’s well established that stroke victims require urgent and prompt specialist assessment and treatment – and that this is the greatest determinant of both survival and recovery.

Either way, the theme of this years World Stroke Day ‘Stroke, What Can I Do ?’ gets to the heart of the issue: that Strokes are preventable, and there is a whole lot that we as individuals can do.

Like so many other health conditions, most strokes are related to overall health and wellbeing. Almost half of all strokes in Wales could be prevented by regular blood pressure checks and by taking steps to improve overall health. I noticed that Joyce Watson AM has done some work on this issue this summer and out of the 1000 people whose blood pressure was taken, a third returned high / borderline readings – a major risk factor for stroke.

Individuals can also do something important just by knowing the symptoms of stroke, how to recognise it and what to do about them – knowing that a stroke requires a 999 response.

Our clinicians and other healthcare partners are struggling to manage the volumes of stroke patients in Wales in an environment which has a severe lack of specialists, which has far from adequate acute care provision and where rehabilitation services, to put it very mildly, are patchy.

Whilst we welcome the news that the new scheme is making improvements in stroke care in Wales – there is much more that the Assembly Government needs to do if Wales is going to achieve the standards seen elsewhere in the UK and begin to provide even an adequate level of services for stroke patients.

To that end, we have made series of recommendations on the steps that should be taken – nationally and more locally - in order to improve the provision of stroke services across Wales. Some of these will need investment, and in the current climate we realise that tough choices have to be made – but money should be chasing need and this is one area of healthcare that Wales can no longer afford to lag so far behind on.

As a priority we need to attract more stroke specialists to Wales while promoting stroke as a speciality to medical students and Junior Doctors; we must improve overall staffing levels including the number of dedicated sessions consultants can allocate to stroke care; and everyone in Wales should have access to a dedicated stroke unit (with appropriate rehabilitation and support services attached) within 30 minutes travel distance from their home.

Significant investment is needed at the acute care level, but the focus needs to be on the whole stroke journey.

What Wales needs is a comprehensive action plan on stroke.

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.

Stroke patients in Wales deserve better

Having come across this latest research into acute stroke care centres, it only serves to demonstrate just how much Wales continues to lag behind other countries, including England and Ireland and how vital it is that Wales not only starts playing catch up, but that it also is at least on a par with other countries.

The research highlights how having dedicated specialist stroke centres greatly improves the acute and long-term care of patients. Being treated in such centres can double a patient’s chances of surviving a stroke and not sustaining any long-term damage. In England, nearly all hospitals have these units, yet only half of Welsh hospitals do.

The NHS reorganisation provides a golden opportunity for the new Local Health Boards to each establish specialised stroke units, not necessarily for every hospital to have a unit, but for patients to be within a reasonable travelling distance of a facility. Someone getting the best possible stroke treatment shouldn’t depend upon where they live, as seems to be the case. A patient suffering a stroke in Cardiff, close to the UHW is undoubtedly in a better position than someone in a more rural area.

Funding is a big factor in the gap between stroke services in Wales and other countries. Just taking the rest of the UK as an example, England has earmarked £105 million and Northern Ireland has set aside £14 million over three years, with a further £9m available. That compares to the Welsh Assembly Government’s £2.5 million per year for three years. And England and Northern Ireland were already ahead of Wales with regard to the quality of stroke services.

The Stroke Services Improvement Programme is visiting all parts of Wales over the summer, hopefully providing an overview of service gaps and giving indications as to what level of funding is required.

The Health, Wellbeing and Local Government Comittee is currently carrying out an inquiry into stroke services. Two of the committee’s main Terms of Reference include looking at the availability of specialist stroke units in hospitals across Wales and geographical variation in these services and the resources devoted to stroke services in Wales. So hopefully, recommdendations will be made and more importantly acted upon, which see stroke patients in Wales getting AT LEAST the same level of treatment as elsewhere in the UK. And any recommendations made in this inquiry need to be acted upon sooner, rather than later.

Wales lags behind when it comes to stroke services

The Royal College of Physicians’ latest report into stroke care services makes for disappointing reading for Wales. There seem to be big geographical differences here, which don’t seem to be occurring in England and Northern Ireland. Has the so-called postcode lottery, seen in drugs and treatment for various forms of cancers, now spread to stroke services? Where you live, should have no bearing on the quality of stroke care you receive.

The report does highlight some areas that have improved, but as is so often the case, there is still plenty more to be achieved, to get Wales just on a par with other UK nations.

Some time ago, BMA Cymru Wales drew attention to the plight of stroke services and patients. In fact, we held a seminar on the issue, inviting Assembly Members to find out more about our concerns. I have to say, rather disappointingly, it was poorly attended by AMs.

No doubt many people reading this blog, will have seen the current TV advert, pointing out the need to act quickly when someone suffers a stroke. That’s to be commended, but we also need to make sure that once a patient reaches hospital, they are able to access the right services. Doctors know only too well how prompt action and the correct treatment can help with rehabilitation and long term damage. That’s why patients should be seen in stroke units up on their arrival at hospital.