It’s a lottery

Earlier this month, the NHS in Scotland published its Stroke Care Audit for 2013. This easily read document can be accessed via the link above and gives an overview of hard data about acute stroke care across Scotland.

The Scottish Government has said that stroke is one of its top health priorities. Yet, as readers of this blog already know, the HEAT target for stroke care was allowed to lapse in March of this year – this target stated that stroke patients should be admitted to a specialist stroke unit within 24 hours: only 5 of the 14 Health Boards in Scotland met this target in 2012. Yes, that’s Five out of Fourteen. The Stroke Care Audit does not break down this disappointing statistic by individual hospitals but none of our largest Health Boards achieved this target. These numbers are not just dry statistics. They matter to anyone who survives a stroke, as early admission to a specialist stroke unit has consistently been shown to improve the outcomes for patients. The report itself admits that where a patient is admitted promptly to a specialist stroke unit, this is likely to mean that the other standards for stroke care will be met for that patient.

What the audit also reveals is that there is huge variation in the standard of stroke care in hospitals across Scotland. For example, Standard 4 in the audit states that at least 80% of stroke patients should have a brain scan on the day of admission to hospital, yet only two of Scotland’s thirty or so hospitals achieved this target in 2012 – in the others the percentage ranged from 77% to only 29%. Again, this dry statistic matters because speed of diagnosis is critical and because a brain scan is essential in determining the kind of stroke a patient has had, and therefore the treatment to be provided.

Looking back over my own experience as a patient in acute stroke care in Oslo in 2004, I conducted my own audit for the treatment I received: the hospital passed the Scottish NHS standards on every count. But that was 2004. In Norway.

What the 2013 Scottish audit tells is a story of huge variations in stroke care standards across the country – for the individual patient this means that the standard of care they receive is a potentially life-threatening lottery. But an audit like this also begs many questions: Why is it that some hospitals and Health Boards can consistently offer a better service than others? Can the worst not learn from the best? What pressure is being applied to hospitals to up their game?

One in six of us living in Scotland will have a stroke. We pay for our health care system through our taxes. We elect our representatives to manage that system effectively. We deserve answers to these questions.