The name of this blog is Man, Dog, Stroke. Recently there has been quite a bit about the man, and quite a bit about the dog. Perhaps it’s time for a bit about stroke.
Last month, later in the year than usual, the Scottish Government published its annual review of stroke care in Scotland. You can read the details here. I am aware that this blog is read well beyond Scotland, but who knows? There may be something in this post that resonates with you wherever you live. In any case, I would like to give you a stroke survivor’s perspective on this report, which is optimistically entitled the Scottish Stroke Improvement Plan 2020. Despite its title, it relates to stroke care statistics for 2019 – i.e. prior to the Covid pandemic.
First the good news. In common with the rest of the UK, Scotland’s stroke care is provided by a host of professionals who strive to do the best they can with the resources, training and guidance at their disposal
However, after almost a decade of these reports we now have a depressing situation where:
- there is a continuing post code lottery across Scotland in terms of acute and community stroke care and we are generally lagging behind the rest of the UK.
- in terms of stroke bundle performance (i.e. the procedures to be followed for stroke patients immediately upon admission to hospital) no NHS Board in Scotland reaches the stroke standard expected.
- thrombolysis door to needle times are variable across Scotland and below rates in the rest of the UK, despite this being an urgent treatment at the onset of stroke. (Thrombolysis is a procedure to dissolve blood clots in patients with an ischaemic stroke – a clot blocking a vein or artery in the brain).
- while the Scottish Government has managed to produce in a matter of weeks a rehabilitation plan for covid-19 survivors, no such national rehabilitation strategy exists for stroke survivors, despite repeated requests for this from charities and professionals over several years. Rehabilitation merits only a passing mention in the audit report, despite being the key to maximum recovery for patients.
- there has been no opportunity this year for Health Boards to respond to their statistics within the published audit. This had in the past been an opportunity for readers of the report to get some of the human and resource facts behind the dry data
- there is still no measure of what a good stroke unit should look like – unlike the measurement of stroke services in many western countries.
- finally, despite its potential to reduce disability for hundreds of Scots each year, progress on developing a national thrombectomy service is proceeding painfully slowly at the planning stage, although thrombectomy has been available for suitable stroke patients elsewhere in the UK for some time. Thrombectomy is a mechanical procedure to remove a blood clot. While it is only suitable for some patients it can significantly reduce the chances of patients having their lives blighted by chronic disability, speech or vision problems and many of the other results of stroke – to say nothing of the savings that it potentially brings to health and social care services.
All of these points are significant, but for me there are important ethical and equality (inequality) questions posed by points 4. and 7. above.
None of these shortcomings is the fault of our stroke professionals who, as I said at the beginning of this post, can only work within the strategies and resources they have.
This blog rarely strays into the zone of politics, which in its on-line form in Scotland can be an extremely unpleasant place. However, it is important to say that stroke professionals, stroke charities and stroke survivors were heartened to see in last year’s Scottish Programme for Government a mention of stroke as a priority. It is a small fraction of the health budget, but £1m was allocated to stroke in that programme, mainly to undertake the first tentative steps towards introducing a national thrombectomy service. One year on and…, well, you have seen my comments above.
Understandably, the pandemic has caused upheaval in our health and social care services, leading to the hasty redeployment of staff and resources, including staff who might have been available to treat stroke patients. There is anecdotal evidence at least of patients being discharged earlier than they might have been from stroke units, and discovering that it is difficult or impossible to continue their rehabilitation in the community. Some of this is understandable, perhaps, but it it does not bode well for how the annual review of stroke services will read next year.
If you wish to read more about how coronavirus has affected stroke services you can read an excellent report by the Stroke Association here.
The Scottish Government’s programme for next year is heavy on plans for Scottish independence (or breaking up the UK, depending on your viewpoint), but light on stroke care. Of course, we have a nationalist government, independence “transcends” (© N Sturgeon) everything else and next year is an election year.
Anyway, man will now cease his rant, dog will rest quietly at his feet, and stroke? Well, stroke will continue its devastating onward march.
