Lizzy Buchan: Stroke patients need better support

STROKE patients aren't getting the help they need, writes Lizzy Buchan

The standards demand 80 per cent of patients should get the full bundle of care, yet none of Scotlands major acute hospital met that target. Picture: TSPL

Great medicine is often about big things such as saving lives or making groundbreaking discoveries. But it should also be about small things, such as the daily tasks that make up the big picture.

Therefore the news that hospitals are failing in the simple task of giving an aspirin to stroke patients who need it within 24 hours should be a cause for great concern.

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Taking an aspirin quickly can help to thin the blood after a stroke, which occurs when the blood supply to part of the brain is cut off.

The results of a stroke can be devastating, leaving sufferers with speech and sight difficulties, paralysis and changes to mental and emotional faculties. One in eight people will die within 30 days of having a stroke.

The Scottish Stroke Care audit published this week found that most hospitals were failing to deliver the relatively simple measures needed to help the 14,000 people who suffer a debilitating stroke each year.

Scotland has one of the highest death rates from stroke in Western Europe, so to rid the nation of this dubious honour, health experts decided that stroke patients should receive a bundle of care within the first 24 hours of being admitted to hospital.

This includes admission to a specialist stroke unit, a brain scan, a swallow screen to prevent them from choking and aspirin if appropriate.

The audit found that all of these standards were missed, bar the brain scan.

Swift access to clot-busting drugs, which can help to reduce the risk of disability and prevent the risk of another stroke, was given to just half of patients.

There have been improvements across Scotland in recent years but more must be done to tackle the “significant disparity” of care, which is rightly highlighted by the Stroke Association.

The standards demand 80 per cent of patients should get the full bundle of care, yet none of Scotland’s major acute hospital met that target.

Once again patients face a postcode lottery, as the Borders General Hospital reported performance of 79 per cent compared to just 44.1 per cent in Raigmore Hospital in Inverness.

There is no easy answer to the problem as many of the causes are deep-rooted.

Continuous nursing shortages are clearly not helping the situation, as stroke patients are likely to be in hospital for a reasonable period of time and to require intensive attention.

Staff that are struggling simply to keep things going are unlikely to be able to deliver that level of care.

One of the major issues is ensuring patients get prompt access to a specialist stroke unit.

Smaller hospitals do better at this as their medical wards meet the criteria, whereas larger hospitals are constantly dealing with the pressure of emergency admissions, according to the audit report.

These pressures mean stroke patients are often boarded – housed in non-specialist wards while stroke beds are taken up by other patients.

How hospitals manage their dedicated stroke beds is evidently an area to focus on.

The Stroke Association warned that delays to treatment could affect people’s chances of making a good recovery.

As the cost of caring for stroke patients accounts for five per cent of the whole NHS Scotland bill, the reasons behind these failings require urgent attention for both patients and the wider health service.