Standards of stroke care is good for Bolton patients

Sadly our track record on this is not at all good, in fact it is the worst among all other western developed countries. The figures recently released by the Organisation of Economic Cooperation and Development ( OECD) show the death rate for the ‘commonest’ ischaemic strokes in the UK was nearly 17%, almost twice the OECD average for 30 western countries and almost three times that for Denmark.

Now the question is why? We have excellent clinicians, superb facilities and a National Health Service the envy of the whole world yet things are not what they should be.

Let me analyse the scenario in more details. Although medical science and care standards and their clinical applications have made limitless progress, their actual delivery has always been difficult.

For example no sensible person can expect complex high powered care for cancer in every street corner and in their GP’s surgeries. Such care warrants high level of organisation, availability of fully trained staff and various facilities 24 hours a day as illnesses do not follow any set time or day. Recently we were reading about weekend care and the resulting poorer outcome of treatment received at weekends. Because NOT the full gamut of expertise is available all the time – lack of experienced staff, lack of facilities etc. Medical treatment does not mean only a bed in hospital. Therefore lots of beds in lots of hospitals, no matter how nice they look and how high they go, don’t mean much.

As for stroke, it has been found by several high quality credible audit surveys that standards in stroke care vary enormously even within the same NHS. The overall survival rates for stroke in central London are about 54% higher than in most other parts of the country. The 30 day death rate is significantly lower than even in other large cities and manufacturing towns.

The reason? London has reorganised its stroke services which has revolutionised the outcome. Only the ‘recognised’ highly specialised centres with 24-hour availability of all facilities and expertise are allowed to treat such patients. All other hospitals even with a ‘’stroke ward’’ or ‘stroke nurses’ are not allowed to accept acute stroke patients for immediate treatment. Under the aegis of RCP stroke unit, they reorganised their city-wide services and hence the good outcome.

That extremely successful and clinically effective London set-up is now being ‘rolled-out’ to the rest of the country. The National Stroke Service Director Prof Tony Rudd was explaining this at a special lecture at the Bolton University a year ago. All patients with suspected stroke in Bolton are now being transferred to the nearest ‘specialist’ stroke centre at Hope Hospital for their immediate assessment and acute treatment then they return to Bolton at a later date for further rehabilitation and on-going care locally.

The management of stroke has changed completely over the last two decades and ‘appropriate immediate treatment’ do make a huge difference to the outcome – between life and death , between life long disability and independence. The stroke scene has become very exciting and people , seeking the best possible care, shouldn’t complain about going elsewhere; as mentioned before not all treatment can be available everywhere.

Hopefully, people will understand why acute stroke patients are sent to Hope Hospital; they have a fully staffed and equipped unit which can assess, manage and care for acutely ill patients with stroke. It of course doesn’t mean everyone does well and commences jumping after two days or no one dies; but chances of recovery are better. Exactly the way patients with cancer are referred to Christie Hospital — and this is the most appropriate line of action. The whole of Greater Manchester is now seen as one ‘comprehensive’ health care facility; certain hospitals doing certain work whilst the basic care is delivered in all townships. This approach is not new being practised for many years but perhaps being highlighted lately. In summary, stroke care is fully available to all Bolton residents when needed.

Arup Banerjee