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Thursday, January 21, 1999 Published at 20:06 GMT


Stroke care is a 'lottery'

Quality care is crucial after a stroke

Every year one hundred thousand people have a first stroke. It is the third biggest killer in Britain after cancer and heart disease and is the largest single cause of disability in the country. However, instead of being one of the top priorities for the NHS, it seems as though the quality of care patients receive is something of a lottery, says BBC Correspondent Justin Rowlatt.

If you are lucky enough to live near a hospital with a specialist stroke unit you will have a 30% better chance of surviving your stroke.

Justin Rowlatt: "Stroke care is a lottery"
Not only that - you can expect to suffer less disability and you will be much more likely to return home afterwards.

Joe Denn suffered a massive stroke almost two years ago. It takes four people to carry him up the stairs from the basement flat where he lives.

It may be hard work getting out but the hospital visit is the high point of his week says his wife, Patsy.

"He does not do anything or see anybody all day long. He has his medication, a drink, a piece of toast, and then he sits in front of the television until he is too exhausted to sit up anymore, then he goes to bed.

"He only ever sees the outside world when the ambulance comes to take him for his day care which is twice a week."

Mr Denn is no exception says Owen Redahern of the Stroke Association. Many stroke victims suffer permanent and very severe disability.

"A stroke is where there is a disruption of blood going to the brain either because a vessel bleeds or because a clot prevents it happening.

"This means a part of the brain lacks oxygen and kills off some of its cells.

"The main consequence could be death, but if the person survives then something of a third of people will have a disability.

"There is something in the region of 300,000 people living with a disability because of a stroke."

Like most stroke victims, Mr Denn's illness came out of the blue. He lapsed into unconciousness during a family picnic.

His wife and their daughter rushed Mr Denn to the nearest hospital. He had what is known as a pre-stroke - an indicator that another full stroke might be on its way.

Nobody checked

Mrs Denn said: "The doctor examined him and all of Joe's senses were coming back quite well, but because of what he had already had they quite rightly decided to keep him in overnight to keep an eye on him.

"Unfortunately nobody did keep an eye on him and during the night he had a bad stroke and nobody even noticed.

"I phoned up in the morning to find out how he was and was told he was fine, about the same as when he was admitted. I brought his clothes in to take him home and found a vegetable laying in the bed. He did not even know me, he certainly could not speak or move."

Mr Denn had been unlucky. He had gone to a hospital where there was no specialist stroke unit.

There is no guarantee that Mr Denn would have been cured if he had received specialist care but the research evidence is absolutely clear - patients who go to specialist units do have a much better chance of not just surviving their stroke but also suffer less disability.

[ image: Patients benefit from physiotherapy]
Patients benefit from physiotherapy
George Faraday suffered a catastrophic stroke two years ago. He lives just a few miles from Joe Denn but George went a specialist stroke unit.

He is still pretty dependent on his wife Florence but his condition has improved dramatically. They put it down to the care he received.

Mrs Faraday said: "They have physio daily, they have got to make the brain work again.

"They give them art lessons. They do talk to them a lot - they do not just put them in a room and leave them - and they arrange little parties, they make them feel there is life after a stroke."

'Terribly let down'

Mr Denn's experience couldn't have been more different. He did not get co-ordinated specialist care. His wife feels he was terribly let down by the care he received.

Mrs Denn said: "The knoweldge of stroke was almost non-existent. In fact hot tea acccidentally got spilt on to Joe. It was a patient on the ward who finally called a nurse to say he was uncomfortable.

"He had an horrific burn down his side, about eight inches long and three inches wide, it was a third degree burn.

"That could not have happened in a stroke unit because hot tea would not have been poured near him."

Amazingly for something that has such a dramatic effect on the health of patients effective after stroke care does not actually cost more money.

Setting up a stroke unit is not about bringing in costly equipment or using the latest expensive drugs - it's much more simple than that.

Co-ordinated care works

According to Dr Jonathan Potter who set up the Kent and Canterbury stroke unit where George Faraday was treated it is about re-organising the way that stroke care is given.

That means building up a team of doctors, nurses, physiotherapists and other professionals who all work together in a co-ordinated way.

Dr Potter said: "It is because of the specialist input from staff with experience in stroke, and the fact that they work in a co-ordinated way that one is able to do two main things.

"Firstly, prevent the complications of stroke that can lead to a deterioration in condition and may even lead to death and also, by working as a skilled team over a 24-hour period, you can enhance the rehabilitation process."

Setting up a stroke unit may even save the NHS money. If patients suffer less disability they will need less long term care.

Yet despite the Government making stroke a priority action area in its Our Healthier Nation White Paper no-one seems to know how stroke care varies around the country.

One thing is certain says Owen Redahern - there is considerable room for improvement.

"Organised stroke care around the country is patchy, and if it is patchy that means the possibility of somebody surviving a stroke is also patchy depending on where they live."

The Stroke Association has commisisioned a major survey of stroke services to give it - and the Department of Health - a clear picture of how stroke care differs around the country.

Only then can work begin to ensure that all stroke victims have the same change of surviving their stroke and of avoiding disability.

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