Fears for stroke patients

Health boards still missing targets in spite of boost in performance

PATIENTS face a postcode lottery in stroke care as the latest figures show health boards improving but still falling short of national targets.

Just over half of patients in NHS Lothian and NHS Greater Glasgow and Clyde received appropriate care, compared with nearly nine in 10 NHS Borders patients.

While a handful of smaller local hospitals, including Galloway Community Hospital and Borders General Hospital, far exceeded the 90 per cent “care bundle” target, this was not matched by any major hospital in Scotland.

The care bundle test was introduced to measure hospital and health board performance in relation to four key aspects of stroke care which should be achieved within 24 hours of admission to hospital, including transfer into a specialist stroke unit, brain imaging, swallow scan and aspirin treatment for some patients.

There were other “significant challenges” in 2014. Only 43 per cent of stroke patients in Scotland were treated with the clot busting drug, thrombolysis, within an hour of admission to hospital, against a target of 80 per cent.

The proportion of patients undergoing carotid endarterectomy, an operation to clear a narrowing of blood vessels in the neck, within 14 days of a stroke also fell to 38 per cent, against a target of 80 per cent.

Mark O’Donnell, chief executive of Chest, Heart and Stroke Scotland, said: “There is clearly some way to go before we can ensure that everyone who has a stroke receives the best possible care.

“The most important point is that patients are admitted to a specialist stroke unit as quickly as possible; while this doesn’t guaran- tee patients the highest quality of care, not being admitted to a stroke unit pretty well guarantees they won’t receive it.”

Across Scotland, 65 per cent of patients are receiving the stroke “care bundle” they require within 24 hours of admission, up from 35 per cent five years ago.

Most health boards are improv- ing year-on-year, some significantly, but the audit highlights regional variations in performance.

In NHS Borders, 87 per cent of stroke patients received their appropriate “care bundle” within 24 hours, but that plunged to just 19 per cent for stroke patients on Orkney – overshadowed by the Western Isles (75 per cent) and by Shetland (72 per cent).

On the mainland, the highest achieving health boards for stroke care were NHS Borders, NHS Lanarkshire and NHS Forth Valley on 87, 83 and 77 per cent respectively.

The largest health boards, Lothian and Glasgow, have been the slowest to improve and are now lagging at the bottom of the league table with 54 and 58 per cent of stroke patients receiving their appropriate care bundle within 24 hours.

Scottish LibDem health spokesman Jim Hume said the shortcomings should be a “wake-up call” for ministers.

NHS Scotland clinical director Professor Jason Leitch welcomed the improvements, but said there was more to be done.

He added: “Our action plan sets out a comprehensive programme for further reducing the number of deaths from both heart disease and stroke. It also focuses on providing the best possible care in the acute setting, as well as helping people’s longer-term recovery in their own communities.”

‘‘ There is clearly some way to go before everyone who has a stroke receives the best possible care