Advances in stroke care at risk of being ‘squandered’

Major improvements in the quality of stroke treatment are at risk of being squandered due to a failure by the HSE to invest in services, a leading neurologist has warned.

Prof Peter Kelly of Dublin's Mater Hospital said recent gains were being lost in some hospitals as services disimproved.

“We can’t allow a system to develop where huge expertise and commitment goes into saving a patient’s life, only for the quality of their life to be squandered because of deficits in services.”

He was speaking at the launch of a national audit of services, which shows the death rate from stroke has been cut by more than a quarter and the rate of direct discharge to nursing homes has almost halved in the last seven years.

The death rate from stroke in hospital has been reduced from 19 per cent to 14 per cent, the study by the HSE and Irish Heart Foundation (IHF) indicates.

Prof Kelly said these achievements were the result of a reorganisation of resources rather than realistic and targeted resourcing. “The HSE can’t be accused of solving the inadequacies of the stroke programme by throwing money at the problem,” he remarked.

Stroke services were at a crossroads and were as likely to slide backwards as to continue their upward trajectory. This was “extraordinary” given that the improvements have saved an estimated €128 million in three years in reduced nursing home costs.

Pecking order

“Despite the toll of death and disability caused by stroke, despite the human and economic benefit and the huge increase in incidence coming down the tracks, the cause of stroke patients comes a long way down the national health service pecking order.”

The audit shows just 8 per cent of patients are now being discharged to nursing homes, compared to 15 per cent in 2008 when a similar exercise was last conducted.

About 7,000 people are hospitalised with stroke each year. The death toll of just below 2,000 makes stroke Ireland’s third biggest killer disease after cancer and heart disease.

Under the HSE’s National Stroke Programme, the number of hospitals with stroke units has been increased from one to 21 and the rate of potentially lifesaving thrombolysis (clot-busting) treatment has been raised ten-fold to 11 per cent - one of the highest national rates in the world.

Despite the programme’s success in developing services, many stroke deaths remain preventable, the IHF says, while a high proportion of stroke survivors continue to suffer undue disability.

Only 29 per cent of patients are admitted directly to a stroke unit and almost half do not receive treatment in a unit at any point during their hospital stay.

Nearly a quarter of hospitals providing acute stroke care do not meet minimum requirements, and three of these had none of the required infrastructure in place for a stroke unit.

Staffing deficits

The audit found staffing deficits of 50 per cent for physiotherapists, 61 per cent for occupational therapists and 31 per cent for speech and language therapists, while only 44 per of hospitals had any access to medical social workers.

"The audit shows encouraging improvement in many areas of stroke care that has been achieved in the midst of the worst economic crisis in the history of the State, a rapidly contracting health service and just a small amount of dedicated financial resource," said programme co-lead Prof Joe Harbison.

Navan, Kerry and Tullamore hospitals have no dedicated stroke units, he pointed out, and dedicated services were also lacking at Letterkenny, Sligo and Blanchardstown.