Stroke care: Condemned to mediocrity

We still lag behind other European countries when outcomes for stroke patients are measured

Having access to a dedicated stroke unit has been shown to significantly reduce disability and to improve long -term prognosis. Photograph: Matthew  Lloyd/Bloomberg

Having access to a dedicated stroke unit has been shown to significantly reduce disability and to improve long -term prognosis. Photograph: Matthew Lloyd/Bloomberg

 

The warning from the head of the national stroke programme is stark: inertia and resistance to change within the Health Service Executive (HSE) is leaving the Republic unprepared to cope with a significant increase in the number of stroke patients.

In a formal review of the programme he has led since 2010, Professor Joseph Harbison is strongly critical of resistance to change within the Health Service Executive (HSE). In a telling insight into the modus operandi of the HSE his review states that “with current HSE structures, implementing and managing change is extremely challenging. Even when a plan is in place and resources found, it is our experience it is a mistake to assume that this will automatically happen without continued attention, intervention and agitation.”

Almost 8,500 Irish people experience a stroke each year. As well as the 800 who die from the condition, many are left severely disabled as a result. The incidence of stroke is set to rise by approximately 50 per cent in the next ten years. Having access to a dedicated stroke unit has been shown to significantly reduce disability and to improve long -term prognosis. Stroke units are staffed by specialist teams of doctors, nurses and allied health professionals. However six acute hospitals in the State remain without such units.

We still lag behind other European countries when outcomes for stroke patients are measured

That it took three years to appoint 40 staff is an example of the inertia that pervades the HSE, and not just in the area of stroke care. There is a culture in the organisation that rewards the status quo; attempting to bring about change frequently exposes managers to retribution rather than affirmation.

Innovation and imagination in the absence of adequate resources has brought some improvement for stroke patients in the last seven years. Mortality from stroke has been cut by a quarter, while the number of patients discharged from hospital without a rehabilitation programme put in place has dropped by almost 50 per cent. But we still lag behind other European countries when outcomes for stroke patients are measured.

Prof Harbison is right to speak out. It is likely roadblocks to enhanced stroke care are replicated in other clinical areas. Which begs the question: must we accept a health service that is condemned to perpetual mediocrity?

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