Reforms must not harm patients

The UK has some of the best acute stroke services in the world. But experts are concerned that changes within the National Health Service may mean stroke slips down the healthcare agenda, as Liz Bestic reports

Imagine going about your daily business, shopping, working, playing with your children. You may feel a little strange or have a headache and suddenly, out of the blue, you can’t move one side of your body. This is how a random blood clot can block an artery causing a stroke and devastating a life in an instant.

Most people think strokes only happen to older people. Yet a stroke can happen to anyone at any age. Children and even babies in the womb have been known to have strokes.

In fact, the incidence of stroke among the elderly is declining while strokes in younger people are on the increase. Recent research in the American Academy of Neurology journal shows that around one in five stroke survivors are below the age of 55.

Latest NHS statistics show that between 1998 and 1999 there were more than 9,000 people under the age of 55 admitted to hospital in England due to stroke. During 2010 and 2011 that figure almost doubled to more than 16,000. Why this is happening is unclear, although experts believe it is in part due to the rise in type-2 diabetes and obesity.

Public awareness campaigns have done much to advance our knowledge about stroke. In 2009, the NHS ran a massive public information campaign known as FAST, an acronym meaning face, arm, speech and time. The campaign saw a 25 per cent rise in stroke-related 999 calls and a 19 per cent rise in stroke sufferers being seen more quickly by medical staff.

New research has also helped us understand stroke better. For example, we now know that atrial fibrillation (an abnormal heart rhythm), which affects more than 800,000 in the UK, increases the risk of stroke by 4 to 6 per cent.

Nowadays, a simple test can ascertain whether someone has the condition and warfarin, as well as a new generation of blood thinning drugs, can dramatically reduce the risk of a stroke.

While it’s true that acute care for stroke has changed beyond recognition in the last two decades, there are more than a million people in the UK living with the effects of stroke. Half of these survivors depend on others for help with everyday activities.

Too many stroke survivors and their families are being left alone to cope with the psychological and emotional impact of stroke

Yet a recent review of stroke care by the Care Quality Commission showed huge variations in support for stroke survivors across the country and this month the Stroke Association launches its timely report into the subject. Feeling Overwhelmed  is based on the findings of a survey of more than 2,700 people affected by stroke. The report pulls no punches.

While hospital care is rated highly, the emotional strain on survivors and their families when they return home is underestimated, and people feel inadequately supported.

“Too many stroke survivors and their families are being left alone to cope with the psychological and emotional impact of stroke, which can be as devastating as the physical effects,” says Joe Korner from the Stroke Association.

Some experts are nervous about how changes to the NHS will impact on stroke services. “I remember when stroke outcomes in the UK were among the worst in the world,” says consultant neurologist Pankaj Sharma, who leads the stroke research unit at Imperial College London.

“The UK ranked below Argentina and Poland, and very few stroke patients benefited from being included in stroke research. What turned this appalling situation around was the introduction of a National Stroke Strategy in 2007 which dragged stroke from a ‘Cinderella’ condition to the top of the healthcare agenda.”

The introduction of regional stroke networks also allowed patients to benefit from participating in stroke research, and be seen and treated by stroke researchers who are experts in their field.

“There is little doubt that being under the care of one of these researchers improves stroke outcome. This is now all under threat and I fear we will reverse the positive changes that have been made within the last decade. This spells very bad news for stroke patients, carers, relatives and the nation as a whole,” says Dr Sharma.