Treatment for stroke is like rushing roulette

Last year about 70,000 people in England and Wales were admitted to hospital suffering from stroke.

A report by the Health and Social Care Information Centre (HSCIC) shows stroke victims don’t always get the rapid attention they need.

If you have a stroke your chances of survival and recovery are very much dependent on prompt treatment. Without it about 15% of stroke victims die and another 10% require permanent care. Many of the rest end up disabled. But if treatment is started soon enough the prognosis is much better for many patients.

How soon is soon enough? About three hours or so. So stoke is an emergency. There’s not much slack, because a person has to be got to a hospital, then moved to a specialist stroke unit, and their condition evaluated, all before treatment can begin.

Given this urgency a lot of emphasis is placed the public being able to recognize stroke symptoms and call an ambulance. This is the message of the FAST campaign.

Even the extra delay caused by taking someone to hospital by private transport rather than ambulance could be significant, because each 30 minute that passes diminishes the chances of their making a good recovery by 10%.

But a report published this month (‘Stroke treatment in England varies widely by location‘, HSCIC) show that getting someone to hospital is often not the weakest link. Once they arrive at the hospital and are admitted they need to be moved quickly to a specialist stroke unit where they can be treated. I believe the target is for 90% of patients to reach a specialist stroke unit within four hours of admission – already about the limit if treatment is to be as effective as possible.

But how quickly you receive treatment depends very much on where you happen to live.

According to the report the average proportion of patients receiving specialist care within four hours is on average just 60%.

And there is a great deal of spread. The best area in the country managed to reach the high 80s. The worst was down in the low 20s. The variability is well illustrated by the map the HSCIC has produced. You can read more detailed statics here.

There are  wide variations between locations that are geographically adjacent, and so a person’s chance of dying can hinge on what side of an arbitrary boundary they chance to live.

The national press picked up the story and of course described it as a ‘postcode lottery’. A cliché yes, but they have a point. There will inevitably be variations in health care provision, for all sorts of valid reasons. But one so wide – a ratio of 4 to 1 between best and worst?



About partialinsight

One evening I had a stroke. Half my sight vanished overnight. Adapting made me grasp how amazing the visual system and brain are. It also taught me to understand disability completely differently and I'm grateful for the lesson.
This entry was posted in Stroke, Disability, Cognition, Uncategorized and tagged , , , , . Bookmark the permalink.

2 Responses to Treatment for stroke is like rushing roulette

  1. Low twenties! Good grief! Its one thing if its an arbitrary target like the general A&E target that might or might not make much difference to an individual patient: but we know this would make a difference.

  2. Yes it’s pretty low isn’t it? It’s difficult to know what the reason is – are people not being transferred fast enough, or is there just not enough capacity?

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