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UK leaving Wales behind in treatment for strokes.

Byline: By MADELEINE BRINDLEY Western Mail

Stroke patients are being let down in Wales by missed targets and delayed diagnoses, and life-saving checks are not being carried out. A national audit of stroke services found the standard of care had improved in the UK, but Wales was lagging behind.

In too many cases fundamental elements of care are not being received by patients and Wales is falling behind clinical recommendations for stroke treatment.

The Stroke Association last night said the lack of a National Service Framework in Wales meant that the disabling condition was not a priority for the Welsh Assembly Government.

Jon Barrick, the association's chief executive, said, 'We are still waiting for stroke to be made the medical priority that it should be. This is scandalous when you consider that it is the third biggest killer and the biggest cause of long-term disability.

'

The National Sentinel Audit for Stroke 2004, published yesterday by the Royal College of Physicians and funded by the Healthcare Commission, found the standard of stroke care had deteriorated since 2001 in Wales.

Just over half of stroke patients (56%) in Wales receive optimum care, judged against 12 indicators. In 2001 the average was 57%.

The report revealed that just 28% of patients are treated in a stroke unit during their stay, highlighting the lack of dedicated stroke units in Welsh hospitals.

The report also found that life-saving checks are not being carried out on all stroke patients on admission to hospital.

Almost half of patients are not screened for swallowing disorders within 24hrs (feeding a patient with an unsafe swallow could result in pneumonia) and almost four out of 10 do not have access to a brain scan within 24hrs of stroke.

Since the last audit in 2001, the number of patients assessed by an occupational therapist within seven days of admission, who are weighed at least once during admission and who have a home visit before they are discharged from hospital, fell.

Mr Barrick added, 'It is extremely disappointing that patients across the country are still waiting to get the essential care that they should receive according to government-set standards.

'How can the Government possibly achieve their target of reducing deaths from stroke by 40% by 2010 if hospitals are not given the essential resources and support to achieve this? By getting this right, lives could be saved.'

Dr Hamsaraj Shetty, a Cardiff- based consultant physician with an interest in strokes, said, 'The reason why we are not hitting the targets is because many hospitals in Wales do not have an organised stroke care service.

'The picture has been painted extremely bleak all over Wales but that is not necessarily the case because even in hospitals where the figures look bad, there are some areas of excellence. We have not abandoned stroke care as we are actively looking at how we can improve the service.'

The results of the audit will be used to help drive improvement across the NHS and later this year a service will be developed by the Royal College of Physicians, the British Association of Stroke and the Stroke Association for NHS trusts to commission visits from a team of specialists to help identify possible solutions.

A spokeswoman for the Welsh Assembly Government said, 'The audit report recognises the improvements already made in stroke services in Wales with increases in the number of consultants and the introduction of specialist nurses in stroke units, and on other hospital wards.

'We recognise nonetheless that there's still a lot of work to be done. The National Service Framework for Older People in Wales is currently being developed and will identify actions to help reduce the incidence of stroke and increase specialist stroke care across Wales in the immediate and longer term.': Stroke 'like sufferingvertigo and dizziness':Andrew McCANN was teaching an after-school class when he suffered a stroke last year. The 39-year-old said the experience, which prevented him from moving and speaking, was like suffering vertigo and dizziness all at once.

Violently sick and unable to speak, it was the quick-thinking actions of a first-aid-trained police officer and parent, who was at the class, who got him immediate medical help and helped to persuade paramedics he was having a stroke.

He was also lucky to undergo a brain scan within 20 hours when he was taken to hospital, which confirmed he had a stroke.

More than a year later, Mr McCann, a PE teacher in a Pontypridd comprehensive, is still undergoing physiotherapy and sports massage - he is paying for private treatment - for the continuing co-ordination and balance problems sustained during the stroke.

Consultants believe that it was caused by a blocked artery in the neck of this fit, athletic man, who had no family history of stroke.

'I was so lucky that I was with someone who could recognise the symptoms and was able to act quickly,' he said.

'Even when the paramedics came, because my blood pressure was normal one said that they could forget about stroke, although they didn't use the word, but luckily the A&E doctor didn't want to take any chances.

'I was fortunate that I had a brain scan within 20 hours because from what I've heard, some patients are sent home.

'But everyone I've dealt with, from the paramedics to now, has been wonderful - I can't praise them enough.

'I've had the support of all my friends and family and my partner Anne has been a terrific source of understanding and help.'

Mr McCann, who lives in Cardiff, was treated on a cardiac ward at the Royal Glamorgan Hospital before he was transferred to the care of a consultant at the University Hospital of Wales.

'It has been very hard to come to terms with having a stroke - it still isn't easy,' he said.

'It has been a really intrusive, devastating and lonely experience and I feel very lucky to have come through it.

'I was 37, physically very active, and although I wouldn't say I felt invincible, it was a wake-up call.

'My prognosis in terms of lifespan and quality of life, even though it will be different to what it was before, is good. It may even make me make better use of the future than I would have done.'
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Publication:Western Mail (Cardiff, Wales)
Date:Mar 15, 2005
Words:1047
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