The last time a member of the Shepwayvox Team saw his great-aunt Joanna she was propped up by many pillows and lying in a hospital bed with a tube protruding from her nose. One side of her face was flaccid and unmoving. There was no spark of recognition at his approach, and when she did manage to speak, all he could do was nod and smile and interpret the unintelligible syllables as best he could. The second stroke brought relief of a sort, killing her outright.
A stroke is a condition where the blood flow to the brain is reduced by a bleed or a blood clot.
Strokes are common – and between 2016/17 – to date 3,260 patients have been admitted to one of the three stroke units at the QEQM Margate , K & CH Canterbury, or WHH Ashford, according to data released by East Kent Hospital University Foundation Trust (EKHUFT) which covers East Kent.
The death rate varies across each of these three sites, but on the whole averages about 21%, which is below the national average of 30%.
However, what is so strange is the amount of Stroke Patients discharged across any of the three sites are as follows:
So the amount of stroke patients admitted minus the amount of stroke patients who died after being admitted, means that less people would be discharged, but not at East Kent Hospital University Foundation Trust. More people leave than went in for each of the three years.
EKHUFT’s data clearly demonstrates that stroke care services have improved and this maybe because of better public awareness, or divine intervention, we know not which. However, mortality rates in East Kent have remained reasonably constant over the last three years of that we can be sure.
About seven years ago the Department of Health recommended major changes in the system for stroke care, having identified that care in a dedicated stroke unit was the biggest single factor having the potential for improving patient care – reducing mortality and preserving ability.
Now as you may or may not know the decision to close three stroke units across Kent, including the unit at QEQM, was taken on Thursday February 14. A public consultation was ran between 2 February– 20 April 2018. The major concerns raised by people who took part in Consultation were:
Relatives and carers visiting loved ones,
Effective rehabilitation close to home and the ability to staff the new units.
The most vociferous campaigners against the closure of the stroke unit at the QEQM Margate was Save Our NHS Kent. One of their serious concerns centred around travel times. As of 2021 the nearest stroke services to Thanet would be at the William Harvey Hospital in Ashford, 40 miles away and would take up to an hour to reach, according to Google maps. Where as people who live in Lydd on the Romney Marsh would be there in less than half the time.
If you have a stroke then you need treatment as fast as possible. And because “stroke” refers to both ischaemic and haemorrhagic (bleeding) events, you can’t give thrombolytics (“clot busters”) to everyone with a stroke willy-nilly. You have to do magnetic resonance imaging (MRI) to ensure it’s an ischaemic stroke before using these drugs – because they dissolve clots, they will make a haemorrhagic stroke (or intracerebral haemorrhage) worse. And MRI machines don’t fit into ambulances. Much has been said about the ‘golden hour’ and indeed the government’s own advertisements over many years have always highlighted that speed is key.
All of the current six stroke sites across Kent rate poorly at the lowest D and E ratings. This includes close to half of patients not receiving a scan within the hour of arrival, and mixed, generally poor statistics on waiting times, after arrival, for clot-busting drugs.
So you have to get the patient to hospital, and get them seen as soon as possible. So perhaps the issue raised by the campaign group Save Our NHS Kent have a valid point?
Not according to Dr Stephen Morris Professor of Health Economics at University College London. In a paper he and his colleagues published in the BMJ ( Published 05 August 2014) found that centralisation of services saves lives. Morris and colleagues calculate that over the course of their study, 96 Londoners each year owed their lives to this centralisation process, over and above the lives saved by improvements to stroke care nationally.
NHS bosses hope to open the new, hyper acute stroke unit at the William Harvey Hospital in March 2021. However, the Trust readily admit they have a shortage in specialist stroke staff.
And the staff shortage numbers for 2019 are:
Figures for 2018 also show that there was a staff shortage for each of the stroke units. However, the Trust hope the existing staff at QEQM will move to work in one of the new hyper acute units, either in Ashford or at Maidstone or Darent Valley Hospitals.
EKHUFT intend to invest £20 million to extend the Richard Stevens Ward stroke unit at William Harvey Hospital, into a 52 bed hyper acute stroke unit. This should provide an extra intensive care bed, and two specialist scanners. The stroke service at QEQM will continue until the William Harvey unit is ready in spring 2021.
The costs for running the William Harvey & QEQM Stroke units are almost identical according to the latest available data from 2017/18.
Yes data says lives are more likely to be saved, and evidence has been provided via the changes made in London. However, evidence in Manchester does not fit with the London data. Data therefore can only tell us so much. Whether or not lives will be saved here in East Kent, only time will tell.
Meanwhile stroke patients will continue to receive care in units rated poorly by the CQC. This is not because staff at the 3 East Kent stroke units at present aren’t good, they are, as only they are able to send more people home than were admitted according to the data, created by East Kent Hospital University Foundation Trust.
On this basis if the new units opening in 2021 cannot perform the same miracle, then we should in 2022 revert back to the old way of doing things, because at least more people will live than die, according to EKHUFT’s data.
The Shepwayvox Team
Journalism for the People NOT the Powerful