On Monday evening I, along with six hundred other local people (and many more who couldn’t get into the packed room) attended the Enniskillen public meeting of the Reshaping Stroke Services Northern Ireland pre-consultation. During a long, often passionate, sometimes heartrending evening, three key points were made again and again.
- In the case of a suspected stroke, time is absolutely of the essence. The longer the delay between symptoms and treatment, the greater the risk of death or permanent disability.
- The stroke unit at South West Acute Hospital in Enniskillen, under the leadership of Professor Jim Kelly, is the best-performing unit in Northern Ireland, and one of the best in the entire United Kingdom.
- Without stroke services in Enniskillen, over sixteen thousand people would be excluded from receiving treatment within the vital ‘golden hour’.
This is a question, not just of efficiency, but of justice. As I said in the slogan which is probably my main contribution to the campaign so far, “If it isn’t fast, it isn’t fair”.
The pre-consultation ends this week, so it’s crucial that anyone wanting to protect SWAH’s stroke services gets their response in by five o’clock on Friday 15th September (the day after tomorrow, as I write).
There are three main ways that you can submit your response:
A. By completing the online response form here. This is the simplest way – but beware! The questions in the pre-consultation are carefully worded to sound reasonable and positive. But if you answer ‘yes’ to every one, you will be putting our local stroke services at risk. To find out why, and how best to respond, click here to read an excellent fact sheet produced by the Fermanagh Stroke Support Group Save Our Stroke Services campaign (of which I’m a member). In brief, we’re suggesting that you answer:
B. By email to email@example.com
C. In writing to:
Reshaping Stroke Services,
12-22 Linenhall Street
BELFAST BT2 8BS
(making sure it will arrive in time!)
I have emailed my own personal response, set out below. Please feel free to use any of this if it is helpful in your own submission.
Response to Reshaping Stroke Services pre-consultation proposals
Proposal 1: Give people who are thought to be having a TIA access to treatment at stroke units 7 days a week.
Response: No, I disagree with this proposal. In an ideal world with unlimited staff and funding, seven day services would be valuable. But in practice this would mean losing vital local weekday clinics and forcing users to travel long distances every day of the week.
Proposal 2: Assess people for clot-busting treatment thrombolysis at an appropriate number of hospitals.
Response: No, I disagree with this proposal. As I asked at the public meeting in Enniskillen, I do not understand why these proposals repeatedly use the phrase ‘an appropriate number of hospitals/units’. It is universally acknowledged that in stroke cases time is of the essence, and the most vital factor in successful outcomes is the length of time between symptoms and treatment. It would therefore be much more sensible to talk about appropriately located services, rather than about the number of hospitals or units. Here in Fermanagh we need to retain the excellent thrombolysis service at the South West Acute Hospital in order to give patients in this region a fair chance of receiving life-saving treatment in time.
Proposal 3: Make the clot removal procedure Thrombectomy available 24 hours a day and 7 days a week to suitable patients.
Response: Yes, I agree with this proposal.
Proposal 4: Create an appropriate number of Hyperacute Stroke Units to deliver special early hospital care to every stroke patient.
Response: No, I disagree with this proposal. As outlined above, the vital factor in rural areas is the location of units, not their number. The research suggesting that fewer, larger units have better outcomes was carried out in London and Manchester, and is not applicable where distances and travelling times are much longer. The report’s author specifically acknowledged that the findings were particular to highly urban and densely populated locations. The stroke unit at SWAH already has sufficient specialist doctors to qualify as a Hyperacute unit, and is only not designated as such because it does not have the requisite numbers of nurses and therapists. It provides the specialist early care which local patients require, and which tragically would be too late for many if they had to travel long distances to other units.
Proposal 5: Create an appropriate number of Acute Stroke Units, located alongside hyperacute units where possible.
Response: No, I disagree with this proposal. Again, this proposal uses the irrelevant factor of number of units instead of the appropriate one of location. In rural areas the vital imperative is that patients should reach a stroke unit (by ambulance, so bearing in mind call-out times) and receive treatment as quickly as possible, and certainly within the ‘golden hour’. The SWAH unit provides this service for the people of this region, and it is, moreover, the best performing unit in Northern Ireland. Forcing patients to travel further, to a less well performing unit, would have inevitably disastrous effects on their survival and recovery.
Proposal 6: Provide community stroke services that can give Early Supported Discharge. They will be able to give the recommended amounts of therapy. They will be able to respond over 7 days.
Response: No, I disagree with this proposal. Again, in an ideal world, this would be an excellent aspiration. But to work properly, an early supported discharge team needs high levels of funding and staffing, and access to social care services which we know are not currently available in Northern Ireland. Without these, this proposal would only take scarce resources from current community stroke services, which are in urgent need of proper support.
Proposal 7: Make sure that stroke survivors and carers can get services from Health and Social Care organisations and voluntary organisations when they need them. This will help them to make a better recovery.
Response: Yes, I agree with this proposal and hope that the wonderful work carried out by carers and voluntary organisations will be better recognised and supported in the future.
Tanya Jones, Enniskillen