Taking care

Northern Echo Health Editor Barry Nelson reports on the implications

DOCTORS in the North-East were among the first in the UK to use clot-busting drugs to treat stroke patients in the early years of this century.

Those pioneers, including stroke specialist Dr Ali Mehrzad, formerly of Bishop Auckland General Hospital and now working at Darlington Memorial Hospital, were impressed at how successful the drugs were in reducing paralysis and other impairment by dissolving clots on the brain.

In 2002, in one of the first cases in the North- East, Dr Mehrzad used a clot-busting drug on an 83-year-old woman from Bishop Auckland who had suffered a massive stroke.

The attack, caused by a clot blocking the flow of blood to her brain, left her unconscious and paralysed on her right side.

But after agreeing to be injected with the then unlicensed drug, widely used in the US at the time, her family witnessed an amazing recovery.

Her daughter said at the time: “Within half an hour of this treatment, the paralysis was gone. It was like witnessing a miracle.”

The only difficulty with these drugs is that they need to be given to precisely the right kind of stroke patient – about ten per cent of those who suffer strokes, or blood clots in the brain – within four hours of the start of symptoms.

Crucially, the only person who can decide which patients can benefit from clot-busters, properly known as thrombolytic drugs, is a specialist stroke consultant.

Unfortunately, there is a national shortage of stroke specialists, which is hampering efforts by the Government to set up 24-hour acute stroke units nationwide.

The Royal College of Physicians has estimated that thousands of lives could be saved each year if patients were admitted straight to acute stroke units, with about 4,500 avoiding disability if they were given clot-busting drugs.

The national shortage of stroke physicians is also causing headaches for hospital managers at the County Durham and Darlington NHS Hospitals Foundation Trust, who this week confirmed they have drawn up plans to close a new eight-bed acute stroke unit at Darlington Memorial Hospital in favour of centralising services at the bigger, better-equipped 20-bed acute stroke unit at The University Hospital of North Durham, in Durham City.

THE proposals, largely caused by a staff shortage triggered by a consultant moving out of the area, have already attracted criticism from Jenny Chapman, Labour’s candidate for Darlington in the next General Election, who said it was intolerable to expect mainly elderly patients and their relatives to travel the 23 miles to Durham City for treatment.

The trust argues that centralisation is probably the only way it can provide the round-theclock service for acute stroke patients the Government wants.

However, The Northern Echo has learnt that a regional review of all acute stroke services is under way, which is almost certain to lead to patients and relatives across the region having to travel farther for acute stroke care.

Dr Bob Aitken, medical director of the County Durham and Darlington trust, said it was working with cardiovascular doctors across the region to find ways of meeting the Government’s targets to have 24-hour acute stroke units staffed by specialists.

He said: “The big challenge is to have every patient who presents with a suspected stroke seen by a specialist stroke physician within 24 hours.

“Every area in the North-East is having trouble meeting this national standard.

“We always planned to appoint more stroke specialists so we had three in the north and three in the south, but we have advertised and had no takers.”

Now, with the trust already struggling to staff both units 24 hours a day, it is about to lose one of its four consultants.

Unless stand-in doctors can be found to staff the units, it is almost certain it will have to close the Darlington unit and move staff and beds to Durham.

Peter Moore, the North-East manager for The Stroke Assocation, said his charity was also working with stroke specialists and NHS managers across the region to improve the acute service.

He said the shortage of stroke specialists meant it was highly likely that hospitals in the region would increasingly have to share the responsibility of providing overnight and weekend care for patients who have suffered a suspected stroke.

That would mean patients and relatives would have to get used to the idea of travelling farther to be seen by stroke specialists.

He said: “I understand the concern, particularly of carers having to travel longer distances, but I think there is an issue about having the best quality of care, wherever that is.

“If that care is in Darlington, people will have to travel there. If it is in Durham, then people will have to travel there.”

DR Aitken estimates that there are only about 31 stroke specialists in the region, and the implication is that hospitals should work together to provide round-theclock acute care.

He said: “Stroke physicians can identify which patients would benefit from a clot-busting drug from home via their computer. Someone else back at the hospital can give the patient the drug.”

In December 2008, the Department of Health launched its National Stroke Strategy, a ten-year plan to improve services to stroke victims.

It covers four main areas – raising awareness of the symptoms of stroke; making sure people who are recovering from a stroke have a good quality of life; and ensuring people get to hospital quickly and receive the right treatment.

But there is a long way to go. In April last year, a survey by the Intercollegiate Stroke Network found that a quarter of stroke patients were still not being treated in specialist units and only a fifth had a brain scan within three hours.