In the wake of the national Stroke Association warning of the rise in working-age men and women falling victim to the condition, we re-visit how the centralisation of hyperacute stroke services at Scunthorpe General Hospital is helping patients in North and North East Lincolnshire and hear from one man near Caistor who has written a book of his experience.
More than 300 people were admitted to the hyperacute stroke unit at Scunthorpe hospital during the last financial year.
The latest figures from Northern Lincolnshire and Goole NHS Foundation Trust show that from April 2014 to March 2015, a total of 355 people were taken to the unit – 173 were from the North Lincolnshire area with the remaining 182 people from North East Lincolnshire.
The Sentinel Stroke National Audit Programme (SNAP) measures the quality of stroke care provided to patients from when they arrive at hospital to up to six months after their stroke.
The Royal College of Physicians compiles the report every quarter and the latest results, based on patients attending hospitals across the region between October and December 2014, puts the Scunthorpe service top of the table for how good it is at treating stroke patients.
The unit was rated ‘A’ on a scale of A to E, the highest out of all 17 stroke units in the Yorkshire and Humber region.
A decision was taken by the Trust in November 2013 to temporarily consolidate hyperacute stroke services on its Scunthorpe site and in doing so provide a service 24 hours a day, seven days a week.
In October 2014 this decision was made permanent following public consultation through the Healthy Lives, Healthy Futures review programme, led by the local clinical commissioning groups.
The stroke acute care and rehabilitation service still remains at Grimsby’s Diana, Princess of Wales hospital, and patients from North East Lincolnshire are transferred there as soon as possible after their hyperacute care is completed (mostly within 72 hours).
A team of independent external clinical reviewers gave the stroke unit at Scunthorpe hospital a clean bill of health last year. They looked into processes, policies and patient pathways and concluded that the service is safe and sustainable.
The centralisation has enhanced many aspects of the service including thrombolysis treatment – a clot-busting drug that helps to preserve part of the brain affected by the stroke.
It means that eligible patients from across the region can receive this drug round-the-clock any day of the week including weekends. Before the centralisation it was only available from 8am to 8pm Monday to Friday.
Holly Cowling, a stroke responder at Scunthorpe hospital, said: “Thrombolysis treatment should ideally be giving within the first four hours of a patient presenting with stroke symptoms. Now we are a 24-hour service we can offer this drug in the middle of the night and at weekends, this was not possible before.
“We have to stress that not all patients are suitable for this drug as there are specific criteria that must be met.
“The centalisation has also meant there are more people with expertise on the condition in one place, equipment is all in one area and there has been room to develop roles within the department.”
Of the 355 patients admitted to the hyperacute unit in the last financial year, 40 were thrombolysed including Chris Dale, 61, of Rothwell, near Caistor.
In July last year Chris was just 12 days away from marrying his partner Gilly when plans were suddenly put on hold.
He said: “I woke up about 6am on a bright sunny morning in a pool of sweat and a pounding headache over my left eye. Sitting up in bed I began feeling nauseous and could not think what had caused all this. I had never felt so bad before.
“I managed to get downstairs to take some paracetamol but started to experience double vision and weakness in my legs. I crawled back to bed and Gilly noticed the alarming state I was in. She asked if I was ok but before I could answer I started fitting.
“As she calls for an ambulance my headache intensifies and the left side of my face becomes numb like a dentist has injected it. I was petrified and could not stop shaking.
“A LIVES responder in the village arrived alongside the paramedics and the decision was taken to transfer me straight to Scunthorpe in case I was having a stroke.
“On arrival into the emergency centre I was surrounded by medics. I cannot fault how quickly everyone treated me and I was urgently taken for a CT scan which confirmed my fear of a stroke.
“I was told it had affected the left side of my brain at the back, the part that controls eyes, ears, nose, mouth and balance which explained my symptoms when I woke up.
“I was admitted to the hyperacute stroke unit and thrombolised. Every 30 minutes medical staff checked my observations over a 24 hour period, I could not have asked for better care and attention.”
Chris was monitored on the hyperacute unit for four days and chose to stay at Scunthorpe hospital to receive rehabilitation treatment on the stroke ward. During his time he decided to write down his experience which has since been made available to patients via a booklet on the stroke ward.
Looking back at his time on the unit, he said: “Every member of staff I came into contact with were the most superb human beings I have ever met. The care, warmth, humour, understanding, help and love given by all these lovely people is infectious and just shows how well this ward is run.
“I want to thank the speech and language team who worked to address my swallowing difficulties and the occupational therapists who instilled so much confidence in me when re-learning to walk, they made the whole process a lot easier.
“I do believe my own positive attitude has aided my recovery and also the support of my family. Gilly has dealt with everything brilliantly, even postponing and rearranging the wedding which is set for June.”
Tina Drewery, ward manager for Scunthorpe’s stroke unit, said: “Stroke patients are getting the best care possible as we are now able to treat them round-the-clock.
“During the Healthy Lives, Healthy Futures review there was a lot of concern and opposition in the Grimsby area regarding travelling to Scunthorpe. I believe some people still have this worry but since the centralisation we have not had one formal complaint towards the hyperacute unit which tells me it was the right thing to do.”
Julia McLeod, regional director across Yorkshire and East Midlands for the Stroke Association, said: “Stroke patients are more likely to survive, make a better recovery and spend less time in hospital if their stroke is treated as an emergency, and they receive specialist care from a coordinated team on a stroke unit.
“Round-the-clock access to stroke units and brain scanners is essential and this often requires centralising emergency care – as is the case here in Scunthorpe. At the Stroke Association we want patients to have access to the best care, and hyperacute stroke units are vital in helping stroke survivors make their best recovery possible.”