Sixty Second Interview

Sixty Second Interview with Joe Korner

A recent National Audit Office report found that the government should made stroke services and prevention a higher priority. Amy Taylor talks to Joe Korner, director of communications at The Stroke Association, about the research.

The NAO report states that the NHS needs to prevent more strokes and drastically improve treatment, by re-organising services in hospitals and using the capacity that is available more widely. Do you agree that current resources can be used more effectively?

Yes definitely. What we have got is a system where stroke has been made too low a priority in the Department of Health and primary care trusts for a long time. It’s not just about extra funding it is about the way the services are organised. For example the National Audit Office report talks about brain scanning capacity. There is a lot of time when scanners are standing idle.

Do you think that more government money is required to improve stroke services as well as re-organisation?

It’s certainly the case that the resources that go into stroke are a small percentage of the resources that go into heart disease. This is demonstrated if you look at the number of stroke specialists compared to the number of heart specialists and the ability of hospitals to get people into stroke units. If you have a heart attack you get straight into a cardiovascular unit. If you have a stroke you only have a 50 per cent chance of going straight to a stroke unit.

The report concludes that a fast response to stroke reduces the risk of death and disability but that services rarely provide effective integrated emergency responses to strokes. How can this be improved?

There’s plenty of evidence that shows that the quicker somebody is diagnosed and gets treatment the better off they are. Thrombolysis (a treatment to help dissolve a blood clot) can be of benefit to 20 per cent of stroke patients but hardly any are getting it. If you go to America or Germany you would get it a lot quicker.

There is a consensus amongst all the health tsars and the government bodies that stroke should be treated as a medical emergency but it is not happening. One of the delays is lack of public awareness about what the symptoms of a stroke are (The Stroke Association launched its Face, Arms and Speech Test (FAST) campaign last month which aims to teach people the signs of stroke.)

Once someone dials 999 there are other things that cause delays. Increasingly the ambulance service is sorting itself out but some ambulance services aren’t able to treat stoke as the emergency that it is. When people get to A&E departments there is another big issue there. The over stretched staff there sometimes don’t recognise that it’s a stroke and misdiagnose or if they do realise they don’t realise it’s an emergency.

The other crucial thing is that people have to be given a brain scan. If you are going to give somebody a clotting drug you have to know that it’s a clot and that they will not be harmed by thrombolysis. They have to have that (the thrombolysis) within three hours, over fifty per cent of patients wait over 48 hours for [brain] scans.

The report states that stroke prevention and treatment services are a lower priority than they should be in the NHS. Why do you think this is the case?

There are a number of factors. The national services framework for older people contains a chapter for stroke. It has been considered as an older person’s condition but this forgets the fact that 20, 000 people under the age of 65 have a stroke a year. It [being in the older people’s NSF] means that it’s treated along with a large range of other things rather than having its own NSF like heart disease. It should be treated separately because of its high impact on the NHS.

There are three myths around stroke held by many health practitioners and the general public.

1. That it’s an older person’s condition
2. That it’s not treatable
3. That it’s not preventable.

The report found that lack of clarity about how responsibilities are divided between health and social care services is a barrier to the delivery of patient centred rehabilitation services once they have had a stroke. How should this be addressed?

One of the things that makes stroke so important is that unlike heart disease it’s an acute vascular condition and once you have had your stroke it becomes a long-term condition. Stroke is the biggest cause of disability in this country. What’s crucial is that there’s a smooth transition between hospital and home. You often get good rehabilitation services for a short time and then long-term care but this is very patchy.

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