Meeting of the Parliament 21 June 2017
I am grateful for the opportunity to open this members’ business debate on stroke care in Scotland, and delighted to take part.
Every year, 14,000 people in Scotland experience stroke, which is the third most common cause of death and the most common cause of severe physical disability among adults. Stroke patients account for 7 per cent of national health service beds and treatments for the condition, which takes up around 5 per cent of the NHS budget.
It may be appropriate at this stage to describe, in layman’s terms, a bit about stroke and why the diagnosis and treatment is so multifaceted. In Scotland, sadly we know and understand “heart attack”; stroke is quite literally a “brain attack”. It happens when the blood supply to part of the brain is cut off. As we all know, blood carries essential nutrients and oxygen to the brain; without that, the brain can be damaged and cells can die. That damage can have different effects depending on where it happens in the brain. A stroke can also affect the way in which someone’s body works, as well as how they think, feel and communicate.
Most strokes are caused by a blockage cutting off blood supply to the brain, but they can also be caused by bleeding in and around the brain. It is also possible to suffer a mini-stroke, which is the same as a stroke, except that the symptoms last a short time—normally no longer than 24 hours. That is because the blockage that stops the blood getting to the brain is only temporary.
As we age, our arteries become harder and narrower and are more likely to become blocked. However, certain medical conditions and lifestyle factors can speed up the process, as has been well documented.
People have often asked me whether it is possible to recover from a stroke. For some people, the effects may be relatively minor and may not last long, although others may be left with more serious problems that make them dependent on other people. Unfortunately, not everyone survives. Around one in eight people die within 30 days of having a stroke. That is why it is important to be able to recognise the symptoms and get medical help as quickly as possible. If that is done, the individual stands a much better chance. It has to be noted that stroke diagnosis, resulting in prompt action, and immediate care in Scotland are amongst the best in the world. However, I want to spend time this evening talking about post-stroke aftercare and assistance in recovery.
Just under a year ago, not long after I became a member of the Scottish Parliament, one of my constituents contacted me and told me a story about his wife’s issues with stroke. He wrote:
“Lynda had a stroke in March 2003. She was 44 years old, a mother then of 10-year-old twin girls, and a primary school teacher in Dunblane. It was totally unexpected. She was having a cello lesson at home.
At the start of the cello lesson she was fine, as she finished her lesson there was obviously something dramatically wrong. By the time Lynda arrived at A&E she was almost in a coma, and stayed in a coma for a few days. She was cared for in intensive care. She was later transferred to a high dependency unit for around a week—where her care was arguably very good—although not specialised in stroke.
After that, she was transferred to what was deemed to be a ‘stroke unit’.”
My constituent learned directly from the consultant that there were no trained stroke nurses in Lynda’s ward, which was predominantly or exclusively geriatric.
Lynda was in hospital for 10 weeks. At the start of her recovery phase, it was very much her right side that showed evidence of damage. She was therefore unable to walk and had limited movement on that side and in her right arm. She received physiotherapy and occupational therapy, but that certainly was not at the minimum level in today’s Royal College of Physicians’ guidelines. Although the people delivering the rehabilitation were good, their time was spread thinly between all the patients and they were present only four days a week, with every Wednesday being taken up with a multidisciplinary team meeting, which meant that there was no rehab directed to patients.
Lynda’s rehab continued at home. That was good while it lasted, but the family were aware of pressure to stop rehab at the earliest opportunity and they felt very much as if they were left alone.
Lynda needed, and often still needs, someone on her left-hand side to support her as she goes about her daily life. Over the years, there has been some recovery of movement in her right side, but that has to be worked on to ensure that it is maintained.
Lynda and her husband Roger are not alone in their experience. It seemed to them at times that, because they lived in a good area and were relatively comfortable, they were abandoned in terms of the care that should have been provided. That gave them the impression that there was very much a postcode lottery regarding aftercare and attention during the recovery period. Therefore, my constituent embarked on committed and tireless work to research stroke aftercare in order to dramatically improve aftercare not only for his wife but for everyone in Scotland. I commend him for the work that he has done.
The 39 per cent decrease in stroke deaths between 2006 and 2016 is to be applauded. I pay tribute to anybody who works in the sector—the physiotherapists, nurses, doctors and clinicians who make sure that individuals are looked after. The challenge that we now face is that around 124,000 individuals are living with the long-term effects of stroke and half of them have a resultant disability. In 2015, the mortality rate for such cerebrovascular diseases was over 40 per cent higher in the most deprived areas of Scotland than in the least deprived postcodes, and people in remote and rural areas, as well as the elderly, face issues with the accessibility of clinical care.
We know that stroke nurses provide wonderful opportunities; they are flexible and provide for health and wellbeing through a holistic approach. They also provide advice on many things including financial issues. That is very welcome, but more needs to be done. There is an urgent need for further investment in high-quality aftercare, with more stroke nurses, support systems and pathways in place in communities such as my region of Mid Scotland and Fife and across the country. That would keep survivors active in order to improve their mobility and wellbeing and it would aid secondary prevention.
I welcome and acknowledge the work that has taken place to date, but there is still much that requires to be achieved for stroke victims and their families if we are truly to tackle the symptoms and to provide aftercare and support. Much more needs to be achieved by the Scottish Government and national health service boards in order to give reassurance to patients and families alike.
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