Lorn and the Islands Hospital fails standards in stroke treatment – in a shocking national picture

In a generally shocking picture of failure of treatment for stroke victims in Scotland, Lorn and the Islands Hospital may not have been the worst – but its poor showing, with little improvement in 2011 from a poor performance in 2010 speaks for complacency as well as failure of care.

The hospital’s performance may have been minimally better than the awful scores for the Royal Alexandra Hospital in Paisley and Glasgow Royal Infirmary but Inverclyde Hospital’s performance was jointly second best in Scotland with Aberdeen Royal Imfirmary and Dundee’s Ninewells, each a single point below the faultless performance of Forth Valley Hospital.

The Scottish Stroke Care Audit report uses 6 standards critical to the effective treatment of stroke patients:

1. At least 60% of all patients who come to hospital with a stroke should be admitted to the Stroke Unit  on the day they come in.
2. At least 90% of all patients who come to hospital with a stroke should be admitted to the Stroke Unit on they day they come in or the day after.
3. Every single patient (100%) should be checked to see if they can swallow safely.
4. At least 80% of patients should have a brain scan on the day they come into hospital.
5. Patients with blocked blood vessels should should have aspirin in the day they come into hospital or the day after.
6. At least 80% of new patients with a transient ischaemic attack should be seen within 7 days from when the referral is received by the clinic.

Each hospital is measured on a three point scale against each of these 6 required standards.

• A is awarded where a hospital meets or does better than the standard; or has significantly improved since 2010.
• B is awarded where a hospital does not meet the standard and has stayed the same since 2010.
• C is awarded where a hospital does not meet the standard and is worse than in 2010.

Lorn and the Islands Hospital either met the standard or had improved since 2010 in Standards 1 and 6 above.

It did not meet the standards and had made no improvement since 2010 in each of the other four standards, 2 to 5 inclusive.

This means that it is not performing in even basic care practice inside the hospital.

All patients are not being checked to see if they can swallow safely – a key issue in stroke victims, with swallowing problems often used in diagnosing stroke. This is a failure in nursing care. There is no additional equipment or cost involved here.

Aspirin is not being given to patients with blocked blood vessels within 48 hours of their coming into hospital. Again, this is shockingly negligent. Aspirin is cheap, available and effective. Its use in such circumstances is hardly specialist knowledge.

This is not just a failure of management – although it is. It is a failure in the care expected of every medical and nursing professional in the hospital who comes into contact with stroke patients. That is disquieting.

Strokes are the most common cause of serious physical disability in adults in Scotland and the third most common cause of death. Something like 13,000 people a year suffer a stroke here and the cost of their care is 5% (or £100 million) of NHS Scotland’s budget.

That paid for care is being subverted by failures in care that cost nothing, that are simply down to poor practice and lack of care.

Apart from the top four – Forth Valley, Inverclyde, Aberdeen Royal Infirmary and Ninewells – the overall results show a picture of significantly failing care for stroke patients.

33% of the hospitals were failing to meet the first two standards. They were failing to admit to the Stroke Unit within 48 hours at least 90% of people coming into hospital with a stroke.

83 % of the hospitals were not checking that every stroke patient could swallow safely – that’s 83%.

A totally gross 90% of hospitals are not administering aspiring to stroke patients with blocked blood vessels within 48 hours.

Nevertheless, in the parallel universe of spindom, from these overall results the Scottish Government spokesperson managed to say  ‘We welcome this report which shows that people are getting better stroke treatment than ever before.’

The reality is that two thirds of the overall 180 scores against all 6 standards showed no improvement at all – or disimprovement.

We are not only paying a massive amount of money for the healthcare services. We are supposed to revere healthcare ‘professionals’.

They see themselves – and are largely accepted as such in popular mythology – as above criticism.

Not on this evidence, they’re not.

How long does it take to check a swallow? How complicated is it? How hard is it to do? How much does an aspirin cost? How long does it take to administer it – after checking the patient can swallow?

What we are seeing in the detail of this Scottish Stroke Care Audit report is unacceptable practice, utterly without defence and a fundamental failure of entry level responsibility.

Note: The worst scoring hospital was Monklands. Hospital in Lanarkshire, with, in order of the 6 standards as given above: C C B B B A.