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Stroke consultant shortage ‘hurtling towards crisis’

Almost half of hospitals have a shortage of specialist stroke consultants, new figures suggest. One charity fears “thousands of lives” will be put at risk unless action is taken, with others facing the threat of a lifelong disability.

In 2016, Alison Brown had what is believed to have been at least one minor stroke.

But non-specialist doctors at different hospitals repeatedly told her she did not have a serious health condition. One even described it as an ear infection.

“I kept telling my dad, ‘If I don’t wake up, I love you,’ because I knew there was something wrong,” she tells the BBC’s Victoria Derbyshire programme, having left hospital in a wheelchair.

Ten months later, aged 34, she had a bilateral artery dissection – a common cause of stroke in young people, where a tear in a blood vessel causes a clot that impedes blood supply to the brain.

It had been caused by a turn of the neck while warming up for a dance class.

She was admitted to hospital – but again struggled for a diagnosis. A junior doctor found an issue with blood flow to the brain but she says their comments were dismissed and she was told it was a migraine.

It was only when she collapsed again, days later, and admitted herself to a hospital with a dedicated stroke ward that a specialist team was able to give her the care she needed.

Alison’s case highlights the importance of being seen by stroke specialists.

But according to new figures from King’s College London’s 2018-19 Snapp (Sentinel Stroke National Audit Programme) report, 48% of hospitals in England, Wales and Northern Ireland have had at least one stroke consultant vacancy for the past 12 months or more.

This has risen from 40% in 2016 and 26% in 2014.

Separate research suggests there is a similar outlook in Scotland.

The Stroke Association charity – which analysed the data – says the UK is “hurtling its way to a major stroke crisis” unless the issue is addressed.

Its head, Juliet Bouverie, is “deeply concerned by the rate at which highly qualified stroke doctors are leaving the profession and the slow uptake of stroke medicine by new doctors”.

And she has called on the government and NHS England to “act now” and make stroke medicine a more attractive proposition for junior doctors to specialise in, as well as training and developing other stroke professionals – such as specialist nurses and therapists.

‘Left on gurney’

Carole Pyke has experienced two strokes and says she struggled for care on both occasions.

In 2014, the signs of stroke were misdiagnosed as symptoms of her autoimmune condition, lupus, and she was placed on a general ward for three days before receiving an MRI scan and being admitted to a stroke unit.

Then, last year, after going to her GP with a headache, she was told to attend hospital for a CT scan.

Despite her past medical record, she was placed on a general ward for 12 hours before being sent for specialist care.

She was eventually discharged but then, two weeks later, was back in the accident and emergency department with what turned out to be a continuation of her second stroke.

She says she spent 24 hours on a trolley in a corridor before being sent to a dedicated unit.

“At the time, I didn’t know any better,” she says. “For most of that I was there by myself, without any medical staff.”

‘Game-changing procedure’

Carole remains positive about the future. But in stroke care, a quick diagnosis is vital, as “time is brain”.

If patients can be seen quickly, they are also more likely to be eligible for “game-changing” thrombectomy procedures.

By removing a clot starving blood to the brain, the treatment can help prevent lasting damage that results in paralysis and speech problems.

But there are fears such medical advances are going untapped, despite as many as one in 10 stroke patients being eligible when admitted to A&E.

Prof Rustam Al-Shahi Salman, president of the British Association of Stroke Physicians, says a shortage of specialists – and equipment – is preventing hospitals carrying out the treatment.

Training of ambulance staff is also important to ensure patients are always transported to hospitals with specialist stroke services.

An NHS official said more people were “already surviving and thriving after stroke”.

The NHS was already looking to “modernise our stroke workforce ahead of long-term funding decisions for training being made by government later in the year” and more clinicians were to be trained in delivering thrombectomy procedures.

The official also highlighted new ways of working in London and Manchester, where specialist care was concentrated at hyper-acute stroke units – saving “170 extra lives” a year.

Alison says she is now managing better but will “never be the same again”.

“If there had been more experienced consultants on my visit to A&E, this could have been prevented,” she says.

She continues to have blackouts and says when she has been taken to hospital recently, only once has there been a specialist stroke consultant on hand – and the situation is “getting worse”.

“If I’d had a stroke while at those hospitals,” she says, “I worry about the care I’d have received.”

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