Strokes are one of the leading causes of death and the future of stroke services is up for discussion at this week’s Cwm Taf Morgannwg board meeting (pdf).
The report says that 70% of strokes are preventable and that two-thirds of those leaving hospital after suffering a stroke will have some form of disability as a result. The biggest risk factors include smoking, diabetes, high blood pressure, lack of exercise and poor diet.
Within the Cwm Taf Morgannwg health board, the rates of stroke are much higher in Bridgend and Merthyr Tydfil (20.6-28.8 per 100,000 people) than Rhondda Cynon Taf (14.4-18.2 per 100,000).
At the moment there are four stroke-related measures for hospitals to measure performance against:
- Direct admission to an acute stroke unit within 4 hours.
- A “door to needle” time for thrombolysis (medicines to dissolve blood clots) of 45 minutes.
- Patients diagnosed with stroke receiving a CT scan within 1 hour.
- Patients should be assessed by a stroke consultant within 24 hours.
Of the two hospitals in the Cwm Taf Morgannwg health board that offer stroke services – Prince Charles Hospital in Merthyr and Bridgend’s Princess of Wales Hospital – over the last year the Princess of Wales Hospital has generally come off poorer on all measures except consultant assessment.
The pandemic has, as you might expect, put pressure on services:
“The need to accommodate Covid “Red Beds” over the pandemic and more recently overall patient flow challenges on both the (Princess of Wales Hospital) and (Prince Charles Hospital) sites have had a direct impact upon the ability to admit to a stroke ward within 4 hours.”
In terms of future improvements to stroke services, Cwm Taf Morgannwg has drawn up measures in the short term (within 6 months), which include improving staff awareness of stroke treatment targets and increasing space at stroke units at Prince Charles Hospital and the Princess of Wales Hospital.
In the medium-term (within a year), proposals include ring-fencing beds on stroke wards, improving rehabilitation capacity (to relieve expected pressures on the Princess of Wales Hospital) and recruiting additional Advanced Nurse Practitioners.
The longer-term (2 years+) vision is to develop regional stroke centres across Wales, but this work is ongoing. One relatively new treatment option is thrombectomy (removing a blood clot manually) but patients from the Cwm Taf Morgannwg health board are referred to Bristol for this.
