Why it is ok to live an hour from a hyper acute stroke unit

Four Kent and Medway consultants share their views on the new stroke units

Photos of Dr Prasanna Aghoram, Dr David Hargroves, Dr Peter Maskell, Dr David Sulch

Above, left to right: Stroke consultants Dr Prasanna Aghoram, Dr David Hargroves, Dr Peter Maskell, Dr David Sulch

We know that some people living in Thanet, Medway and Swale will be very concerned about the recent decision to establish hyper acute stroke units providing 24/7 specialist stroke care at the William Harvey Hospital in Ashford, Maidstone Hospital, and Darent Valley Hospital in Dartford. These new specialist stroke units will mean the closure of existing stroke wards at Queen Elizabeth the Queen Mother Hospital in Margate (QEQM), Medway Maritime Hospital and Tunbridge Wells Hospital, so that staff, resources and specialist expertise are concentrated in the three new units rather than being spread thinly across the current six departments.

People who live further away from the proposed specialist centres are understandably worried about how long it will take them or a loved one to be transported there by ambulance. We have heard concern that stroke patients could come to harm as a result of longer travel times. There is talk of a ‘golden hour’, and fear that more deprived communities will suffer unless there is a specialist stroke centre near them.

We understand why these arguments sound concerning, but they have little basis in fact.

The reality is, sadly, that any stroke patient who dies within a few hours of having a stroke would almost certainly have died whether they were at home, in an ambulance or being cared for in the best stroke unit in the world. For the very small percentage of patients whose strokes are the cause of almost instant death, or who fall into a coma and never wake up, currently little can be done.

However most people will survive their stroke, and the critical factor for them is how we can reduce their risk of dying in the following days, minimise their risk of long-term disability and therefore improve independence. 

We can do that best by getting them to a specialist stroke centre where they can get clot-busting treatment within 30 minutes of arrival if they need it, and round-the-clock care for the vital first few days after their stroke.

Patients who have had a stroke can be at high risk of a further stroke or other serious complication (such as a blood clot in the lungs, a heart attack or infection) in the 72 hours afterwards. These complications can cost lives and increase the risk of life-changing disability. 

Expert care, treatment and monitoring in a specialist centre providing 24/7 care can make a huge difference. Specialist staff who get stroke patients up and moving in the right way can help to prevent blood clots. Close monitoring and use of the right drugs can prevent them having a further stroke which could prove fatal. Highly trained therapists checking their ability to swallow can guard patients against inhaling food into their lungs and so developing life-threatening pneumonia.
With the level of care, therapy, monitoring and support from a specialist team in a hyper acute stroke unit, more people survive and more of them have greater independence than would otherwise be the case.

So, what about the ‘golden hour’? It doesn’t exist for stroke. From the time symptoms start, national guidelines state we have four and a half hours to administer clot-busting drugs to the 15 to 20 per cent of patients likely to benefit from them. (We like to do it sooner, and under our proposals we want to give patients clot-busting drugs within two hours of calling 999).

What about deprivation? Isn’t it obvious that people in deprived areas will have more strokes? We have looked at this very carefully and the highest rates of strokes in Kent and Medway are not in the most deprived areas.

Our experience, and the huge body of evidence set out by the Royal College of Physicians’ 2016 guidelines on stroke, tell us that best care – the care that gives patients the best chance of a good recovery from stroke – is to have specialist units that can offer 24 hour a day, seven day a week care from stroke consultants and other stroke specialists. 

A note on the FAST campaign

The FAST campaign was started because it is very common for people to experience stroke symptoms and not know what they are. As stroke specialists, we regularly see people who have gone to bed to ‘sleep it off’ or waited to see if the symptoms improved.

Please do not do this. Recognising the most common symptoms of stroke – face fallen on one side, unable to lift both arms and keep them there, slurred speech – and calling 999 straight away is critical.

Please don’t try to drive yourself or a loved one to hospital (this also happens more often than you’d imagine), just call for an ambulance. 

Whichever way we look at it in Kent and Medway – and we’ve been looking at it for five years now – the only way we can offer this type of 24/7 care is by consolidating our staff and resources into three specialist units. It does not matter if that high-quality service is on your doorstep or 40 miles away, we just have to have it in place so it’s ready should you need it.

Dr Prasanna Aghoram, Consultant Physician in General and Geriatric Medicine – Special Interest in Stroke Medicine, Dartford and Gravesham NHS Trust

Dr David Hargroves, Consultant Stroke Physician, East Kent Hospitals University NHS Foundation Trust; Clinical Lead for Stroke, South East Clinical Network and Senate; senior clinical advisor on stroke medicine to national Getting It Right First Programme

Dr Peter Maskell, Medical Director, Maidstone and Tunbridge Wells NHS Trust

Dr David Sulch, Medical Director and Consultant Physician in Stroke and General (Internal) Medicine, Medway NHS Foundation Trust