By Andrea Cail
AT the start of the year, we at the Stroke Association were optimistic things were going to shift for the better in stroke care. The Scottish Government had included stroke in their workplan with ambitious but much-needed commitments to improve the whole stroke pathway. We were pleased to see the first commitment met with the appointment of Specialty Advisers on Stroke.
Then Covid-19 happened and things changed. Not everything. Hospitals remained open for business to treat stroke patients. However, we were told that many people did not feel confident and were fearful of going to hospital because of being a burden or afraid of contracting the virus. We spent time urging the public to familiarise themselves with the signs of a stroke: Face, Arms, Speech and Time (to call an ambulance) – Act FAST.
However, in the midst of Covid-19, the commitment to define and implement a progressive stroke service commenced, but there must be no delay.
In September, the Scottish Stroke Care Audit highlighted that even before the pandemic, door to needle times for thrombolysis (time to receive treatment), had worsened or stalled. Thrombolysis can significantly reduce disability caused by a stroke. It is possible, therefore, that even those getting to hospital fast during the pandemic may not have received life- saving treatments needed.
And thrombectomy, a game-changing treatment for stroke, has not been available since 2018. The workplan has committed to delivering thrombectomy. A pilot is about to start for eligible patients in NHS Tayside and NHS Fife. But a national service has been discussed for a number of years now and we want to see equitable access to a thrombectomy service across the country as soon as possible.
For most – if not all– the pandemic has taken an enormous toll on people’s mental health. There are of course some things that keep us going: going for a walk and Zoom calls with friends and family. Some of these small freedoms are less possible for many stroke survivors. A recent Stroke Association survey highlighted that over two-thirds of people affected by stroke reported feeling more anxious or depressed during the pandemic. Cancelled appointments, the closing down of gyms and reduced interaction with others has been devastating slowing down recoveries for many.
The brain can recover and lives can be rebuilt again, but it takes specialist support and an enormous amount of individual determination. The pandemic made us as a charity think and act quickly. We trained our network of lived experience volunteers to provide phone calls to stroke survivors and family members in need.
We developed a series of online videos and information to help people stay mobile at home, manage finances and importantly, mental health and wellbeing.
But meeting the needs of people affected by stroke is complex and requires expertise and the care of family and friends. Nobody wants to live with a lifelong disability, but it doesn’t have to be so. Access to the right treatment at the right time is vital and it is possible. There is Hope After Stroke.
Things can improve. People affected by stroke must be heard: they want stroke improvements to happen now. We’ve got the good will and expertise of so many and the Scottish Government’s promises. Internationally, other countries have improved. It is time for Scotland to step up.
Andrea Cail is Director Scotland of the Stroke Association
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