Brain patients denied specialist care, say experts

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The NHS needs a fourfold increase in the number of brain specialists to bring it closer to standards across the rest of Europe and provide a comprehensive 24-hour service to all patients, doctors' leaders said yesterday.

The NHS needs a fourfold increase in the number of brain specialists to bring it closer to standards across the rest of Europe and provide a comprehensive 24-hour service to all patients, doctors' leaders said yesterday.

The shortage of consultant neurologists is so acute that most patients admitted to hospital with brain disorders, including stroke, epilepsy and meningitis, never see one. They have to be treated by specialists in other disciplines such as hearts or chests.

The Association of British Neurologists said yesterday that the present number of 350 neurologists should be expanded to 1,400 in 10 years. Even so, the number would still lag behind the European average. There is one neurologist to 177,000 British patients, compared with one to 20,000 or 30,000 in Europe.

The association said some patients needed immediate assessment by a neurologist, including those with sudden coma or potential meningitis or brain haemorrhage, but this was often impossible in hospitals without 24-hour cover. Less than 50 of the 250 district general hospitals in the UK have a 24-hour neurology service to deal with emergencies.

Professor Charles Warlow, president of the association, said: "We believe that all hospitals should have a neurological service around the clock to give prompt and accurate diagnosis and treatment to all patients who are admitted with acute neurological illnesses. This is routinely achieved in other European countries, such as the Netherlands."

Amanda Pitt, who had a stroke at the age of 33 in 1995, shortly after her fourth child was born, said she was taken to hospital in a semi-coma and still does not know whether she was seen by a neurologist. "My husband did not see one and when my parents phoned they were told they could see one in a week's time," she said.

Ms Pitt said that it had been a "life and death" situation and that she had needed expert care. A neurologist would have guided her recovery and given "hope and direction," she said. "I have recovered – I used to be in a wheelchair and unable to talk – but I would have got better quicker if I had had proper support."

Dr Peter Humphrey, of the Walton Centre for Neurology in Liverpool, said the shortage of neurologists had come about because of the historical reluctance of consultants to share their learning. "It used to be seen as an élite specialty and we didn't want to do the common things," he said. "We recognise now that we have to look after the common illnesses such as stroke because there has been a huge expansion in the therapies available and no one else is going to do it."

A 1996 study showed that a neurologist who had seen 169 patients had given them a new diagnosis 18 per cent of the time, demonstrating the importance of specialist attention.

Seven patients had their diagnosis of epilepsy reversed, one had his diagnosis changed from dementia to phenytoin toxicity (caused by overdose of an anti-epilepsy drug) and the remainder had not previously been given a diagnosis at all.

* Britain has the highest rate in Europe of cases of drug- resistant superbugs infecting patients in hospital. In the first six months of 2001, the proportion of drug-resistant infections isolated in Britain was 46.1 per cent, compared with 44.1 per cent for Israel and 38.6 per cent for Greece. The European Antimicrobial Resistance Surveillance System, which collected the data, said the level of infections was "alarmingly high."

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