Britain's stroke shame

It is Britain's third most common cause of death, yet patients are missing out on life-saving treatment, which could save more than 1,300 lives a year. Nina Lakhani reports

A failure to deal properly with stroke victims is costing Brit-ain billions of pounds a year, The Independent on Sunday can reveal.

Ignorance among NHS staff is one of the most disturbing reasons for the UK's high death and disability rates following a stroke. Guidelines to be published next week will demand that all stroke victims receive potentially life-saving treatments within 24 hours.

Stroke is the third most common cause of death and the leading cause of disability in the UK. One in four strokes occur in people under 65; around 1,000 each year affect people under 30.

Despite this, figures from the Royal College of Physicians reveal that less than 1 per cent of stroke patients receive clot-busting drugs proven to reduce disability. Less than half receive a brain scan within 24 hours, and less than two-thirds are treated by specialist health staff. The failure to use proven treatments has led to care costs increasing to £9bn, according to experts at King's College London.

Most strokes are caused by clots in blood vessels, resulting in a lack of oxygen to the brain. Around 150,000 people suffer a stroke in the UK each year. Nearly 45 per cent of victims die, while a third of survivors are left with severe disabilities.

For these patients, thrombolysis – or clot-busting – can open up the vessel and allow oxygen to get through. The sooner the drug is given, the better the patient's chances of recovery.

Experts say that unless patients, ambulance and A&E staff treat strokes as an emergency the window of opportunity is lost and the need for expensive long- term care increases.

According to estimates by researchers at King's College, improving access to the full range of preventive drugs and treatments could save more than 1,300 lives every year while helping hundreds more people to make a full recovery.

In an effort to improve performance, the National Institute for Clinical Excellence (Nice) will release the guidelines which it hopes will raise standards. According to Nice, all patients should be scanned, diagnosed and, if needed, treated with a clot-busting drug within an hour of the stroke. Currently only 0.8 per cent of stroke patients are treated this rapidly.

Nice say patients with mini-strokes should be investigated and treated within 24 hours to minimise the risk of a major stroke and it says all stroke patients should be cared for in specialist units by highly skilled teams with access to the best equipment and technology.

The Government has sought to give the illness greater priority and in 2006 appointed Professor Roger Boyle as its "stroke tsar" as well as its heart disease expert. Professor Boyle admits the Nice guidelines will be a challenge, as services remain "patchy" despite recent improvements.

"There is a lot of catching up to do but a lot has been achieved. Some places have the capacity right but yes, there is still a lot of work to be done," he said.

Dr Peter Humphrey, president of the British Association of Stroke Physicians, believes the guidelines must be backed up with money and audits to ensure implementation. He said: "There has been 10 times more money spent on research for cancer and heart disease than on stroke. Yet it is a chronic and disabling condition which consumes 5 per cent of all NHS resources. Committing money to prevent mini-strokes and on the treatment of major strokes would be cost-effective. Without money, the guidelines may achieve nothing."

Andrea Outram, 56

The mother of four from Sunderland suffered a serious stroke last year, but the quick reactions of her husband and A&E staff mean she has made an almost full recovery. "My husband noticed I was dribbling and my face had drooped. He called an ambulance and we were in hospital within 20 minutes. The hospital gave me thrombolysis with an hour or two, and the next day I could walk, my vision had returned – everything was OK apart from my speech."

Jim Shields, 55

Jim suffered a stroke five years ago. "I'd been at home all day when I started to have problems raising my left arm. By the next day I had difficulty swallowing and my left foot was dragging. When my wife called NHS Direct, they told me to go and see my GP. Eventually I ended up in A&E and was told I'd had a stroke. I was left with terrible short-term memory, poor balance and weakness on my left side. Many people still don't know they should rush to hospital, just like a heart attack."