Dont have a stroke in Scotland. Tribalism leads to another cause of rationing.

Preventing a stroke by keeping fit, not getting diabetes, and keeping the blood pressure down is all very well. But it means that we still have strokes, only older. The cost of looking after a stroke victim is long term, and beyond the time horizon of our politicians. On the other hand, treating strokes early fairly and universally will cost money, and in the immediate future. By saving the lives of stroke patients there should be a long term saving on health and social care costs, and a patient may well succumb to a different illness eventually.

If you think treatment and support is bad in Scotland, its even worse in Wales! Regional rationing, some of it from tribal causes…

Helen Puttick on June 12th reports from Scotland: Stroke patients miss out on vital treatment as doctors prolong row

Infighting between hospital doctors threatens to block access to a life-changing treatment for stroke patients in Scotland, it has been claimed.

Relationships among specialists in Glasgow have soured to the point that psychologists are needed to improve workplace culture, a report concludes.

They were expected to help introduce a new treatment, thrombectomy, which can spare stroke patients lifelong disability by swiftly removing blood clots from the brain. NHS England is spending £100 million implementing the procedure, but plans to introduce it in Scotland have not been published.

The only Scottish hospital to have performed the procedure was Edinburgh’s Western General, but it was never a routine service and last year was withdrawn because of a lack of specialist staff and funding. About 600 patients could benefit from the procedure, but in 2017 it was performed 13 times.

It is understood that personality clashes between doctors and prolonged periods of sickness have resulted in disruption in Glasgow. A report, obtained by The Times via a freedom of information request, has revealed that a history of tension has made it difficult to attract and retain specialists, known as interventional neuroradiologists (INR).

It says: “Poor collaboration and discord have impacted on recruitment into the INR service in Glasgow and could compromise introduction of a thrombectomy service. Ongoing monitoring of behaviours in the Glasgow service is required and appropriate mentoring/coaching put in place to enable the service to move forward.”

Jane-Claire Judson, chief executive at the charity Chest Heart & Stroke Scotland, said: “People who have missed out on a thrombectomy in Scotland will be angry at this news. Any discord and delay must stop; everyone needs to work together to put stroke patients and their families first.”

Insiders have expressed frustration at the time it is taking to develop thrombectomy services in Scotland.

The report says: “At the present time, in common with many parts of the UK, there is not capacity within the current consultant interventional radiology workforce within Scotland to provide a mechanical thrombectomy service. However, there is ongoing engagement with national bodies to determine if other specialty consultants can be trained in this technique.”

A spokesman for NHS Greater Glasgow and Clyde said: “Staffing issues, skills shortages and relationships have been at the core of the challenges facing the service. The aim of these actions is to provide enhanced clinical leadership, effective teamwork, collaboration and communications and this is already having a positive impact.

“Our recruitment process is progressing and we are optimistic of recruiting a third consultant very soon.”

Eight-hour A&E waits on the rise
Hundreds of patients have been stuck waiting in Scottish emergency departments for more than eight hours with long delays hitting the highest level for the time of year since records began (Helen Puttick writes).

The latest figures show that 313 patients queued for over eight hours in the week to June 2, with 75 stuck for 12 hours or more.

The proportion of patients seen within the Scottish government’s target time of four hours has dropped to 88 per cent, the lowest figure for early June since weekly data was first released in 2015.

Edinburgh Royal Infirmary, where 63 patients spent more than eight hours before being admitted or discharged, had some of the worst delays.

The figures released by NHS Scotland yesterday also showed that there were long waits at Wishaw General and Hairmyres hospitals, which are both in Lanarkshire.

Waiting times tend to drop in the warmer summer months.

August 14th Eric Sinclair comments in letters:

Sir, As a stroke survivor, I was angered and depressed to read that thrombectomy for stroke patients in Scotland is to be further delayed, not just by Scottish government bureaucracy but by the workplace culture among Glasgow clinicians (“Stroke patients miss out on vital treatment as doctors prolong row”, Scotland edition, Jun 12). The cabinet secretary for health promised action on thrombectomy by May this year. This has not happened.

Now, apparently, the workplace culture among some clinicians is preventing progress. This is nothing short of scandalous. Thrombectomy is a procedure that every year could avoid the unnecessary blighting of hundreds of lives by severe disability. It has the potential to save the NHS and social care millions of pounds. It is being invested in heavily in the rest of the UK and around the world, yet there seems no apparent urgency by the Scottish government to make this procedure available to Scottish patients who suffer a stroke.
Eric Sinclair

Aboyne, Aberdeenshire

ITV News 18th June: Charity warns of “desperate need for support” for stroke survivors in Wales


This entry was posted in A Personal View, Commissioning, Rationing, Stories in the Media, Trust Board Directors on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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