Some stroke patients experienced delays in receiving "time-critical" treatment in Swansea Bay and some were discharged without a care package in place, according to a report. There were also distressing waits for ambulances to turn up, with some relatives driving their loved ones to hospital.
Swansea Bay Community Health Council (CHC), a patient watchdog, looked at the progress of 22 stroke patients who were cared for in Swansea and Neath Port Talbot - although one was admitted to a hospital in Carmarthen - and found inconsistencies and gaps. This included a lack of dedicated stroke beds.
The CHC said it had raised many of the same concerns in its latest report as one it had published in 2017. But the new report also included a lot of positive feedback, and half of the 22 patients rated their overall care as good, very good or excellent.
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Strokes are a life-threatening condition caused by the blood supply to part of the brain being cut off. Patients can suffer debilitating, life-changing effects, including a loss of mobility and speech. Patients with milder strokes often make a better recovery.
Hugh Pattrick, chairman of Swansea Bay CHC said: "The care you receive in the first few hours after a stroke can make difference to how well you can recover. Swansea Bay University Health Board must reflect on the feedback in the CHC reports to improve stroke services across Swansea Bay." The health board said it welcomed the report and its positive comments, and that its recommendations would help improve quality of care further.
Eight the 22 stroke patients were taken by ambulance to accident and emergency, with six of them experiencing long waits. One of the relatives who drove their mother to A&E claimed the ambulance did not take her mother because her symptoms weren't worsening - this, the relative claimed, despite a slurring of the speech, inability to walk, and left-sided weakness.
One of the six patients taken by ambulance - a 94-year-old - was said to have waited 24 hours for paramedics to arrive; another was said to have waited five hours on the floor of a Tesco store having suffered a heart attack as well as a stroke. Two others said paramedics arrived promptly - and the feedback generally about the care provided by ambulance staff was positive.
Some of the stroke patients taken by ambulance then had to wait a long time outside A&E at Swansea's Morriston Hospital before being admitted. Two of the 22 were taken to Singleton Hospital, Sketty, while another was admitted to Glangwili Hospital, Carmarthen.
The report said 14 of the patients received prompt assessment and diagnosis on admission to hospital, with 13 of them taken directly to a stroke ward. Just over half the 22 stroke patients did not receive blood clot-busting treatment, while for some others the treatment was delayed. One said that after a nine-hour wait in A&E it was too late for the treatment to be administered. "Some people told us about delays receiving ‘time-critical’ treatment," said the report.
The patients generally felt they were given enough information about strokes, although only half felt that this included information about their potential long-term impact. The overwhelming majority said they received respect from all hospital staff.
But the report said 12 patients didn't receive a care plan on being discharged, which was often described as being a rushed process. One said: "Just discharged as quick as possible with no follow-up support offered to husband or family."
The report said 14 of the patients told the CHC that they did not receive any rehabilitation treatment. "Was not given any," said one. "Just sent home and forgotten about."
Strokes and their ramifications can be frightening for relatives as well as patients, and the CHC report said psychological support was particularly important. It said: "Some people told us they experienced fear and anxiety following their stroke and were not clear about what they could do to prevent future strokes."
Swansea Bay University Health Board has 49 stroke beds in an acute unit at Morriston Hospital and two rehabilitation wards in Singleton Hospital and Neath Port Talbot Hospital. The health board said there was a lack of dedicated stroke beds due to wider pressures of unscheduled care. It plans to create a single specialist stroke centre, with patients triaged on arrival at Morriston Hospital in an area separate to A&E.
Stroke patients and their relatives said a skilled, multi-disciplinary workforce capable of meeting the needs of stroke patients was required. The CHC said it backed the concept of a specialist stroke centre but was concerned about whether it would be staffed sufficiently.
It has called on the health board to provide a consistent level of stroke care, to carry out periodic reviews of the discharge process, and ensure that emotional support was offered along with other rehabilitation.
CHC chairman Mr Pattrick said: "It is vital that the health board makes sure all stroke care services are fit for the future, whilst achieving the quality standards, and maintaining great outcomes that are sustainable."
The health board has set out actions it is taking a result of the report, including a review of the hospital discharge process to ensure patients were signposted to effective support and self-care. “We welcome this report and its positive comments from patients," said a health board spokesman. "It also has clear feedback and recommendations which are a valuable contribution to the development of services and further improvement in quality.”
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