Hospitals across Scotland are failing to give the timely care and treatment which can save the lives of stroke patients, an official audit revealed yesterday.

The quality of stroke services varies greatly across the country, with people more likely to die or suffer greater disabilities in areas where performance is poor, according to the hard-hitting report.

The authors say most health boards need to take some action, pointing out no hospital in the country meets all the standards set by the health service's own watchdog, NHS Quality Improvement Scotland (NHS QIS), more than four years ago.

Stroke is the largest single cause of severe disability in Scotland and the third biggest killer. Every year doctors see 10,000 to 15,000 cases and more than one in five of the patients are under 65.

The goals set by NHS QIS include admitting stroke patients to a specialist stroke unit within a day of their arrival in hospital and testing whether sufferers can swallow properly on the day they arrive. Trials have shown one life is saved for every 20 patients admitted to a specialist unit. Patients whose swallowing problems go undetected can face malnourishment, illness and death.

Progress has been made in these two areas since the last investigation in 2005.

However, the new figures show 56% of patients being admitted to a stroke unit within a day - against a goal of 70% - and 51% of patients receiving the swallow test in time, compared a target of 100%.

The Stroke Association said the report revealed surviving a stroke is a postcode lottery.

Maddy Halliday, director of the charity in Scotland said: "The Stroke Association is pleased to see progress in most health boards. However, The Scottish stroke care audit confirms that there is considerable variation in the extent to which health boards in Scotland are meeting the clinical standards for stroke.

"This means there is a postcode lottery in Scotland in terms of access to effective stroke care, creating inequalities in who has access to services, who lives and who dies and how disabled survivors are."

Professor Martin Dennis, who chairs the Scottish national advisory stroke committee, said bed shortages when hospitals were busiest was one of the problems preventing stroke patients reaching specialist units quickly.

Professor Dennis added: "Most clinicians in all acute branches of medicine would say that our hospitals are running at too high an occupancy (rate) to be very efficient. We are constantly spending a lot of time trying to find beds."

More than 80% of stroke patients now receive a brain scan within two days of admission, beating the QIS.

Professor Dennis said the question remained how rapidly doctors were given the results. Strokes can be triggered by a blocked blood vessel or a burst blood vessel which haemorrhages. The two have to be treated differently. All patients with a blockage should take aspirin within two days of their stroke to ward off recurrence. The audit found 66% of eligible patients received aspirin in time.

Delays in performing surgery which can stop patients who have suffered a minor stroke having further attacks were also highlighted.

The audit, undertaken in 2007, found the mean delay was more than seven weeks and in Paisley and Greenock hospitals the median wait was more than three months.

Health Secretary Nicola Sturgeon said: "Delays in carotid surgery are a concern. We want to ensure that patients are benefiting from their surgery and have initiated the Scottish carotid interventions project to look at how outcomes might be improved."

Other key figures

BIRTHS: The number of caesarean births is increasing. The rate of planned caesarean sections rose from 4.7% in 1976 to 9.1% in 2006 and 9.7% last year. Additionally, the most common age to give birth is now 30-34.

DRUGS: The bill for NHS prescriptions in Scotland has crossed the £1bn mark. The net cost of medicines to the NHS in 2007-08 was £1,017.5m. This equals £187 for every person registered with a GP.

CANCER: Deaths from cancer have fallen by just over 7% in Scotland in the last decade. Lung, bowel, breast and prostate cancers claimed the most lives, but mortality rates for all four have dropped, except for lung cancer among women.

MMR: The proportion of two-year-olds receiving the triple vaccine is still below target. In the thee months to the end of June, the uptake was 91.7% compared to a goal of 95%.

DRUG ADDICTION: Hundreds of drug addicts have had to wait more than a year for an appointment.

COMPLAINTS: Complaints about hospital and community health services fell to 7294 in 2007-08 from 7977 in 2005-06.

 Wednesday 1st October 2008

By HELEN PUTTICK, Health Correspondent

Reproduced with the permission of The Herald, Glasgow © 2008 Herald & Times Group