Amidst the recent turmoil of Brexit, SNP in-fighting and all the other political dramas dominating our headlines, you can be forgiven if you have failed to notice a recent letter in the Times signed by a Scottish charity, 20 senior clinicians in Scotland, and a grateful patient.
You can also be forgiven if you have not heard of a medical procedure called 'thrombectomy'. This is a highly skilled procedure, suitable for a particular cohort of stroke patients, in which the blood clot causing the stroke is mechanically removed from the brain. Carrying out this procedure within six hours of the onset of stroke can significantly reduce the devastating physical and psychological effects of the condition. In other words, instead of consigning patients to a lifetime of physical disability, loss of speech or other faculties, and ongoing dependence on health and social care, this procedure has the potential to prevent all of those highly undesirable outcomes. The charity Chest, Heart and Stroke Scotland (CHSS) estimates that approximately 600 Scottish patients per annum could benefit from the procedure.
So, back to that letter, published in the Times on 14 January. Those signing it pointed out that thrombectomy is not currently available to any Scottish stroke patients because no hospital in Scotland can carry it out. This is in sharp contrast to the rest of the UK, where thrombectomy is available almost everywhere for suitable patients and, in particular, is being robustly supported as part of a comprehensive plan for NHS England. Indeed, the consultants who signed the letter go further: 'Most European capital cities have a stroke mechanical thrombectomy service. Edinburgh (and Scotland) has none'. The grateful patient who signed the letter, Robert Baldock, was one of the few to benefit from the procedure when it was briefly available to 13 Scottish patients, though only in Edinburgh.
There is, of course, a cost to providing a thrombectomy service in terms of personnel and training, and there is currently a shortage of skilled interventional radiologists. However, CHSS estimates the cost of providing the service at approximately £7.5m to £10m per annum, an amount which would be recouped many times over in reducing the huge ongoing health and social care costs of looking after patients suffering the chronic effects of stroke.
I should state that I have an interest in all of this. I suffered a major stroke some years ago while visiting my son in Oslo. I did not benefit from thrombectomy, though I did benefit from a Norwegian health service which has invested heavily in stroke care and research.
We need to do the same in Scotland and we could easily do so given the political will. It is scandalous, and a terrible indictment on our most recent cabinet secretaries for health, that Scotland is so far behind the rest of the UK, and the rest of the Western world, in stroke care provision.
Despite the best efforts of health and social care professionals, thrombectomy is only one aspect of stroke care where Scotland is failing to provide the best treatment for patients. Some 15,000 people a year of all ages suffer a stroke in Scotland. Because of advances in acute care, more of them will survive a stroke beyond the limited group who would benefit from thrombectomy. For this army of survivors, particularly younger people, decent long-term rehabilitation is essential.
In Scotland, provision of such rehabilitation – physiotherapy, speech therapy, etc – is patchy or non-existent, not because our therapists do not want to provide it, but because for years there has been a failure to invest properly in planning a comprehensive service that will enable stroke survivors to regain a reasonable quality of life after they leave hospital. Many stroke survivors are reliant on the limited services provided by charities such as CHSS or the Stroke Association. Some, if they can afford to do so, find themselves forced to pay for private therapy where it is available.
Some real vision and long-term thinking is needed to improve stroke care in Scotland. Sadly, this seems to be beyond the capability of our present crop of Holyrood politicians.