Lister Hospital’s stroke unit has again received the worst possible score in a national audit, despite parts of the region’s stroke care beginning to improve.

Wait times for scans and clot-busting drugs remained worse than the national average.

In January the Comet revealed the East and North Hertfordshire (ENH) NHS Trust’s stroke services, delivered by Lister, had been downgraded by the Sentinel Stroke National Audit Programme (SSNAP).

Its score fell from A to C, then to D – and the stroke unit itself got an E.

The latest data, for the fourth quarter of 2021, saw ENH overall rise back to C but the stroke unit remain at E.

Its performance on thrombolysis – the administration of clot-busting drugs to people who have just had strokes – was rated D.

“The pandemic clearly had an impact on the delivery of services, including stroke care,” an NHS spokesperson said, when the Comet asked why ENH’s scores remained low.

But as we reported in January, concerns have been raised at board level about ENH’s stroke care since 2019.

Stroke Unit

The stroke unit’s continued E rating was based in part on the percentage of patients admitted to a stroke unit within four hours.

The national average was 41.8 per cent. Lister’s figure was 24.4 per cent.

The median wait for admission to Lister’s stroke unit was 6h54m, compared to a national average of 4h49m.

The median is an average taken by listing every patient’s wait time from shortest to longest, then identifying the mid-point.

Thrombolysis

According to a 2015 report by Canadian doctors, “speed of treatment is a critical factor” in strokes caused by blood clots, so clot-busting thrombolysis treatment should be administered “rapidly”.

A 2020 study in Sweden found that for every minute which passed before thrombolysis was given, odds of survival fell by 0.6 per cent and chances of reduced mobility or quality of life rose by 0.4 per cent.

Lister's median wait for clot-busting drugs was 1h02m, compared to 54 minutes nationally.

The proportion of patients who got the treatment within an hour nationally was 60.6 per cent.

At Lister it was 50 per cent.

Scanning

ENH scored a B for scanning and was over-performing when it came to the proportion of stroke patients scanned within 12 hours (98.9 per cent, compared to a national average of 95.4 per cent).

But scanning should take place much sooner than 12 hours, to identify what type of stroke a patient has suffered and whether thrombolysis is needed.

According to the NHS website: “Everyone with suspected stroke should have a brain scan within one hour of arriving at hospital.”

Lister was failing on that measurement.

The median time waited for a scan at ENH was 1h02, compared to a national average of 51 minutes.

At Watford General, 25 miles away, it was 27 minutes.

Aftercare

ENH’s multi-disciplinary team working – based on its occupational therapy, physiotherapy and speech and language therapy – was rated E.

ENH’s median wait for an occupational therapy assessment was 43h39m – almost double the national average (21h54m).

The median wait for a physiotherapy assessment (42h11m) was again almost double the national average (21h20m).

The median wait for speech and language therapy 27h22m – almost 20 per cent over the national average (23h10m).

Only 13 per cent of patients eligible for an assessment six months after their stroke received one – even worse than the third quarter of 2021, when it was 21 percent.

Response

ENH said it was implementing an “action plan”.

It has recruited four new therapists to help assess stroke patients sooner and see them more often.

“We have a dedicated, hardworking specialist team who are committed to providing high quality and compassionate care for all our patients,” said chief executive Adam Sewell-Jones.

“Our survival rates for stroke remain within the national average, even as a hyper-acute stroke unit treating the most serious cases.”

An NHS east of England spokesperson said the service had faced “unprecedented demand” in the past two years and staff had “worked tirelessly under significant pressures”.

They said the NHS was “undertaking detailed analyses” to “better understand current challenges” and “enhance the standard of stroke care in our region”.

Asked whether it would give patients a guarantee that its scores would keep improving, ENH did not answer.