Stroke patients put at risk at Lister Hospital, NHS auditor says

In the last two years, the East and North Hertfordshire NHS Trust’s stroke unit has been marked down from the highest grade of A to a C, with some areas of its service rated E – the worst possible score.

Documents show concerns have been consistently raised with the hospital's board since 2019.

In January 2020, the trust was contacted by SSNAP – the Sentinel Stroke National Audit Programme – and warned about its high stroke mortality rate.

The latest SSNAP performance report, using data up to summer 2021, saw the trust receive an E grade for its delivery of thrombolysis treatment, to remove blood clots.

A hospital spokesman said the Trust had accepted that improvements were needed and said it was experiencing staff shortages in the stroke unit.

Worst in east England

According to SSNAP, Lister is the worst-performing trust in the east of England for thrombolysis - the potentially life-saving injection of clot-busting drugs for stroke patients.

Professor James Martin, clinical director at SSNAP, said patients had to wait too long after arriving at hospital to get the drug.

Nationally, roughly 11 per cent of stroke patients receive thrombolysis, whereas at Lister it is only given to around six per cent, he explained.

The treatment should be given within one hour of arrival at hospital, but Lister’s average wait is almost two hours – by far the worst in the region.

“The sooner the clot-busting treatment is administered after a stroke, the more effective it’s likely to be,” he continued.

A Swedish study in 2020 found that for every one-minute delay to the administration of thrombolysis, a patient’s chances of survival reduced by 0.6 per cent, whilst their chances of being left disabled increased by 0.4 per cent.

Jeannette Thomas, lead councillor for health at Stevenage Council, has been her husband’s full-time carer since he suffered a stroke in 2005.

While he was not eligible for thrombolysis, she said she had learned a lot about stroke treatments.

“I’m fully aware of what the consequences could be,” she said last week. “I’m somewhat concerned that members of our community could be ending up disabled or losing their lives because the Lister stroke unit isn’t performing to the expected standard.”

She said she would be raising concerns with colleagues at County Hall.

Family’s concern

The daughter of one stroke patient - 85-year-old David Adams - said she feared Cllr Thomas's concerns had become a reality in her father's case.

David suffered from an Ischemic stroke - where a blood clot blocks blood and oxygen from flowing to the brain - in April last year.

When Tracy Adams, 51, noticed her father’s mouth dipping, she recalled information from an advert on TV about stroke signs.

Knowing her father was prone to having a stroke because he previously had a “blockage in his neck”, she rushed him to the Lister at 5.30pm on April 6, 2021.

After a nurse did David’s observations, Tracy recalled she was told: “It could be a stroke so we better call the stroke team.”

Tracy said she and her dad waited an hour until someone took David’s blood pressure. She said she was confused by the hospital’s the lack of urgency, given her father’s age.

“I was thinking ‘Why are we just sitting here? This is completely pointless’. They weren’t doing anything even though they were aware he was still having a stroke,” she claimed.

Tracy said she finally left at 10.30pm, while her dad was still waiting. In those five hours, she said he wasn’t offered Thrombolysis.

She claimed he walked into hospital, but he left in a wheelchair and was unable to walk again.

Tracy was also dissatisfied with Lister’s post-stroke physiotherapy - another area lagging behind the trust's targets - and believes that contributed to her father’s decline in mobility.

Tracy said she was unable to see her father for two weeks after his stroke, due to COVID-19 restrictions.

During that time, she said she received distressed phone calls from him, saying he was “sick of sitting in bed” and that “no one has tried to get [him] up”.

“I think he just deteriorated. He got so bored of staying in bed. His arms got weaker and then one day he just couldn't walk,” Tracy said.

Lister was also rated the worst in the region for the percentage of patients receiving six-month follow-up appointments, and third-worst for the time waited before seeing a specialist stroke consultant.

“There are relatively slow assessments of their disabilities, which obviously means that they’re not getting started in their rehabilitative treatment as they should be,” said Professor Martin.

Off target

According to SSNAP, Lister is in line with the average for the time taken to admit stroke patients to specialist stroke wards.

But according to board papers, the trust has been regularly missing its own target – to get patients onto stroke wards within four hours – since 2017.

In September 2021, 29.7 per cent of stroke patients made it to a stroke ward within four hours – compared to a target of 63 per cent.

Professor Martin said getting patients onto specialist wards “reduces complications and improves outcomes”, but that it is “notoriously difficult” because in times of pressure, spaces are given to non-stroke patients.

Board papers said that since the COVID-19 pandemic hit, this had become a problem at Lister.

What the hospital says

The trust said that although its pre-pandemic mortality rate was described as “high” in board papers, it was now within the national average.

“However, we know that improvements need to be made and have stated this publicly,” said medical director Dr Michael Chilvers.

“We have completed a ‘deep dive’ of our services to assess what challenges our experienced and committed staff are facing, and the impact this has sometimes had on patient care.”

He said demand on A&E and inpatient beds meant that “we haven’t been able to keep beds empty for stroke patients”.

He also cited staff shortages on the stroke ward and a national shortage of occupational therapists.

“In response, the trust has put together an action plan,” said Dr Chilvers – with plans including ring-fencing stroke beds, working with the ambulance service to reduce delays at A&E, getting rehab plans in place within five days of admission, and “putting in place a plan to improve staffing levels”.