Witness Statement from Annabel Maciver, Patient Rep, Stroke Committee

Witness statement from Annabel MacIver, Patient Rep, Stroke Committee

There have been dramatic changes to rehabilitation for the victims of stroke in Hertfordshire over the past year. Prior to this when a patient had a stroke and was discharged from hospital in Hertfordshire, unless he or she required treatment at a specialist unit such as the Danesbury, they generally received little or no physiotherapy, occupational therapy or speech therapy (number of therapists were at a minimum). Many were being kept in hospital as doctors felt unable to let them go home as there were no services there for them. The PCT should have been providing care for all such patients and this was not happening. The situation was going on for many years (although had been highlighted) and it was only over the latter half of 2011 and into 2012 that this has started to change.

As a note, the first six months of therapy are the most important for stroke patients and those with brain injuries, as the body is at its most receptive to treatment at this stage and getting this right will make the difference between a relatively fulfilled independent life, and one that is highly dependent.

The Life After Stroke Committee was formed in late 2010, and has now started to make considerable inroads into changing this appalling situation and improving the lot for these neglected individuals.

Key issues:

Patients on discharge from hospital need to have regular physiotherapy, speech therapy and OT for a number months after discharge to enable them to make as complete a recovery as possible and regain control of their lives. If this is not given then individuals risk an increased rate of re-admission to hospital, depression, inability to cope and even premature death.

Great many inroads have now been made, and these are highlighted together with some more immediate concerns.

a)At the most recent meeting it was suggested that the backlog of patients needing therapy would be clear within the coming 4-6 weeks. It is necessary to ascertain what this will entail for these individuals and to ensure that they will get more than adequate therapy given the time they have had to wait and the subsequent set backs they have no doubt encountered as a result. It is also essential that this deadline does not slip.

b)All patients are now being contacted within 72 hours after discharge to ascertain care needs etc. This is a dramatic and welcome improvement. However, there is a concern that although this target is being achieved, the majority of patients are being contacted by telephone rather than a visit. I have not looked at relevant research but preliminary discussions with medics suggest a level of discomfort with this, as proper assessment of how a patient is coping by telephone is possibly not the best way. It is very easy to say everything is fine at the end of a phone line, so as not to be a nuisance, whereas face to face it is more difficult. The Committee is looking into this but it is worth noting.

c)What is also impressive is that all patients who need follow on care are getting some. It would be worth ascertaining the proportion who are getting group therapy versus one-to-one therapy. Both are very important but there are vague concerns that group is being used rather than one-to-one as it is easier to treat a greater number of patients faster. However, intensity is also key. I have not been party to any of these groups, but this is worth checking this. In addition it would be worth ascertaining how many therapists are currently being employed (temporary and permanent) within the community to provide therapy, and finding out how many more would be needed for optimum provision of care.

d)It is necessary to obtain guarantees that this situation will not happen again and identify and put in place controls to prevent a repeat occurrence. (The hospital is usually the first place to identify problems with home rehabilitation as they do/should not let individuals be discharged without the relevant home care, thus possibly this is a place to start for monitoring).

e)The other key is to how this improvement will be maintained and further improved. It is possible I am sure. However, it is imperative that the gains be maintained and the improvements continue. It was never acceptable for this situation to have happened in the first place and it is astounding and shocking that no one within the Herts PCT listened and acted for so many years. So many frail stroke victims must have slipped through the net to horrendous situations over the years and it remains the moral responsibility of the PCT and whatever emerges in the future to ensure care is given and continues to be given in the proper and most clinically effective way.