UK stroke care falling behind

Professor Hugh Markus of St George's hospital, London, says that three comparative studies of outcomes for stroke sufferers shows that those in Britain fare the worst.

Writing in the British Medical Journal, he calls for a reorganisation of stroke services. "In many european countries stroke care is an integral part of neurology," he says.

Below is a transcript of Professor Markus's interview with Channel 4 News reporter James Blake.

Is there a sense that the attitude of patients and staff are causing problems with the treatment of strokes?

In the past people haven't really been interested in strokes - and this applies to doctors. And patients haven't realised how important it is to get into hospital soon. And there hasn't been the funding put into strokes.

Things are now changing and people are realising it is a disease you can treat. You can make a dramatic difference to a patient's outcome. And there's a lot more interest in it.

But it takes a long time to train a new cohort of people to look after stroke patients. It is being addressed now - there's a new training scheme in place. But it'll take quite a time to get enough people into place to look after all stroke patients.

Why has it taken so long for people to realise that there's a problem here?

I think in the past people thought stroke was boring. I remember as a medical student there was nothing you could do about stroke. It's only fairly recently we've had treatments that really can change stroke care.

And also we've shown that simple things, like looking after the basic care well, can actually make a dramatic effect on outcome.

How bad is it compared with other European countries, do you think?

A number of studies have shown that if you have a stroke in the UK you're more likely to die, and if you do survive you're more likely to end up disabled. So we certainly have worse care than many of our European colleagues such as France and Germany and Scandinavia.

And what's interesting is that we spend probably as much as these countries on stroke care, if not more than some of them, which suggests that there are some problems in organisation of the care. Perhaps we're not using our resources as effectively as we could.

And interestingly, in the government's own National Audit Office report in 2005, they suggested that if we reorganised stroke care we could save about 500 lives a year, and also prevent 1700 prople who would otherwise be disabled from being disabled.

What do they do in France, Germany and other countries that we don't do here in terms of care or treatment?

We're not absolutely sure, but the data we've got suggests that people take acute care quite differently, so they treat strokes in emergency. For example, if you get a stroke, you get a scan straight away - maybe even in the A&E department. You then are put on the appropriate treatments to prevent further strokes.

And in some cases now you can actually dissolve the clot that's causing the stroke with a treatment called thrombolitis, or clot-busting treatment. But you have to give that very quickly, within three hours, so that obviously means you need to get the patient in quickly and have a service that can assess them very rapidly.

People will be amazed that we're not doing that here.

We are in some centres, and there are some very good centres in the UK. But they're in a minority.

So in terms of your own centre, what have you done to help the treatment of strokes?

Simple things to start with. We've put all the stroke patients in one unit. We've made sure that everybody comes straight to that unit. We've started administering clot-busting treatment.

And we've trained enough stroke physicians so we can have good care of the patients at all times. So a lot of it's simple things.

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