Overview
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Introduction
Wales is under pressure to improve its stroke services. Consequently, various measures have been instituted to prioritise the care of stroke patients.1–3 Medical care for stroke patients in Wales is predominantly provided by geriatricians with a special interest in stroke. Even though stroke care constitutes only a small proportion of their job plan, in reality it may take up significantly more time and effort. Hence, there is a growing feeling that attempts to improve stroke services in Welsh hospitals occur at the expense of other geriatric medicine services. In order to explore this view we undertook an internet-based questionnaire survey of all geriatricians in Wales.
Results
At the time of the survey there were 84 whole-time equivalent geriatrician posts in Wales. Of those, 11 were unfilled and 10 were filled by locums. We sent the questionnaire to 59 geriatricians in substantive posts of whom 30 responded. A response rate of 50% is in line with the expected web-based response rate for impact evaluation surveys.4 Results are shown in Table 1.
Questionnaire results.
Discussion
While 57% of the respondents were geriatricians with a special interest in stroke, the survey does seem to obtain a representative view of the consultant geriatricians in Wales. An overwhelming majority (97%) felt that Wales does not have adequate resources to provide high-quality stroke services. Clinicians in the NHS would be familiar with the statement that one could improve services just by changing the way we work. However, 85% did not feel that stroke services in Wales would improve simply by readjusting existing services and work patterns without recourse to extra resources.
The majority (77%) reported that they were under pressure to prioritise stroke care at the expense of general medical and geriatric medicine services. 60% felt that the drive to improve stroke services in Wales has adversely affected other services, notably in geriatric medicine. Comments have highlighted that in some hospitals, physiotherapy and occupational therapy workforce have been moved from general geriatric to stroke services.
Many (70%) felt that geriatric medicine is losing consultants to stroke medicine as a number of these posts are taken up by trainees from geriatric medicine. Despite this, the majority (80%) were supportive of geriatric medicine trainees obtaining experience in stroke through out-of-programme fellowships.
Surprisingly, the majority of physicians on the stroke rota do not have dedicated time recognised in their job plan for providing stroke thrombolysis services during working hours and out of hours. It is not uncommon for clinicians to temporarily discontinue their ward rounds or outpatient clinics to assess patients with acute stroke to consider thrombolysis. This implies that stroke thrombolysis services in Wales are largely supported by clinicians out of goodwill.
To conclude, prioritisation of stroke services in Wales is occurring at the expense of other services for the elderly. We do not know whether other devolved nations in the UK are having a similar experience. It is crucial not to drain resources from existing core clinical services to augment disease-specific services.
- © Royal College of Physicians 2015. All rights reserved.
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