The pandemic's devastating impact on stroke survivors
The health service survived the first, despite all fears. And there seems a quiet confidence amongst the authorities that we have learned enough about the virus first time around to be able to cope with the next significant wave of hospitalisation.
However a heavy price may be paid elsewhere.
Right from the outset there have been concerns about the impact of dealing with Covid-19 on the very many people who have other conditions affecting their physical and mental health.
For example, cancer services have been devastated. Screening, diagnosis and treatment have all been affected. How this will translate into lost lives is not yet known. Predictions vary wildly – from 3,300 across the UK to more than 60,000, according to Cancer Research UK There’s currently a backlog of 2 million people waiting for screening, tests or treatment. This does not bode well given that cancer is the biggest killer and early intervention is imperative.
As the weeks go by more and more emerges about how other patients have been impacted.
Stroke is the third biggest killer in Northern Ireland and the biggest cause of disability. Around 4,000 people suffer a stroke every year here and there are around 1,000 fatalities as a result.
Today there are around 39,000 stroke survivors here – who collectively need a wide range of services to help them recover.
Unfortunately they have been especially badly hit as an important survey of 2,000 survivors and carers carried out by the Stroke Association reveals.
Every stroke is unique to the person who suffers it. There are two main causes: those which result from a blocked blood vessel (clot) in the brain and those resulting from bleeding in the brain.
The effects of stroke depend on two factors: the part of the brain it affects, and the extent of the damage it causes.
That is why symptoms can very so much and, consequently, why such a wide range of professionals are potentially involved in helping survivors recover.
Examples include: people finding it hard to speak and understand speech, to read, write or use numbers; slurred speech as a result of weakened facial muscles; problems with concentration and memory; anxiety and depression; changes to behaviour; paralysis and muscle weakness.
With enough physio, speech and language therapy and mental health support, stroke survivors can recover but the Stroke Association report suggests that recovery services are at crisis point.
The impact on carers has been especially devastating, with 61% in NI saying that they feel overwhelmed and unable to cope. 94% of carers say they are finding it more difficult to carry out practical tasks, such as buying food or picking up prescriptions – this is again higher than the UK average of 80%. And yet only half of respondents said they had been given enough information, guidance and support during the pandemic.
As to stroke survivors 69% reported feeling more anxious or depressed during the pandemic, while 40% have felt abandoned. 65% have worried more about what the future holds.
The Stroke Association finds this especially troubling: “Before the pandemic, we already knew that 90% of stroke survivors in Northern Ireland felt that their emotional and cognitive needs were not being met.”
Indeed a research paper published before the pandemic argued that the level of long-term stroke care, rehabilitation and mental health support available was already letting down stroke survivors.
The Struggling to Recover Report outlined gaps in:
• the length and intensity of post-hospital rehabilitation
• the provision of information to stroke survivors and their families
• emotional support
• support for carers
• help getting back to work
• public awareness of stroke.
It stated: “Best practice guidelines recommend at least 45 minutes a day of each type of rehabilitation therapy needed by stroke survivors for as long as it’s of benefit to them. However on average stroke survivors in Northern Ireland only receive a third of that.”
It also reported that 45% of stroke survivors felt abandoned when they left hospital.
The report concluded: “We cannot have another decade of unmet needs and underfunding of community based stroke care. While hospital stroke services are developed and improved, it is vital that rehabilitation and long term support for stroke survivors is not left behind and we invest in community based stroke care.”
So therefore the stroke recovery services that have been so badly impacted by the pandemic were already falling short of need.
This report is important and timely and is likely to be one of the first of many outlining how the pandemic has impacted health and social care services that were already struggling to cope. The pandemic is providing more reasons for reform and should not be seen as a reason to delay.
Barry Macaulay Director of the Stroke Association in Northern Ireland said: “While we appreciate the challenges posed by the pandemic for the health and social care sector, the Covid-19 crisis should be seen as an opportunity to reform our health system. Change is long overdue and we must do better to improve outcomes for stroke survivors and their families, both now and in the future. Staying as we are is not an option and a lack of progress puts lives and recoveries at risk”.
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