14 March 2002
In a report published today, the Association of British Neurologists (ABN) describes the alarming inequality and lack of specialist treatment throughout the UK because of a shortage of neurologists.
Currently there is just one neurologist for every 177,000 people in the population. This is worse than all other European countries where these data are available. (France, for example, has one neurologist per 38,500 people.)
The report, Acute Neurological Emergencies in Adults, calls for an increase in the number of neurologists from 350 to 1400 over the next ten years in order to establish a fully comprehensive UK-wide service.
Professor Charles Warlow, president of the ABN, said at the launch, “We believe that all hospitals should have a neurological service around the clock to give prompt and accurate diagnosis and treatment to all patients who are admitted with acute neurological illnesses.”
There are approximately 250 district general hospitals in the UK and more than 200 of these do not have a 24-hour on-call, on-site neurological service.
Professor Warlow concluded, “Our goals for the next 10 years are ambitious but entirely necessary and represent an investment in healthcare. The Government must recognise the crisis we and our patients are in.”
The ABN’s press release ...
Patients with emergency
brain disorders are denied specialist care
14 March 2002
Association Of British Neurologists Press Release
The majority of patients who are admitted to hospital as an emergency with brain-related disorders, such as stroke, epilepsy, brain haemorrhage, meningitis and encephalitis will never be seen by a neurologist. It is a matter of luck and where you live. A report, Acute Neurological Emergencies in Adults, published today (14 March) by the Association of British Neurologists (ABN) describes the alarming inequality and lack of specialist treatment throughout the UK because there are simply not enough neurologists to provide adequate care.
Figures (1) show that within the NHS Northern Ireland, Wales, Trent, the Midlands and the South West have the lowest number of neurologists, each serving a population of well over 200,000 in their region. Patients, however, in the Thames regions, Anglia and Oxford benefit from a greater proportion of neurologists, but this is still way below anything like a sufficient number.
Professor Charles Warlow, from Western General Hospital in Edinburgh and president of the ABN said at the launch of the report, "We believe that all hospitals should have a neurological service around the clock to give prompt and accurate diagnosis and treatment to all patients who are admitted with acute neurological illnesses. This is routinely achieved in other European countries, such as the Netherlands. The numbers of neurologists around this country vary significantly, showing there is great disparity in the level of care patients may receive."
The ABN is calling on the Government and health authorities to increase the number of neurologists from 350 to 1400 over the next ten years in order to establish a UK-wide and fully comprehensive service. Currently there is just one neurologist for every 177,000 people in the population, which is dramatically worse than all other European countries where these data are available. (France, for example, has one neurologist per 38,500 people.)
Because of the lack of neurologists and the overall increase in acute medical admissions, general physicians have been under enormous pressure. According to the ABN, it is unrealistic to expect them to continue the care of acute neurological emergencies. Such patients should be admitted directly under the care of a neurologist or at least be seen by one within 24 hours. Almost 20% of patients in hospital at any one time have a neurological illness but many of them are inevitably denied specialist care from a neurologist. Ideally, neurologists should be more involved with stroke, but with around one in 500 people suffering from a stroke every year, this is currently almost impossible.
Most hospitals do not have a consultant neurologist but a neurologist from elsewhere may visit once a week if at all. The report calls for at least two to three full-time neurology consultants to provide a barely adequate service in each district general hospital serving an average of 250,000 people in the region. "We need at least 600 neurologists just to cope with outpatients alone between the hours of nine to five," said Professor Warlow.
Broadcaster, Ms Julia Somerville, who had emergency surgery to remove a brain tumour following a swift diagnosis by a neurologist in 1992, said, "I was very fortunate that the facilities I needed were there for me but I am aware that it was a matter of luck. The ABN has highlighted the appalling scarcity of expertise nationwide for patients in a similar situation."
The report makes a series of recommendations for how this could be achieved. Dr Peter Humphrey, consultant neurologist at the Walton Centre for Neurology and Neurosurgery in Liverpool who chaired the ABN working party said, "The early correct diagnosis and management of acutely ill neurological patients can make the difference between life and death. We, therefore, need a four-fold increase in the number of neurologists to 1400 to provide a 24-hour service to patients requiring urgent care. The service we provide must inevitably include access to neurological beds, intensive care facilities and neuroradiology." To achieve this requires new strategies for more trainees and better teamwork with nurses and therapists trained to manage neurological patients. Patients whose illness does not demand immediate attention should be assessed by a neurologist within 24–48 hours.
There are approximately 250 district general hospitals in the UK and more than 200 of these do not have a 24-hour on-call, on-site neurological service. Dr David Bateman, consultant neurologist at the Royal United Hospital in Bath said, "This proposed change whereby acute neurological emergencies are admitted directly under the care of a consultant neurologist is one of the most important developments in the management of emergency medicine in the last decade."
The report is endorsed by the Royal College of Physicians. Professor Carol Black, Clinical Vice-President of the RCP, said, "This report is important because it sets out the view of the professional association of neurologists in an important area of acute care. It makes a strong case for a 24-hour nationwide acute neurological service close to the point where the patient is admitted to hospital initially. It is a realistic report because it sets out the options in expansion and acknowledges that what can be done depends on this more than anything else."
It is timely that the report is launched during Brain Awareness Week where the challenges and promises of brain research are revealed in an international programme of public events.
Professor Warlow concluded, "Our goals for the next 10 years are ambitious but entirely necessary and represent an investment in healthcare. The Government must recognise the crisis we and our patients are in."
Notes to Editors
Acute Neurological Emergencies in Adults is available from the Association of British Neurologists free of charge. Tel 020 7405 4060, Fax 020 405 4070
The ABN, founded in 1932, promotes the advancement of the neurological science, education and training and the practice of neurology in the UK. It has 1050 members who are consultants and trainees both in the UK and abroad.
Figures for the regional distribution of NHS neurologists are from the ABN Consultants Database, December 2000.
Brain Awareness Week, 11- 17 March, is co-ordinated by the European
Dana Alliance for the Brain, an alliance of 120 scientists which promotes
brain research. http://www.edab.net