Published: 20 December 2017

Legislative Council Tuesday 28 November 2017

Ms  FORREST (Murchison ) - Mr President, I wish to make a fairly brief contribution on adjournment.  In recent days a national stroke audit has been released which clearly shows disturbing truth about lack of adequate and appropriate care for victims of stroke, particularly in the north-west and north of the state. 

A bit of background regarding stroke statistics in Australia.  One stroke occurs every nine minutes; that is 56 000 new strokes each year, of which many occur in regional areas.  Regional Australians are 19 per cent more likely to have a stroke than their city counterparts.  Stroke is the leading cause of death and disability, costing over $5 billion a year.

Tasmania has the highest stroke instance per capita of population - 1453 strokes will be experienced by Tasmanians this year, and 12 384 stroke survivors are living in Tasmania.  More than 8000 Tasmanian stroke survivors are living with an ongoing disability.  One in three stroke survivors are of working age.  Without action, by 2050 Tasmanians will experience almost 3500 strokes annually.  There will be more than 25 000 stroke survivors living in the community.

In terms of the stroke risk, Tasmania has 108 202 people with high blood pressure; that is 19 per cent of our population;  26.9 per cent have high cholesterol; 46.1 per cent are physically inactive; and 2.2 per cent of Tasmanians have atrial fibrillation or an irregular heartbeat, which increases their risk.  The north-west coast has some of the highest rates of cardiovascular disease in the state.  This area is a hotspot for stroke.  I have some figures broken down by lower House electorate.  The number of strokes per year in Bass is 293; in Braddon, it is 297; Denison, 291; Franklin, 292; and Lyons, 280.

These figures are per year.  Some people have more than one in a year.  That is the number of strokes per year.  This means that 870 strokes are suffered predominantly in our regional electorates based in the north of the state compared with 588 in the southern-based electorates.  Admittedly some of those are also in regional areas in the southern-based electorates.  Very few of any of those who experience these 870 strokes are receiving lifesaving and quality of lifesaving therapies we can and should be delivering.

This is the reason I am raising this on adjournment.  It is a matter of urgency.  Advancements in stroke treatment and care mean stroke is no longer a death sentence for many.  However, patient outcomes from stroke vary widely depending on where you live and your ability to access appropriate treatment.  The two key types of treatment include thrombolysis, which is clot dissolving treatment, which must occur within four-and-a-half hours of stroke symptoms occurring, and endovascular thrombectomy, or clot retrieval - ECR, it is called - which involves removal of a clot by a retractable mechanical device.  This needs to be administered within six hours of symptoms occurring.

Currently the state has two stroke units, one at the Launceston General Hospital and one at the Royal Hobart Hospital.  They both have thrombolysis, clot-busting capabilities.  The Royal Hobart Hospital is the only hospital currently delivering clot removal, the endovascular thrombectomy, or ECR.  However, this service is not available for 24 hours a day.  There are no services on the north-west coast.  This is where there is most need and a new collaborative approach.  Some of the most recent advances are in ischaemic stroke, which is caused by a clot; treatment is particularly time-crucial and only can be provided within the first few hours of a stroke.  The earlier the treatment is delivered, the better the outcomes for stroke patients.

This is an important matter because if patients can access this timely care, they can make a full and rapid recovery, with minimal, if any, residual deficit.  Effectively they walk home the next day or walk out the door to go home.  If you compare the cost of establishing these services in the north-west and northern Tasmania with the cost of providing years of care to stroke victims, the loss of productivity and the ongoing burden to families and health budgets, this should be an easy decision. 

I urge the Government to establish a Victorian-based and supported Tasmanian telehealth stroke service.  A telemedicine service enables fast assessment of suspected stroke patients in regional areas by metropolitan-based stroke specialists.  Regionally based clinicians are supported in administering thrombolysis treatment and/or arranging transfer to a comprehensive stroke centre for ECR treatment. 

Victoria has recently trialled a stroke telemedicine service which links regional hospitals to senior neurologists at the Royal Melbourne Hospital.  As a result of this link, patients across Victoria are receiving clot busting therapy in their regional hospital and those who can benefit from clot retrieval therapy are being transferred to the large city hospital for treatment. 

A telemedicine stroke service could be introduced to Tasmania very easily and for a moderate cost.  A real and valid cost option would be for Tasmanian patients to be linked to the Victorian service. 

With regard to the comprehensive statewide ECR treatment system, ECR is technically challenging and should only be performed by a highly trained specialist.  ECR is delivered in Hobart at limited times but the service capabilities of the existing infrastructure are insufficient to meet the rapidly increasing demands.  There is also a need to develop a statewide protocol to coordinate transfer of eligible patients to an ECR centre to ensure equal access for all.

I will provide a brief comment about how the Victorian stroke telemedicine, VST program, works.  It started in 2010 and the program allows people living in rural and regional areas to quickly access stroke specialists and new acute stroke therapies, such as clot-busting and clot removal treatments.  Until now, regional hospital emergency departments have often been unable to give these therapies as patients with stroke required detailed assessment by a specialist with stroke experience to ensure a patient is suitable for treatment.  This is because timely brain therapy must be given as soon as possible after symptoms commence to achieve the best possible outcomes. 

The VST program is unique in Australia and works by seamlessly connecting 16 Victorian rural and regional emergency departments to a roster of a metropolitan-based neurologist.  I understand there are about 20 neurologists on that list who are willing to cooperate with Tasmania, particularly the north and north-west of the state.  The neurologists are accessible every day, 24-hours a day, 365 days a year with a single 1300 telephone number.  Through new state-of-the-art mobile technology and software, the stroke specialist team can remotely examine patients at the bedside, review brain imaging and provide rapid diagnosis and treatment advice in consultation with local clinicians and the patient, irrespective of their geographic location.

The VST program commenced in 2010 and received funding support from the Commonwealth Department of Health and the Victorian Department of Health, Victorian Stroke Clinical Network, Monash University and some other smaller contributors.  The VST program has deployed fully integrated telemedicine technology in emergency departments to all 16 hospitals in regional Victoria.  There is extensive data collection and ongoing monitoring of VST activity and clinical outcomes with the use of the Australian Stroke Clinical Registry supporting the full clinical health and economic evaluation of the VST program. 

The work has been done; the proof is already there.  The program has seen 130 per cent increase in patients with acute stroke being treated under 60 minutes of a hospital arrival, 30 per cent decrease in treatment time - for example, door to the CT/door to stroke thrombolysis times - and 60 per cent decrease in complications following thrombolysis.  The VST program has been very successful and delivered equity of access to acute stroke care for people living in regional Victoria. 

I support the notion that this telestroke model can be expanded to northern Tasmania.  I am informed the establishment of this service will be highly cost-effective.  The estimate in terms of cost will be $500 000 over the forward Estimates period, including initial set-up costs and an ongoing estimated cost of $80 000 to maintain operations of the service, once established.  Costs are not yet finalised and work is currently underway to fully determine the set-up and ongoing costs to deliver such an important service. 

When one considers the significant costs associated with caring for stroke victims who are not being provided with quality care - others in the south of the state and occasionally the north are, but never getting it in the north-west - it is simply not okay.  The inequity of care means people living in the north of the state and particularly the north-west are receiving substandard care and we are not doing our best for them. 

A Victorian-based Tasmanian telemedicine stroke service exists and could easily be adopted.  We do not need to reinvent the wheel:  the evidence is clear and the service is proven.  I know we do not have the critical mass of population and/or neurologists to provide a 24 hours a day, seven days a week service within our state so it makes sense to link with Victoria, a tried and proven service and save millions of dollars, save lives, and improve patient outcomes in a timely and cost-effective manner. 

I urge the Government and the Opposition to fully assess and consider this important health opportunity for all these reasons.


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