Thousands of patients denied access to ‘miracle’ stroke treatment

Just a quarter of thrombectomy centres operate 24/7 services, while 42% are only open from Monday to Friday during office hours.

27 July 2022

Thousands of stroke patients who could benefit from a “miracle treatment” that pulls them back from “near death” are being denied access to it, a charity has warned.

The Stroke Association said more than 47,000 patients will miss out on the treatment on the NHS over the next seven years unless NHS England and the Government take immediate action.

Mechanical thrombectomy involves using a stent to manually remove large stroke-causing blood clots from the brain via a catheter inserted into the patient’s groin.

The procedure can cut hospital stays by several months and some patients have been able to leave hospital the next day, rather than spending months in rehabilitation units.

According to the Stroke Association, thrombectomy is one of the most effective procedures ever discovered for stroke and is suitable for around 10% of all patients. There are more than 75,000 strokes in England every year.

In its new report, the charity said there is an urgent need to have a 24/7 thrombectomy service so that all patients can benefit.

It predicts this would save £73 million per year owing to the reduced costs of looking after people with stroke in the long term.

The study said NHS England has missed its target to make mechanical thrombectomy available to all patients it would benefit – only delivering to 28% of all suitable patients by December 2021.

Stroke specialists quoted in the report argue that they cannot deliver a 24/7 service in part due to a lack of biplane suites, which contain specific radiology equipment.

The charity also highlighted an “unacceptable postcode lottery” in care, with almost 8% of stroke patients receiving thrombectomy in London, compared with just 0% to 3% in other parts of the country.

Just a quarter (25%) of thrombectomy centres operate 24/7 services, while 42% are only open from Monday to Friday during office hours, the report added.

Thrombectomy can be performed up to 24 hours after a stroke, but it is most effective in the first six hours.

Juliet Bouverie, chief executive of the Stroke Association, said: “Thrombectomy is a miracle treatment that pulls patients back from near-death and alleviates the worst effects of stroke.

“It’s shocking that so many patients are missing out and being saddled with unnecessary disability.

“Plus, the lack of understanding from Government, the NHS and local health leaders about the brain-saving potential of thrombectomy is putting lives at risk.

“There are hard-working clinicians across the stroke pathway facing an uphill struggle to provide this treatment and it’s time they got the support they need to make this happen. It really is simple.”

Ms Bouverie said thrombectomy rates “are rising gradually” due to the efforts of stroke teams, “but progress is far slower than it needs to be”.

She added: “Tens of thousands will miss out if rates stay the same as in 2020/21. NHS England’s original target was missed by a long way and we need to see proper efforts being made to make sure we’re not in the same position in 2029.”

The new report found that thrombectomy rates are also being kept low by lengthy ambulance response times and slow handover of patients to A&E.

To achieve a 24/7 service, the Stroke Association said the number of interventional neuroradiologists (INRs) would need to be doubled.

It also called on the Department of Health and Social Care to develop a sustainable workforce plan to fill the gaps in qualified staff.

Professor Martin James, consultant stroke physician at the Royal Devon and Exeter NHS Foundation Trust and a clinical trustee of the Stroke Association, said: “Thrombectomy really is a game-changing treatment, yet the number of people receiving the treatment in the UK remains much lower than elsewhere in Europe, and has been only slowly increasing over recent years.

“At this rate, it won’t be available to all those who could benefit for many years to come.”

An NHS spokeswoman said: “Despite the impact of the pandemic, NHS teams across the country have continued to improve stroke prevention and treatment services – including access to thrombectomy – in line with our Long Term Plan ambitions to save more lives.

“By bringing services together through newly-created stroke networks, we are supporting local clinicians to deliver 24/7 access to thrombectomy, clot-busting drugs and other life-saving specialist stroke services in every part of the country, so if you experience stroke symptoms, it’s vital that you call 999 immediately.”

A Government spokesman said: “We are growing the health and social care workforce, with over 4,000 more doctors and 9,600 more nurses compared to last year, and over 1,400 more doctors in general practice compared to March 2019.

“We are grateful for healthcare staff across the country who continue to improve stroke prevention and treatment services – including access to thrombectomy – as part of the ambitious NHS Long Term Plan.”

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