Key stroke treatment still not available around the clock across England
Exclusive: Seven of England’s 24 stroke centres still not providing mechanical thrombectomy 24/7 despite ministers’ pledges
The NHS has not made a “life-changing” treatment for stroke available around the clock across England despite ministers repeatedly promising that it would.
The health service was expected to improve stroke care by making a clot removal technique called mechanical thrombectomy available everywhere in the country 24/7 from 1 April.
Doctors describe it as a gamechanging intervention that, if done quickly, can help someone who has had a severe stroke avoid ending up with a serious disability as a result.
However, seven of England’s 24 regional stroke centres are still not providing thrombectomy on an all-hours basis, mainly because they do not have enough doctors and other staff to do so.
Experts fear the NHS’s failure to deliver universal 24/7 access to the treatment could mean patients who have a stroke overnight, in the evening or at weekends in underserved areas may become avoidably severely disabled, or may even die, because they could not have the procedure.
More than 100,000 people a year in the UK have a stroke, of whom 38,000 die and many others are left with life-changing disabilities that rob them of their independence.
Dr Sanjeev Nayak, a stroke specialist at the Royal Stoke hospital in Stoke, said: “A patient presenting during normal working hours in a well-served area may receive rapid, life-changing treatment, whereas the same patient presenting at night or in a different region may not receive thrombectomy at all. This creates a real postcode lottery in access to one of the most effective treatments in modern medicine.”
Seventeen of the 24 centres for thrombectomy already offer it around the clock all year round. But the seven others – in Hull, Middlesbrough, Leeds, Sheffield, Newcastle, Brighton and Coventry – could not comply with the 1 April deadline to expand their service to a 24/7 operation.
Karin Smyth, the NHS minister, confirmed as recently as 23 March that the health service was meant to make thrombectomy available everywhere in England 24/7 by the start of this month.
NHS England had made extra money available to the seven areas to secure 24/7 access to service provision. The funding was confirmed in February.
Alexis Kolodziej, the deputy chief executive of the Stroke Association, said: “It’s deeply troubling that access to thrombectomy remains dependent on the time of day and the area in which you live, with around-the-clock access to thrombectomy being simply impossible for some patients in parts of the UK. The government’s failure to deliver on its promise leaves patients at a significant disadvantage.”
She welcomed the investment in expanding the availability of thrombectomy but added: “Its implementation in certain parts of the country is woefully slow.”
The NHS spends more than £100m a year on the treatment. It is seen as a key way of helping the government achieve its aim of reducing the 113,000 avoidable deaths that occur annually in England from major killer conditions, especially cancer and heart disease.
Thrombectomy is a minimally invasive, non-surgical treatment for severe strokes caused by a blocked artery in the brain. Doctors put a catheter into the patient through an artery in their groin or wrist, move it to the brain and remove the clot, allowing blood to start flowing again.
Nayak said while the NHS had made substantial progress in making the treatment available in recent years, “the concern is that without consistent 24/7 access across all regions, some patients … will face critical delays or miss the opportunity for thrombectomy altogether.”
University hospital Coventry, one of the seven centres that missed the deadline, sends stroke patients who need a thrombectomy outside the hours that its own service operates to University hospital Birmingham. Royal Sussex county hospital in Brighton has a similar arrangement in place with University College London hospital
That leaves Yorkshire and the north-east as the areas without any form of 24/7 service. Shortages of stroke doctors, specialist nurses and interventional neuroradiologists, who carry out thrombectomies, are the main reason not all hospitals yet offer all-hours access.
NHS England confirmed that it had not fulfilled its ambition to bring in universal 24/7 access to thrombectomy by 1 April but said doing so remained a priority.
A spokesperson said: “The majority of thrombectomy centres currently offer 24/7 services and we are working directly with trusts and integrated care boards to further improve access for all patients as soon as possible. This includes providing £14m of extra targeted funding to support service expansion, including training additional staff to carry out mechanical thrombectomy.”