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Dear Scottish Government… This is how important thrombectomy is

“I cannot understand the rationale to cut funding for a service that improves patients’ lives and also saves money at the same time.”

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Earlier this week SR Times reported on the proposed cuts to thrombectomy that the Scottish Government are set to impose, which causes a real threat to the stroke community in Scotland. 

Since it was announced in July 2022, SR Times has shown its support for the Stroke Associations ‘Saving Brains’ campaign, in which over 10,000 individuals signed an open letter to parliament, showing their support for nationwide 24/7 thrombectomy services, which could save thousands of lives.

Now, Chest, Heart & Stroke Scotland have started a petition against the cuts, titled rather fittingly ‘thrombectomy for all’ and you can sign that petition here.

The cut would see a 50 per cent reduce in funding for thrombectomy, with any further recruitment for thrombectomy services also put on hold, just to make matters worse.

It would seem the Scottish Government have backtracked on their previous support for thrombectomy services. 

NHS Tayside received funding from the Scottish Government to carry out a pilot of a mechanical thrombectomy service in 2020, with an eye to this service becoming available 24/7 by April 2023.

SR Times reached out to NHS Tayside for a response to the proposed cuts, their response was “We cannot comment on the Scotland questions, but there is currently no impact on the Tayside service.”

SR Times spoke with John Watson, Associate Director Scotland of the Stroke Association, Dr Sanjeev Nayak, who was part of the team behind the UK’s first 24/7 thrombectomy service and has also been on the frontline of the ‘Saving Brains’ campaign, and Joanne Graham, interim director of services, Chest, Heart & Stroke Scotland, on the threat these cuts pose to Scottish stroke patients.

What threats do these cuts pose?

Watson says: “The thrombectomy programme was set up to ensure that around 800 eligible patients every year would be able to benefit from one of the most effective medical interventions we have available. 

“There is now a solid evidence base showing the improved patient outcomes and reduced disability achieved by such a service. Until we have a round-the-clock thrombectomy service covering the whole of Scotland, we will continue to deny patients the opportunity of these benefits because of where they had their stroke or when.”

Graham expresses the Chest, Heart & Stroke Scotland’s concerns, she says: “Chest Heart & Stroke Scotland remain deeply concerned at the proposed cuts to thrombectomy funding, which will cost the NHS significantly more in the long term and leave stroke survivors without access to life changing surgery.

“Thrombectomy is an extraordinarily effective medical treatment. Around one in every three people who receive a thrombectomy will be less disabled after their stroke as a result. Around one in five will be able to function completely independently afterwards.

“Thrombectomy gives people a better chance of walking again, talking again, and living independently.

“Cuts to thrombectomy will have serious consequences for people’s lives. It will lead to people being significantly disabled by their stroke, including losing the ability to live independently.”

On the impact of the proposed cuts, Nayak says: “It is very obvious that these cuts and recruitment freeze will have a huge impact on stroke patients. 

“It is estimated from the “Scottish Stroke Care Audit” that 15,000 people in Scotland have a stroke each year. Hospital care for these patients account for 7% of all NHS beds and 5% of the entire NHS budget. 

“Large vessel occlusive strokes that are eligible to be treated with mechanical Thrombectomy are the patient subset that will be facing the worst outcome with severe disability. A large proportion of 1,500 patients (10% of all strokes) who are eligible for mechanical Thrombectomy will miss out on this life changing treatment in Scotland.  

“The Scottish government’s budget cut on Thrombectomy amounts to less than 0.1% savings of the Scotland’s total health budget.   

“Instead the government will be spending much more on the hospital bed stay and community rehabilitation costs for these stroke patients which will be ten or hundred folds more than the savings incurred. In addition, a large number of stroke patients will suffer permanent disability which could otherwise be avoided by investing in developing a 24/7 thrombectomy infrastructure in Scotland.”

Adding pressure

Watson acknowledged the added pressure that cuts could bring to Scottish stroke wards, he says: “Cutting the thrombectomy programme would increase the pressure on stroke wards. Thrombectomy is such an effective procedure that it can significantly reduce hospital stay and rehabilitation needs for those who receive it. 

“In addition, the need to progress stroke patients quickly through the system in order to receive a thrombectomy in time has resulted in improvements across the stroke pathway – cutting the programme would represent a missed opportunity to make the whole stroke pathway work better.”

Graham agrees that these cuts will only add unnecessary pressure to stroke wards, and also highlights how thrombectomy can reduce the length of hospitalisation, she says: “Research tells us that Thrombectomy reduces hospital length of stay and can create large savings on community rehabilitation and lifelong social care.

“These cuts will add even more pressure to a workforce that is already struggling.

“Thrombectomy is an excellent example of preventative spend. Robust evaluation shows that thrombectomy has the potential to save the health and social care system up to £47,000 per patient in the first five years. 

“To slash investment in this well-evidenced, cost-effective procedure would in our view be a mistake and unfortunately will mean increased length of stays and pressure on rehabilitation service.”

A step backwards

Nayak pleads that these cuts will “take us back in time” and “destroy all the good work done by many clinicians,” he says: “It will be very concerning if further cuts are made in the Stroke sector. The government needs to invest in Stroke and Thrombectomy infrastructure and not reduce its funding. 

“The current cut and recruitment freeze will take us back in time and destroy all the good work done by many clinicians in providing good quality research that supports Thrombectomy as one of the most innovative and ground-breaking treatments for stroke patients.”

Graham also expresses concerns about the future of stroke care in Scotland, she says: “Stroke care was underfunded before the pandemic and the problems facing stroke care have only got more acute, so we are incredibly concerned about the future of stroke care in Scotland.

“A combination of greater demand and complexity of need increasing due to people struggling to access full recovery support during the pandemic, staff burnout and lack of proper funding has the potential to create a stroke care crisis in Scotland.”

Watson adds to the point of further cuts by saying: “We acknowledge the severe resource pressure that the NHS is under, and the gap between demand for services and the supply that can currently be resourced. 

“However, stroke was a neglected part of the health and social care system before the current crisis evolved and should not be subject to further cuts. In addition cuts to stroke services do not save money overall – stroke is the largest cause of adult disability, and getting stroke acute care and rehabilitation right reduces hospital stays, rehabilitation need and the costs to health and social care of ongoing support needs. 

“Improved stroke services are the kind of investment that our health and social care system needs in order to weather the current crisis and meet future demands.”

Taking action

On their action plan if these proposed cuts are to happen, Watson says: “As advocates for the stroke community we will have to speak out publicly against any cuts to the thrombectomy programme. 

“The Stroke Association, Chest Heart and Stroke Scotland, BIASP and the community of stroke professionals in Scotland have great faith in the case we have set out for reinstating the Scottish Government’s thrombectomy programme. For relatively small investment this improves patient outcomes while making the system better and saving much greater sums in the future.”

Adding to this, Graham says: “We need to come together and make it clear to Scottish Government that these cuts are unacceptable. The more people who sign the petition and the more we campaign together as a stroke community, the better chance there is of putting pressure on decision makers to think again – and support the national roll-out of thrombectomy over the longer term.”

Do your research

We asked Sanjeev whether he believed the Scottish Government had done their research into how important thrombectomy is, to this he says: “If they had done their research than they would have invested in Thrombectomy and not reduce it’s funding. Thrombectomy saves brains, money and lives. 

“I cannot understand the rationale to cut funding for a service that improves patients’ lives and also saves money at the same time. This just does not make any sense and is a serious blunder on part of the government which will have a huge negative impact on the lives of stroke patients.”

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