Tens of thousands of people risk missing out on “miracle” acute stroke treatment if thrombectomy levels are not significantly raised, a new report has warned.
During 2021, NHS England has been found to have missed its original target to make mechanical thrombectomy available to all patients for whom it would benefit – only delivering to 28 per cent of all suitable patients.
And if that rate remains the same, 47,112 stroke patients in England would miss out on the potentially life-changing intervention.
The Stroke Association’s ‘Saving Brains’ report calls for a 24/7 thrombectomy service, which could cost up to £400million – but counters that figure with calculations that treating all suitable strokes with thrombectomy would save the NHS £73million per year.
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 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. Thrombectomy saves brains, saves money and changes lives; now is the time for real action, so that nobody has to live with avoidable disability ever again.”
Mechanical thrombectomy is a procedure involving a stent used to manually remove large stroke-causing blood clots from the brain via a catheter inserted into the patient’s groin.
The procedure vastly reduces disability and has been known to reduce hospital stay by a large number of months, with some patients being able to leave the next day, rather than spending months in in-patient rehab.
The procedure has been described as one of the most effective procedures ever discovered.
Thrombectomy rates vary across the country. Almost eight per cent of stroke patients receive thrombectomy in London, compared to zero to three per cent in other parts of the country.
Despite stroke striking at any time and urgent treatment being critical, only a quarter (25 per cent) of thrombectomy centres operate 24/7 services. Almost half (42 per cent) only operate Monday to Friday, during office hours.
The Stroke Association is calling for:
- The Treasury to provide urgent funding for thrombectomy in the Autumn Budget 2022, for infrastructure, equipment, workforce training and support, targeting both thrombectomy centres and referring stroke units.
- Department of Health and Social Care to develop a sustainable workforce plan to fill the gaps in qualified staff.
- NHS England to address challenges in transfer to and between hospitals in its upcoming Urgent & Emergency Care Plan.
- Putting innovation – such as artificial intelligence (AI) imaging software and video triage in ambulances – into practice.
The report – which also includes an open letter to the Government, which people are urged to sign – highlights staffing shortages and estimates that to achieve universal 24/7 service would require doubling the number of Interventional Neuroradiologists (INRs) in the workforce.
- 52 per cent of stroke units in England have a stroke consultant vacancy, which remain unfilled for an average of 18 months
- Only 46 per cent of stroke units meet the minimum recommended staffing levels for senior nurses
- There are only 106 professionals who can perform thrombectomy in England (~4 per centre)
“There is an unacceptable postcode lottery of stroke treatment, at a time when tackling health inequalities is a key priority for the government and NHS,” said Juliet.
“Rates are rising gradually due to sustained efforts from national and local stroke teams, but progress is far slower than it needs to be. 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.
“Global clinical trials have proven thrombectomy’s efficacy and cost effectiveness multiple times over, yet we haven’t seen any real change. This is incredibly short sighted. A small investment, could save the NHS billions of pounds and that’s before we even start to think of the life-changing benefit to stroke patients.
“NHS England missed its target and it will miss this target again and again unless we see proper investment into making this happen.
“We have known for years that a thrombectomy service requires capital funding. This never came. We have seen lengthy vacancies lists for stroke clinicians. No plan was made to fill the gaps.
“Making capital funding available and having a proper workforce plan are the best places government and the NHS can start to make sure that everyone can have a thrombectomy when they need one.”
The Stroke Association report also finds that thrombectomy rates are being kept low by lengthy ambulance response times, lengthy handovers and delayed inter-hospital transfers. The report outlines that:
- For every ten minutes of delay, the procedure has a one per cent reduction in chance of patient benefit
- For every minute a stroke goes untreated, 1.9 million brain cells die
- 13.2 per cent of strokes are fatal
- Two-thirds of stroke survivors leave hospital with a disability
Professor Martin James, consultant stroke physician at the Royal Devon & Exeter Hospital 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.
“We need to ensure that thrombectomy is available to people with stroke wherever and whenever they need it, and that will require a big investment in people and equipment for the NHS.
“That sort of investment is long overdue and is urgently needed, and will change many lives for the better and save money.”
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