Key stroke treatment still not available around the clock across England | Stroke

The NHS has failed to make “life-changing” stroke treatment available 24 hours a day across England, despite repeated promises from ministers to do so.

Health services were to improve stroke care by making a clot-removal technique called mechanical thrombectomy available nationwide, 24/7, from April 1.

Doctors describe it as a revolutionary procedure that, if done quickly, can help someone who has suffered a serious stroke avoid ending up with serious disability.

However, seven of England’s 24 regional stroke centers still do not carry out thrombectomy at all hours, mainly because they do not have enough doctors and other staff to do so.

Experts fear that the failure of the NHS to provide universal access to treatment 24/7 could mean that patients who suffer strokes during the night, evenings or weekends in underserved areas could become seriously disabled, or even die, because they were unable to undergo the procedure.

More than 100,000 people each year in the UK suffer a stroke, with 38,000 dying and many more left with life-changing disabilities that rob them of their independence.

Dr Sanjeev Nayak, 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 area may not have a thrombectomy at all. This creates a veritable postal lottery for access to one of the most effective treatments in modern medicine.”

Seventeen of the 24 thrombectomy centers already offer it 24 hours a day, all year round. But the other seven – in Hull, Middlesbrough, Leeds, Sheffield, Newcastle, Brighton and Coventry – were unable to meet the April 1 deadline to expand their service to 24/7 operation.

Karin Smyth, the NHS minister, confirmed on March 23 that the health service was set to make thrombectomy available across England, 24/7, by the start of this month.

NHS England had made additional funding available to the seven areas to ensure 24/7 access to services. Funding was confirmed in February.

Alexis Kolodziej, deputy chief executive of the Stroke Association, said: “It is deeply troubling that access to thrombectomy remains dependent on the time of day and the area you live in, with 24-hour access to thrombectomy simply not possible for some patients in some 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 some parts of the country is painfully slow. »

The NHS spends more than £100 million a year on treatment. This is seen as a key way of helping the Government meet its target of reducing the 113,000 preventable deaths that occur in England each year from serious life-threatening illnesses, particularly cancer and heart disease.

Thrombectomy is a minimally invasive, nonsurgical treatment for serious strokes caused by a blocked cerebral artery. Doctors insert a catheter into the patient through an artery in the groin or wrist, move it to the brain and remove the clot, allowing blood to start flowing again.

Nayak said that while the NHS has made substantial progress in making the treatment available in recent years, “the problem is that without consistent 24/7 access in all regions, some patients… will face critical delays or miss the opportunity to have a thrombectomy altogether.”

Coventry University Hospital, one of seven centers which missed the deadline, refers stroke patients requiring thrombectomy out of hours to its own department at Birmingham University Hospital. Royal Sussex County Hospital in Brighton has a similar arrangement in place with University College Hospital in London.

This leaves Yorkshire and the North East as areas without any form of 24/7 service. The shortage of stroke doctors, specialist nurses and interventional neuroradiologists, who perform thrombectomies, is the main reason why not all hospitals yet offer round-the-clock access.

NHS England confirmed it had not achieved its ambition to introduce universal 24/7 access to thrombectomy by April 1, but said it remained a priority.

A spokesperson said: “The majority of thrombectomy centers 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 £14 million of additional targeted funding to support the expansion of services, including training additional staff to carry out mechanical thrombectomy.”