NHS urged to take action as thousands of stroke patients miss out on ‘miracle treatment’
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Mechanical thrombectomy uses a stent inserted into a patient’s groin to remove dangerous blood clots from the brain and can cut hospital stays by months – with some patients able to leave hospital the next day.
The Stroke Association said it’s one of the most effective procedures ever discovered for stroke and is suitable for around 10 per cent of all stroke patients, with over 75,000 strokes in England every year, and for best results must be performed within the first six hours.
But now the charity fear over 47,000 stroke patients in the next seven years could miss out on the life-changing operation unless NHS England (NHSE) takes immediate action to make it available all across the country 24/7.
Their new ‘Saving Brains’ report highlights how making thrombectomy an option to all suitable stroke patients could in fact save NHSE a staggering £73 million-a-year – as it will reduce the need for treatments and care in the long term.
The study explains NHSE has missed its target to make mechanical thrombectomy available to all patients it would benefit – only delivering to 28 per cent 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 the specialist suites, citing an “unacceptable postcode lottery” in care.
The paper revealed almost 8 per cent of stroke patients receiving thrombectomy in London, compared with just a shameful 0-3 per cent in other parts of the country.
Just a quarter (25 per cent) of thrombectomy centres operate 24/7 services, while 42 per cent are only open from Monday to Friday during office hours, the report added.
Juliet Bouverie, chief executive of the Stroke Association, explained: “Thrombectomy is a miracle treatment that pulls patients back from near-death and alleviates the worst effects of stroke.
“It’s shocking 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.
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.”
Responding to the damning report, NHSE 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.
“My husband’s recovery was hindered by staff shortage”
A thrombectomy would have been life-changing for father-of-two Paul Smith – but suffering his stroke on a bank holiday left doctors admitting they had no staff free to perform it.
Married Paul, 43, of Liverpool, suffered a sudden and unexpected stroke on Easter Sunday in April 2018 while downstairs at home playing with his youngest son Teddy, now aged seven.
Shocked wife Jane came down to find Paul slumped on the kitchen floor, leaning against the wall and unable to speak and “looked right through” her – so Jane immediately dialled 999.
At hospital Jane consented for Paul to urgently have the thrombectomy to remove the deadly clot from affecting his brain but then doctors revealed as it was a bank holiday there were no staff free to perform the procedure.
Instead Paul had to spend three weeks in hospital having physio, speech and language therapy – which continued for six months – and initially needed liquid food as he had problems swallowing.
He also suffered with severe Aphasia, a difficulty with language and speech caused by damage to the left side of the brain – leaving him only able to say ‘yes’ and ‘no’ and unable to make sense of questions.
Jane said: “I know we can’t live on ‘what ifs’ but we always think what could have happened if Paul had had the procedure.
“We felt so unlucky and it didn’t seem a good enough reason to just say it was a bank holiday! Paul’s biggest thing is his speech, so we always wonder what could have happened if we were more lucky.”
Recalling the moment Paul suffered his stroke Jane explained: “I thought he was playing with Teddy, our youngest.
“I asked him what he was doing but he didn’t answer, instead he looked right through me and was trying to reach out with his left arm. I noticed his right arm was tucked behind his back.
“I asked him again was he ok and what the matter was but he kept staring at me and couldn’t speak.”
After ringing an ambulance and Paul’s parents, they all attended hospital where Jane was asked to sign a consent form to give Paul a thrombectomy to remove the clot.
However, while doctors wanted to transfer Paul to another hospital for the procedure, Jane was told it would take hours to set up and they would miss the time window for the procedure – and also there were no staff anyway to do it.
Jane said: “We were told that the next 48 hours were critical for Paul. I kept asking what do we do next but I really wasn’t hearing what they were saying.
“We were completely in the timeframe for a Thrombectomy but no one was available to do it – I was massively frustrated and shocked.”
Thankfully, after a few days he managed to get up and walk, with assistance and began to show great improvements in his mobility even though he became tired very quickly.
Paul also began to be weaned off blended foods as his swallowing improved but still has to take care when eating or drinking.
Thankfully, Thrombectomy is now available to others in Merseyside seven days a week but the couple are determined to highlight the issue for others across the UK.
She added: “It’s not just the initial impact, it’s the long term devastation that strokes cause. I’m grateful that the procedure is available so others don’t need to go through what we have.
“I don’t ever want to live on what ifs but I know it’s only natural. Paul’s had so many problems but I’m so proud of the progress he has made.”
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