A new report released by the UK Stroke Association warns that, if thrombectomy rates remain at 2020/21 levels, a total of 47,112 stroke patients in England would miss out on “game-changing” mechanical thrombectomy treatments over the length of the newly revised National Health Service (NHS) Long Term Plan. As such, the charity has called on the UK government to prioritise a 24/7 thrombectomy service and improve nationwide access to this “miracle treatment” moving forward.
This year, NHS England missed its original target of making thrombectomy available to all patients for whom it could provide benefit, only delivering the procedure to 28% of all suitable patients by December 2021, as per a Stroke Association press release.
In light of this, the Stroke Association’s ‘Saving Brains’ report has called for a 24/7 thrombectomy service. While this service could cost up to £400 million, the charity claims that treating all suitable strokes with thrombectomy would save the NHS £73 million per year. Stroke professionals quoted in the report cite insufficient bi-plane suites, containing radiology equipment, as a barrier to a 24/7 service being established.
Despite the fact mechanical thrombectomy has been shown to reduce disability and length of hospital stay in suitable stroke patients, rates of these endovascular procedures vary across the UK. Almost 8% of stroke patients receive a thrombectomy in London, compared to 0–3% in other parts of the country, the release notes. And, despite the unpredictability of stroke occurrences and criticality of timely treatments, just 25% of thrombectomy-capable centres operate 24/7 services, and close to half (42%) only operate Monday to Friday, during office hours.
New thrombectomy recommendations
As per its recent report, the UK Stroke Association is calling for:
- The UK Treasury to provide urgent funding for thrombectomy in the 2022 autumn budget, including infrastructure, equipment, workforce training and support, targeting both thrombectomy centres and referring stroke units
- The UK Department of Health and Social Care (DHSC) 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 and Emergency Care Plan
- Innovation—such as artificial intelligence (AI) imaging software and video triage in ambulances—to be put into practice
- Local systems to act on their Thrombectomy Quality Reviews and solve pathway issues that are currently holding back thrombectomy rate improvements
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 is 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 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 is 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.
“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. 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 are not in the same position in 2029. Global clinical trials have proven thrombectomy’s efficacy and cost effectiveness multiple times over, yet we have not seen any real change. This is incredibly short-sighted. A small investment could save the NHS billions of pounds—and that is before we even start to think of the life-changing benefit to stroke patients.”
Challenges facing stroke care
The Saving Brains report highlights staffing shortages and estimates that achieving a universal 24/7 service would require doubling the number of interventional neuroradiologists (INRs) in the workforce. It also states that 52% of stroke units in England have a stroke consultant vacancy, which remains unfilled for an average of 18 months. In addition, some 46% of stroke units meet the minimum recommended staffing levels for senior nurses, while there are only 106 professionals who can perform thrombectomy in England (roughly four per centre). The report also indicates that thrombectomy rates are being kept low by prolonged ambulance response times, lengthy handovers and delayed inter-hospital transfers.
“NHS England missed its target, and it will miss this target again and again unless we see proper investment into making this happen,” Bouverie added. “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.”
Martin James (Royal Devon and Exeter Hospital, Exeter, UK), 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 will not 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.”
The Stroke Association is also calling on the public to sign an open letter calling on UK government to act on the recommendations in its Saving Brains report and provide a 24/7 thrombectomy service for those in need of these timely stroke treatments.