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

The National Health Service has yet to provide round-the-clock access to a potentially “life-changing” stroke treatment across England, despite repeated assurances from ministers that it would be available. The treatment, a clot removal technique called mechanical thrombectomy, was expected to be universally accessible 24/7 beginning April 1.

Stroke Treatment Access Remains Uneven

Doctors describe mechanical thrombectomy as a game-changing intervention that, when administered quickly, can significantly reduce disability in severe stroke cases. However, seven of England’s 24 regional stroke centers are currently unable to offer the treatment on a 24-hour basis, primarily due to staffing shortages.

Experts express concern that the lack of universal access could lead to increased severe disability or even death for stroke patients presenting overnight, during evenings, or on weekends in underserved areas. More than 100,000 people in the UK experience a stroke annually, resulting in 38,000 deaths and numerous life-altering disabilities.

Dr. Sanjeev Nayak, a stroke specialist at the Royal Stoke hospital, highlighted the disparity: “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 region may not receive thrombectomy at all. This creates a real postcode lottery in access to one of the most effective treatments in modern medicine.”

Currently, seventeen of the 24 centers provide thrombectomy services around the clock. The remaining seven – located in Hull, Middlesbrough, Leeds, Sheffield, Newcastle, Brighton, and Coventry – failed to meet the April 1 deadline for expanding their services.

NHS minister Karin Smyth confirmed on March 23 that the health service intended to make thrombectomy available nationwide 24/7 by the start of this month.

NHS England allocated additional funding to the seven areas in February to facilitate 24/7 access. Alexis Kolodziej, deputy chief executive of the Stroke Association, stated, “It’s deeply troubling that access to thrombectomy remains dependent on the time of day and the area in which you live… The government’s failure to deliver on its promise leaves patients at a significant disadvantage.” She acknowledged the investment but criticized the slow implementation in certain regions.

The NHS currently spends over £100 million annually on thrombectomy, viewing it as a crucial component in reducing the 113,000 avoidable deaths that occur each year in England from major conditions like cancer and heart disease.

Thrombectomy is a minimally invasive procedure where a catheter is inserted through an artery in the groin or wrist to reach the brain and remove the clot, restoring blood flow. Dr. Nayak emphasized that while the NHS has made considerable progress in recent years, “the concern is that without consistent 24/7 access across all regions, some patients … will face critical delays or miss the opportunity for thrombectomy altogether.”

Hospitals in Coventry and Brighton have arrangements to transfer patients requiring thrombectomy outside of their operating hours to facilities in Birmingham and London, respectively. This leaves Yorkshire and the north-east as the only areas without any 24/7 service.

Shortages of stroke doctors, specialist nurses, and interventional neuroradiologists are the primary obstacles to providing all-hours access. NHS England acknowledged that it did not meet its April 1 target but affirmed that achieving universal 24/7 access remains a priority. A spokesperson stated that the majority of centers currently offer 24/7 services and that £14 million in additional funding is being provided to support service expansion and staff training.