The treatment is still only available during daytime hours on weekdays
It will be two years before a specialist procedure that can vastly improve the outcome for people who have suffered a stroke will be available 24 hours a day in Lancashire and South Cumbria, LancsLive can reveal. And it comes after a call from the Stroke Association last week for a rapid rollout of a round-the-clock thrombectomy service in the region.
The treatment – which is delivered at the Royal Preston Hospital to patients who need it from across the wider patch – is currently available only during daytime hours on weekdays. Plans were already in place to expand access to the procedure as part of a major overhaul of Lancashire and South Cumbria’s stroke services – but the NHS has now provided a more detailed timetable for when it will be more widely on offer.
The aim is for the region to be carrying out thrombectomies seven days a week from autumn next year, with phased moves towards a 24-hour service over the course of the 12 months thereafter. Thrombectomy is suitable only for those strokes caused by a blood clot in a large artery in the brain and is most effective the sooner it is carried out after a stroke.
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However, a stroke survivor from Garstang – who missed out on having the procedure because his stroke happened on a Sunday – says that the two-year wait for the service to be available at all hours of the day and night will put patient recoveries at risk.
“Every extra day without this fully-functioning service means local people are highly likely to be living with unnecessary lifelong disability,” warns Phil Woodford, who was struck by a stroke back in 2016. The father of two young daughters, who was 45 at the time he was taken ill, ended up spending four months in hospital learning how to walk again – and then a further two months in a wheelchair – after the left side of his body was paralysed.
Although he has now regained what he estimates to be around 80-90 percent of his pre-stroke capability, Phil has been left with a limp and struggles with some everyday tasks like dealing with cash. What frustrates him most, however, is what he had to go through to get back on his feet – when a thrombectomy might have spared him and his family such trauma.
He was already in the Royal Preston at the time of his stroke, collapsing in the shower having previously been admitted with a transient ischaemic attack (TIA) – a so-called mini-stroke – and receiving clot-busting thrombolysis treatment. But although medics told him he was a prime candidate for a thrombectomy after he went on to suffer a more severe stroke, there was nobody available to perform it.
“I was really selfish and had my stroke on a Sunday,” Phil says. “But I have no bad feelings towards the doctors and nurses. They tried to get staff in, but these people had already been working a full week and they weren’t available – and I get that. I’m not bitter about that, but I’m really angry about the commissioning of [the service]. [Thrombectomy] doesn’t work for everybody, but for a lot of people, [they’re] walking home the next day or are sat up in bed laughing – which isn’t the picture people have in their mind [about] stroke.”
However, that speedy recovery was far from the reality for Phil, who recalls the ordeal of battling to overcome the effects of his stroke.
“I didn’t realise I had muscles in my stomach, I thought it was just fat – it’s not something you see, unless you’ve got a six pack. While I lost the use of my left arm and leg, I didn’t realise I’d lose the muscles in my stomach on that side as well. So it wasn’t just trying to walk [again], it was trying to sit up, trying to eat with the left side of my mouth and [there was also] urinary incontinence – it was really difficult. My family got me through it and the [hospital] staff.”
The NHS in Lancashire and South Cumbria is aiming to increase its thrombectomy rate to 10 percent – in line with both a national target and the estimated proportion of stroke patients who could benefit from the procedure. As of February this year, just two percent of those who suffer a stroke in the region received the treatment. If the planned increase is achieved, it will mean almost 200 additional thrombectomies are carried out each year.
There is also an ambition to almost double the thrombolysis rate from eight to 15 percent – equivalent to an extra 140 of the treatments annually. Figures presented by NHS bosses to a meeting of Lancashire County Council’s health scrutiny committee earlier this year estimate that at least £11,000 in combined health and social care costs could be saved for every additional patient who is given a thrombectomy.
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Responding to the issues raised in this report, a spokesperson for the Lancashire and South Cumbria integrated care board (ICB) said: “The thrombectomy service is a key area of development for the stroke service across Lancashire and South Cumbria. A workforce plan is in place for the thrombectomy service, based within the comprehensive stroke unit at Royal Preston Hospital and we are actively recruiting neuro-interventional radiographers, which are vital posts required for the expansion of the service.
“We expect the thrombectomy service to be operating a weekend service from Autumn 2023 and to move in phases to a 24/7 service over the following year as we recruit to other additional posts. The service needs the staff in place to be able to reach its maximum capacity. In addition, the service is investing in two new bi-planar angiographic systems to support the expansion of the service over the coming months.”
A recent Stroke Association report warned that more than 47,000 people who have a stroke in England could miss out on a thrombectomy over the next seven years. Speaking before the specific timeframe emerged for the phased full rollout of the procedure in Lancashire and South Cumbria, Jennifer Gardner, North West associative director at the Stroke Association, welcomed the “real commitment” to what the organisation calls a “game-changing” treatment being made available around the clock.
She added: “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. 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. Since the time we commissioned the report there have been some steady signs of improvement in accessing thrombectomy in the North West. It’s also promising to see the improvements being made to existing stroke units and the funding that is being allocated too.
“However, there is still 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.”
Meanwhile, Phil is also keen to see the thrombectomy procedure made available in Lancashire and South Cumbria, whenever it is needed, in a lot sooner than two years – and not just because his own stroke has made him a more impatient man.
“You lose two million brain cells for every minute that [an artery] is blocked and blood isn’t getting to the brain. We do have billions of brain cells, but we can’t really afford to lose millions of them. My plea is that [the 24-hour thrombectomy] needs to happen quicker – we deserve first class treatment now, not tomorrow.”
How stroke care is changing
A near £20m overhaul of stroke services in Lancashire and South Cumbria could see more than 360 additional patients discharged from hospital with reduced disability each year and slash the length of time that stroke sufferers spend on the wards, it is hoped. The NHS in the region is around halfway through a three-year investment programme, which it is also estimated could save the lives of 22 extra stroke sufferers annually. A total of 442 people died as a result of a stroke across the patch during 2020/21, while 2,575 individuals were admitted to hospital after suffering a stroke.
Under the transformation plans, details of which were presented to a meeting of Lancashire County Council’s health scrutiny committee in February, so-called “hyper-acute” stroke care which meets national best practice standards, will be available around the clock. The Royal Preston will act as a comprehensive stroke unit – the only facility in the region to offer the full range of stroke services, including neurosurgery and thrombectomy.
Hyper acute units will operate at Blackpool Victoria and the Royal Blackburn hospital. Although no stroke unit in the region is closing, stroke patients who would typically attend the Royal Lancaster or Westmorland General will be diverted directly by ambulance to the Royal Preston for the first 72 hours of their care, before being returned to their local hospital. Stroke arrivals at Furness General will also be transferred to the Royal Preston for their initial care, but only after they have been triaged and received any necessary treatment at the Barrow site.
Several North Lancashire-based members of the health scrutiny committee sought reassurance at February’s meeting that the divert-to-Preston model was feasible in the face of traffic hold-ups or in the event of major road closures. They were advised that journey modelling work was being done at the time with the North West Ambulance Service. The committee resolved that the changes did not amount to a substantial variation in services, which could have led to a delay in implementing them
A seven-day rehabilitation service will also ultimately be available across all sites, while ambulatory care – an approach which aims to send sufferers of the most minor strokes home the same day with the necessary support – will also operate every day of the week in Central Lancashire, Blackpool, Blackburn and Barrow.
The new arrangements will be the culmination of several years of patient engagement and consultation, including with stroke survivors and their carers something which Phil Woodford welcomed as “refreshing”.. As with the 24-hour rollout of thrombectomy treatment in Preston, the other county-wide improvements will rely on the recruitment of additional staff.
The average length of hospital stay for stroke patients in Lancashire and South Cumbria is currently 25 days – far higher than the 17 days seen in Greater Manchester.
Pressure on Preston?
The boss of the trust that runs the Royal Preston says that changes to stroke care in North Merseyside and West Lancashire must be monitored to ensure that they do not have an undue impact on his hospital. Kevin McGee was speaking at a meeting of the Lancashire and South Cumbria integrated care board (ICB) last week, which heard that a new comprehensive stroke centre is due to be established at Aintree Hospital.
The facility would treat patients for the first 72 hours after their stroke before they return to a hospital facility closer to their home for care.
However, papers presented to the meeting reveal that stroke sufferers in parts of West Lancashire – particularly around Tarleton and Hesketh Bank – who would previously have attended Southport and Ormskirk hospitals, would now likely be taken to the Royal Preston. That could lead to up to 54 extra patients being treated in Preston each year.
“It’s already a service under significant pressure – and even if we took [the] scenario where they’re talking about only one [additional] patient a [day], because we’re talking about patients who have quite a long length of stay, if you multiply that over a year, that’s an awful lot of bed days that will be occupied. So I think while I support [the change], we have to monitor the impact…very carefully – and there may be a requirement and a need to invest in the services at Lancashire Teaching [Hospitals],” Mr. McGee said.
- 05:05, 5 AUG 2022
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