Thousands of stroke patients across the UK are being put at risk because of NHS staffing shortages and delays to crucial treatment, according to a trio of reports out this week.
Currently, just 600 patients each year are undergoing an innovative procedure called mechanical thrombectomy to remove clots in the brain, which studies indicate can be more beneficial than thrombolysis alone in some cases.
More than 9,000 patients could be eligible for this treatment, but currently very few UK hospitals have enough specialists and the necessary support teams to be able to provide mechanical thrombectomy 24 hours a day, according to researchers from Newcastle University, Northumbria University, Oxford Academic Health Science Network (Oxford AHSN) and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care - South West Peninsula (NIHR PenCLAHRC).
"Delivering mechanical thrombectomy to the 9,000 people who need it will require major changes to the configuration and skill sets of existing acute stroke services," said Dr Martin James, consultant stroke physician at the Royal Devon and Exeter Hospital. "We must work quickly to establish what needs to be done so that more people in the UK can benefit from a treatment which can dramatically reduce disability after a stroke as well as cutting associated costs to the NHS and social care."
Also, an audit by The Sentinel Stroke National Audit Programme found that, despite evidence showing that Intermittent Pneumatic Compression (IPC) can cut the risk of deep vein thrombosis (DVT) in hospitalised stroke patients, just 16.6 percent received the treatment this year. Experts had expected the figure to be much higher given that around 50 percent of patients are immobile after their stroke.
Elsewhere, the audit shows that less patients are benefitting from the FAST message, which aims to ensure arrival at hospital within the crucial four-hour window for best treatment outcomes. In 2015/16, 59.9 percent of patients arrived at hospital within four hours of stroke onset, versus 63.1 percent in 2013/14.
Stroke experts have also voiced strong concerns over staffing levels, after data revealed that 40 percent of hospitals now have an unfilled stroke consultant post, up from 26 percent in 2014, and that only 20 percent of acute hospitals are meeting the standard for weekend nurse staffing levels.
On the up side, 47.5 percent of patients received a brain scan within one hour of arrival at hospital, compared to 41.9 percent in 2013/14, while 84.9 percent of eligible patients received thrombolysis versus 74.3 percent. Also, more than 90 percent of patients now receive a scan within 12 hours, compared with two hours 17 mins median time of arrival to assessment by stroke specialist nurse.
"Stroke care has improved beyond recognition in the last 20 years," said Professor Pippa Tyrrell, associate director for stroke for the Royal College of Physician's Clinical Quality Improvement Department. "Patients are almost routinely being admitted to specialist stroke units where, in general, they receive high quality care, they stay in hospital for a very much shorter period of time, and are often discharged to early supported discharge (ESD) services where rehabilitation continues at home. Thirty-day mortality has dropped significantly, and people leave hospital with less disability than they did in the past".
"However, we still have marked variation of services and patient outcomes across the UK," she stressed. "Some patients cannot access acute stroke units rapidly, and are therefore denied treatment such as thrombolysis or thrombectomy. Seven-day working is improving, but access to speech and language therapy at weekends remains extremely low".
In the UK, nearly 90,000 people are admitted to hospital following a stroke each year.