Lifesaving stroke treatment plan in jeopardy due to difficulty recruiting staff

A plan for Lancashire residents to have a potentially lifesaving stroke treatment available to them around the clock by the autumn could be in jeopardy – because of difficulties recruiting the staff needed to carry out the procedure.

Known as a thrombectomy, the surgical intervention can not only prevent death from some types of stroke, but also preserve more of a person’s mobility if they receive it within a short time of being taken ill. It is currently conducted at the Royal Preston Hospital seven days a week – for patients from right across Lancashire and South Cumbria – but only between 8am and 6pm.

Hospital bosses have also acknowledged that the operation of the service at the weekend is dependent on workforce availability. Now there is a question mark over an aim to offer the procedure 24 hours a day from later this year after it emerged that the necessary specialist staff were yet to be found.

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Dr David Levy, medical director of the Lancashire and South Cumbria Integrated Care Board (ICB), told a meeting of the organisation last week that the 24/7 operation had been “commissioned”, but said the “key issue” was that Lancashire Teaching Hospitals NHS Foundation Trust (LTH) – which runs the Royal Preston – was currently “unable to recruit the workforce required to deliver it”. The trust says it remains “committed” to providing the service.

It comes just days after a coroner ruled that the lack of access to a thrombectomy “contributed” to the death of a care home resident from Chorley. Edna Moss died in February 2023 after a stroke which was treated with thrombolysis, which dissolves blood clots.

However, the inquest into her death heard that Ms. Moss’s stroke was severe and that thrombectomy treatment, which physically removes stroke-causing clots, was “appropriate” – but was not then available at the weekend.

That situation changed in September last year when a thrombectomy service was introduced on Saturdays and Sundays – having previously been available on weekdays alone – but still only during daytime hours.

As the Local Democracy Reporting Service (LDRS) revealed a year earlier, that was part of the planned phased move towards 24-hour availability by autumn 2024 – for which a “workforce plan” had been devised.

However, at the time of the seven-day expansion last year, neither the ICB nor LTH restated the commitment to a round-the-clock operation within 12 months. Instead, the LDRS was told only that the next provisional move would be to increase capacity to carry out the procedure of an evening sometime during 2024.

Yet following an inquest last year into the death of another stroke patient, Sarah Read, at the Royal Preston in 2022 – which was not directly linked by the coroner in her case to the absence of a 24-hour thrombectomy service – the national medical director of NHS England, Professor Sir Stephen Powis, stated that it was nevertheless the “ambition” of the trust for the procedure to be available “24/7 from September 2024”.

Responding to the news about staff recruitment difficulties revealed at the ICB meeting, Dr Gerry Skailes, chief medical officer for Lancashire Teaching Hospitals, said: “Since having the funding confirmed for a seven-day thrombectomy service last year, we have been out to recruit additional radiologists into the service. Recruitment is also underway for radiographers – and successful recruits will then undergo an in-house training programme.

“These roles are hard to fill due to a national shortage of these very specialised colleagues, but we are committed to providing an extended service as soon as we have sufficient staffing numbers and the theatre space to offer this consistently. A second angiogram theatre is currently under construction at Royal Preston Hospital,” Dr. Skailes added.

‘RETRAIN IF YOU CAN’T RECRUIT’

News of the lack of staff for a 24-hour thrombectomy service for Lancashire and South Cumbria has angered stroke survivor – and former NHS director – Phil Woodford.

He spent four months in hospital and a further two months in a wheelchair after he lost the use of his left side following a major stroke in 2016.

Phil was actually in the Royal Preston when it happened – having previously been admitted following a mini-stroke. However, in spite of being eligible for a thrombectomy, he was unable to undergo the treatment because his collapse came outside of the then operating hours of the service.

He subsequently had to learn to walk and talk properly again and was faced with months of intensive physiotherapy, which he then had to continue independently.

In spite of eventually returning to work, the weakness with which the 53-year-old was left down one side of his body was a contributory factor in him deciding to take early retirement.

“Trying to do things differently is just so tiring – you’ve really got to think about it,” Phil told the LDRS.

The chance of a better outcome had he been given a thrombectomy has resulted in Phil becoming a passionate advocate for 24-hour availability of the procedure. He says more could and should have been done to get the necessary neuro-interventional radiology staff in place for Lancashire and South Cumbria by now.

“The ICB approved the plans for this service several years ago and they have dragged their feet. [There are] interventional radiologists [working in the county], but they are not trained in neuro.

“I contacted an interventional radiologist elsewhere, who is one of the leads in the country, and he said, ‘I can do the training for you. [If] you find clinicians who want to be retrained, they can come down and take part in thrombectomies here.’

“So in the three or four years [the ICB] have spent trying to recruit, they could have retrained people,” Phil said.

He added that the cost of retraining – or even incentivising already qualified staff in other parts of the country to move to Lancashire – would “pay for itself”.

“At the crudest level, it reduces costs to the NHS, but the real benefit is in families not being devastated,” said Phil, who previously chaired an area stroke, carer and neuro patient group.

“I unreservedly apologise for not being strong enough to ensure I held the NHS to account for not getting this service up and running.

“They should be ashamed of themselves – I am.”

THROMBECTOMY BENEFITS

  • 1 in 10 of all stroke patients – around 9,000 people across the UK each year – would benefit from a thrombectomy.

  • 4 in 10 thrombectomy patients experience reduced disability as a result of the procedure.

  • For every 10 minutes of delay, there is a one percent reduction in the chance a stroke patient will benefit from having a thrombectomy.

Source: Stroke Association

HOW DOES IT WORK?

Thrombectomy can be used to treat some types of ischemic stroke involving blood clots blocking blood flow to part of the brain

The procedure requires a specially-designed clot removal device to be inserted through a catheter to pull or suck out the clot, in order to restore blood flow. The device can remove clots that are too big to be broken down by clot-busting drugs or thrombolysis.

The surgery is most effective if carried out within the first six hours of a stroke occurring – and usually takes between one and three hours to complete.

STROKE STATS

  • 75,000 – approximate number of strokes in England every year

  • 1 in 8 strokes are fatal

  • 2 in 3 strokes leave sufferers with a disability

Source: Stroke Association