An estimated 8,000 stroke patients a year are set to benefit from an advanced emergency treatment which can significantly decrease the risk of long-term disability and also save millions of pounds in long term health and social care costs.
NHS England has announced that it will commission mechanical thrombectomy so it can become more widely available for patients who have certain types of acute ischaemic stroke – a severe form of the condition where a blood vessel to the brain becomes blocked, often leading to long-term disability. If used within the first six hours of symptoms beginning to show – alongside other specialist medical treatment and care – the procedure has been shown in clinical trials to significantly improve disability free survival and quality of life by restoring blood flow and therefore limiting brain damage*.
Work by NHS England is now underway to assess the readiness of each of the 24 neuroscience centres across the country which are set to introduce the service. It is expected the treatment will start to be phased in later in this year with an estimated 1,000 patients set to benefit across the first year of introduction. NHS England will work with Health Education England and trusts to build on the expertise that is currently available in these specialised centres, developing the workforce and systems to enable an estimated 8,000 to receive this treatment in coming years.
Stroke is a devastating disease for patients and their families, and is estimated to cost the NHS around £3bn per year, with additional cost to the economy of a further £4bn in lost productivity, disability and informal care.
This is all part of NHS England’s plans to introduce world leading and innovative healthcare as set out in Next steps for the NHS Five Year Forward View.
Simon Stevens, Chief Executive of NHS England, said: “This major national upgrade to stroke services puts the NHS at the leading edge of stroke care internationally. It’s another practical example of the NHS quietly expanding innovative modern care that will really benefit patients, but which tends to be invisible in the public debate about the NHS.”
Prof Tony Rudd, National Clinical Director for stroke at NHS England, said: “Stroke can be devastating for patients and their loved ones – both at the time and the long term impact it can have on their everyday lives.
“The quality of care and survival rates for stroke are now at record levels, and NHS England is committed to fast-tracking new and effective treatments – particularly, as in this case, where they deliver long-term benefits for both patients and the taxpayer.
“We will therefore now be working with and investing in specialist stroke services across the country to ensure we can introduce this out to all patients who would benefit, as soon as possible.”
Juliet Bouverie, Chief Executive at the Stroke Association, said: “Thrombectomy is a real game changer which can save lives and reduce the chances of someone being severely disabled after a stroke. Stroke is the fourth biggest killer in the UK, and a leading cause of disability. Current treatment options are limited and do not always work.
“This decision by NHS England could give thousands of critically ill stroke patients an increased chance of making a better recovery. It could mean more stroke survivors living independently in their own homes, returning to work and taking control of their lives again as a result. And this will undoubtedly lower NHS and social care costs for stroke.
“However, thrombectomy is a complicated procedure. Its delivery across England will need significant changes to NHS stroke services, as well as an increase in the number of trained professionals who can carry out the procedure so that as many people as possible can benefit from this powerful new treatment.”
St George’s University Hospital NHS Foundation Trust became the first hospital in the UK to have a fully staffed 24/7 thrombectomy service for acute stroke. The Hyper Acute Stroke Unit (HASU) at St George’s treats over 1200 stroke patients each year. The thrombectomy procedure itself is carried out by interventional neuro-radiologists, with the patient’s before and after care provided by the stroke team.
Dr Jeremy Madigan, Consultant Diagnostic and Interventional Neuroradiologist at St George’s, said: “This is great news for patients. At St George’s, our patients are benefiting from the thrombectomy service we provide – with an 80-90% chance of opening up blocked vessels via this technique, compared to 30% with traditional clot-busting drugs. Patients with acute stroke require a range of different interventions, but providing a thrombectomy service – including at all times of the day, as we do at St George’s – radically improves the range and mix of interventions available to us as clinicians.”
Thrombectomy services will be commissioned by NHS England as a specialised service, following a review of evidence from clinical trials. Routine stroke services are commissioned by Clinical Commissioning Groups. NHS England anticipates that the improved long term quality of life for patients who will be treated with thrombectomy will result in multimillion pound annual savings for the NHS and local authorities thanks to lower rehabilitation and long term care costs.
* Updated following further clinical advice.