Stroke patients ‘left without vital treatment’ in hospital
●Specialist surgery withdrawn from Scotland due to lack of staff and funding
The complete withdrawal of a specialist surgery for stroke patients in Scotland due to a lack of funding will mean 300 people being left more disabled each year, according to a leading charity.
Chest Heart & Stroke Scotland made the claim after the annual Scottish Stroke Care Audit showed only 13 patients underwent a vital “blood clot-busting” procedure known as a thrombectomy.
The audit came as a whistleblower laid bare the extent to which acute stroke patients in the Lothians missed out on the vital treatment last year. The doctor, who wished to remain anonymous, told The Scotsman a report published in the influential International Journal of Stroke looked at the lack of an out-of-hours service in NHS Lothian hospitals between May 2016 and April last year. In a precursor to the withdrawal of the thrombectomy service, the study reveals at least ten patients – and potentially as many as 36 – missed out on the procedure due to having their strokes at “unsocial hours”.
This meant they were left more disabled than they would have been
if they received the surgery, based on a sliding scale known as the modified Rankin Scale, which measures the degree of disability or dependence in the daily activities of people who have suffered a stroke.
None of the patients or their families are thought to have been made aware of the consequences of missing out on the treatment.
The whistleblower said: “I find it woeful, unconscionable even, that an acute thrombectomy service is not provided in Edinburgh and the Lothians and the population of the region deserves better.
“The thrombectomy procedure is time critical, so if patients don’t get it after they suffer their stroke and come to medical attention, then they miss out for good and this impacts on the residual level of long-term disability they are left with. This will change patients’ quality of life poststroke and leave them more dependent, with the to-beexpected impacts on families, carers and health services.”
A lack of funding has led to a shortage of trained staff and suitable facilities. Scottish Labour’s health spokesman Anas Sarwar last night accused the health board of “staying silent in a bid to avoid the truth” and described the situation as “appalling”.
NHS England has pledged £100 million to develop the thrombectomy service, which involves removing blood clots from the brain with a thin tube. Paul Okroj, director of communications at Chest Heart & Stroke Scotland, said: “The risk of stroke survi- vors being left more disabled is now much higher than this 2017 study shows.
“Where previously NHS Lothian had provided an adhoc thrombectomy service, the new Scottish Stroke Improvement Programme report has confirmed that now no hospital in Scotland is able to offer thrombectomy, meaning as many as 300 people per year are more disabled and over 100 people are more dependent on others than if they had received the procedure.
“This lack of availability places Scotland far behind both England, where 25 hospitals deliver the treatment and £100m has been identified to develop this further, and the Republic of Ireland, where between 200 and 300 people receive a thrombectomy each year, in adopting the procedure.”
Strokes are the third biggest killer in Scotland with around 4,500 deaths each year, which is “exceptionally high” compared to elsewhere in western Europe. Tracey Gillies, medical director at NHS Lothian, said in recent years the health board had provided stroke thrombectomy on an occasional basis.
She said: “The provision of interventional neuroradiology (INR) in Scotland is under unprecedented pressure with our three consultant interventional neuroradiologists in Edinburgh supporting all emergency interventional neuroradiology work for Scotland in recent months.
“Without expanding this highly specialised workforce ... a decision has been made to stop any ad-hoc stroke thrombectomy in Edinburgh until further notice, with the exception of mechanical clot retrieval for basilar artery thrombosis. This decision took effect from 15 June. Work is under way in NHS Lothian and through a national group to review how a stroke thrombectomy service for Scotland could be provided.”
A Scottish Government spokesperson said work was under way to develop a national planning framework to provide thrombectomy.