Introduction
Petition number: P-05-910
Petition title: Make thrombectomy available 24-7 for Welsh patients
Text of petition: We call upon the National Assembly for Wales to urge the Welsh government to end the inequality in access to life-saving stroke thrombectomy treatment.
Thrombectomy is a treatment used for ischaemic stroke where the blood clot is removed with a special device inserted through a catheter. There is a wealth of evidence supporting its benefits in reducing long term disability (morbidity), and saving lives (reducing mortality) In April 2017, NHS England agreed to fund thrombectomy on the NHS, it will take many years before all eligible patients can receive it. It is not currently available routinely in Wales. Agreements with NHS England for Welsh patients to access their services are variable and tenuous.
Patients such as Colin Rogers are literally dying. He was 55 when he died. He was denied treatment because it was a Sunday and there was no agreement to allow him to be sent to England. Whilst there was no guarantee he would have been saved, it is estimated that over 500 people in Wales could be helped by this treatment. We do not want people who could be saved to die like Colin, or be left profoundly disabled.
We call upon the Welsh government to end the postcode lottery and act to save the lives of the Welsh people.
Mechanical thrombectomy is one of the possible treatments for a stroke. It aims to restore normal blood flow to the brain by using a device to remove the blood clot blocking the artery. The procedure is performed by ‘interventional neuro-radiologists’. If performed within six hours of the onset of stroke symptoms, thrombectomy is an effective treatment that can reduce brain damage and prevent or limit long term disability.
It has been estimated that mechanical thrombectomy would be appropriate for around 10% of ischaemic stroke cases, which would equate to around 500 interventions each year for Welsh patients.
In August 2017, the Health Minister highlighted a lack of appropriately trained neuroradiologists able to perform thrombectomy across the UK – ‘Wales, like many other regions across the UK, does not yet provide 24/7 access to this service’.
From April 2019, the Welsh Health Specialised Services Committee (WHSSC) will formally commission mechanical thrombectomy services on behalf of the seven Health Boards in Wales.
A February 2019 update to the WHSSC joint committee states that work has been carried out to secure access to services in NHS England for Welsh patients, and provision has been made in the 2019-22 Integrated Commissioning Plan (ICP) to develop the service in Cardiff for the population of mid and south Wales. It sets out the current provision of thrombectomy for Welsh patients:
Interventional neuro-radiology in Wales is currently only provided in Cardiff. This is a fragile service, with only one consultant interventional neuro-radiologist. Some thrombectomies have been undertaken in Cardiff on an ad hoc basis, but the service is unable to provide the treatment effectively with the current infrastructure. The update states that the service has recently advertised for additional interventional neuro-radiologists. It notes that there are staff shortages in this specialty throughout the UK.
Small numbers of patients have been accessing the thrombectomy service in North Bristol, where capacity has allowed. For patients in north Wales, access to thrombectomy is at the Walton Centre, Liverpool. The numbers accessing the service are lower than projected for the population. Patients from Powys have had a greater access to thrombectomy, based on their population size, provided by North Midlands. This could be attributed to Powys patients accessing all their emergency treatment in NHS England.
On 11 June 2019, the First Minister told AMs:
the Welsh Health Specialised Services Committee are well advanced in planning a Wales-wide service for thrombectomy here in Wales. It will require recruitment. It will require training. In the meantime, we are commissioning services from across our border where scarce spare capacity exists. But the answer, not in the long term but as soon as we can do it, is to create that all-Wales service with the people that we will need and with the coverage that will be required.
The Welsh Government’s response highlights that thrombectomy is a highly specialised and relatively new procedure for treating acute ischaemic strokes. It describes a UK-wide shortage of clinicians who are able to deliver this procedure, and states that the Welsh Government is working with WHSSC to develop a Wales-wide thrombectomy service. WHSSC has drafted a service specification for thrombectomy which is due out for consultation imminently. The specification outlines the pathway for accessing thrombectomy and the expectations of local services for prompt repatriation following treatment.
In the meantime, the WHSSC team continues to work with Health Boards in Wales to put in place interim arrangements for the commissioning of thrombectomy procedures from NHS England providers, where capacity allows. However, English providers face the same challenges to recruit or train clinicians in this specialism. As a result only small numbers of patients have accessed thrombectomy services in north Bristol, north Midlands and Liverpool to date.
Cardiff and Vale University Health Board has recently recruited an additional clinician and is out to advert for a further consultant which is key to being able to offer a thrombectomy service for south Wales. Once the additional consultant is recruited we anticipate thrombectomy services to be available at the University Hospital Wales, Cardiff.