NHS England to expand provision of "gamechanging" stroke treatment

Thousands of stroke patients will be saved from lifelong disability after NHS England decided to invest millions of pounds in a new treatment hailed as a “gamechanger”.

About 8,000 people a year who have a stroke will benefit from a massive expansion in the number of hospitals offering mechanical thrombectomy.

Currently only a few hundred patients a year receive the treatment and just a handful of hospitals in England offer it, despite its proved effectiveness. Stroke experts say the procedure can produce remarkable results, with patients who would otherwise have ended up in a wheelchair instead able to walk out of hospital within 48 hours of having it.

“Thrombectomy is a real gamechanger which can save lives and reduce the chances of someone being severely disabled after a stroke,” said Juliet Bouverie, the chief executive of the Stroke Association.

“This decision by NHS England could give thousands of critically ill stroke patients an increased chance of making a better recovery. It could also mean more stroke survivors living independently in their own homes, returning to work and taking control of their lives again as a result,” she added.

A thrombectomy is used to remove a blood clot in someone’s brain which has not dissolved despite the patient receiving clot-busting thrombolytic drugs. It involves a doctor putting a thin tube into a patient’s artery, usually through their groin, and then feeding it up through their body to where the clot is in their brain. Once there, a wire mesh tube called a stent – usually used in heart or vascular surgery – on the top of the tube is wrapped around the clot and it is then pulled out by a doctor called an interventional neuroradiologist.

Doing that restores normal blood flow to the brain and greatly reduces damage to brain tissue, which is what causes patients to suffer long-term, often serious damage to their physical and mental functions. Patients are either sedated or under general anaesthetic during the procedure, which must be carried out within six hours of the stroke occurring.

“This major national upgrade to stroke services puts the NHS at the leading edge of stroke care internationally,” said Simon Stevens, NHS England’s chief executive. “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.”

Stevens is keen that the NHS follows the lead of Germany and France, which undertake 7,500 and 3,500 thrombectomies a year respectively. While the procedure can help 10% of the 90,000 people a year in the UK who are admitted to hospital following a stroke, fewer than 600 patients a year in England have one.

Although the procedure costs about £12,000 to perform, the big savings in medical and social care for patients who would otherwise have been left seriously disabled have convinced NHS England that it represents value for money.

St George’s in London is the only hospital in the UK to offer thrombectomy around the clock every day of the week. NHS England hope the massive expansion will lead to 24 NHS trusts which are centres of excellence in neuroscience operating on the same 24/7 basis as the NHS becomes more of a seven-day service.

Dr Jeremy Madigan, a consultant diagnostic and interventional neuroradiologist at St George’s, said: “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.

“Providing a thrombectomy service at all times of day, as we do at St George’s, radically improves the range and mix of interventions available to us as clinicians.”

However, Bouverie said that creating 24 centres to perform the procedure would compel the NHS to centralise acute stroke services in fewer places, which would likely prove controversial.

It would also require a big increase in the number of interventional neuroradiologists the NHS employs – currently about 90 – especially if the service is to operate around the clock.

NHS England to expand provision of "gamechanging" stroke treatment

Councils may cut social care provision due to underfunding, LGA says

Older and vulnerable people could stop receiving vital help to get out of bed, washed and dressed, because the underfunding of social care has become so severe, councils have warned.

Leaders of 370 local authorities in England and Wales fear that some councils are finding it so hard to provide the right level of support they could face a high court legal challenge for breaking the law.

The Local Government Association said care visits could become shorter, carers could face greater strain and more people could be trapped in hospitals, making NHS services even busier as a result. The LGA estimates that there will be a £2.6bn gap by 2020 between the amount of money social care services need and their budgets.

Cllr Izzi Seccombe, the chair of the LGA community wellbeing board, said: “The intentions and the spirit of the [2014] Care Act that aims to help people to live well and independently are in grave danger of falling apart and failing, unless new finding is announced by government for adult social care.”

The act, which came into effect in 2015, was intended to ensure that councils provided help with basic everyday tasks to anyone who was struggling to undertake at least one of them on their own, because of a physical or mental impairment. But the purpose of the legislation is at risk because councils cannot afford to meet demand, the LGA told the Treasury in its submission ahead of the budget in March.

Only 8% of council directors of adult social care said they were confident that they could fulfil their full duties under the act in 2017-18.

Barbara Keeley, the shadow social care minister, said: “It is deeply worrying that councils are now having to spell out the risks that this lack of funding is causing. We should not tolerate the fact that growing levels of basic needs are going unmet, care visits are shorter and there is increased strain on unpaid family carers.”

A government spokesman said: “Local authorities have a duty to implement new rights introduced in the [2014] Care Act and while many are already providing high-quality social care services, we will continue to challenge and support those not currently doing so.

“We have provided councils up to £7.6bn of dedicated funding for social care over the course of this parliament, significant investment to ensure that vulnerable people get affordable and dignified care as our population ages.”

Councils may cut social care provision due to underfunding, LGA says

PM to unveil measures to boost mental healthcare provision

Theresa May is set to announce major government action to improve support for people struggling with mental illness, including moves to help troubled young people and reduce the number of suicides.

In a rare speech on domestic policy on Monday, the prime minister will pledge that the whole of government will do more to improve the care received by the one in four people every year who develop anxiety, depression or other related conditions.

She will also detail how employers can play a much bigger role in helping staff who are forced to take time off work as a result of mental health problems. She is also finalising plans to outline steps schools can take to better identify and help the growing number of pupils who are becoming mentally vulnerable, sometimes as a result of sexting, bullying and pressure to do well in exams.

May’s move will be the climax of a concerted attempt by the prime minister, starting this weekend, to show that she is determined to make progress on the social justice agenda that she described on her first day in Downing Street as the “burning injustices” in society. “If you suffer from mental health problems, there’s not enough help to hand,” she said.

The prime minister has been interested in mental illness and its consequences since learning during her six years as home secretary how much police time is taken up dealing with the issue and the very high number of prisoners who have serious psychological or psychiatric conditions.

Mental health charities have praised May’s record on the subject, which included a big drop in the number of people in acute distress who are put in a police cell to undergo an assessment of their mental state because there is no other available “place of safety” nearby.

The speech will be her first on health, an area in which opponents have criticised her over her claim to be giving the NHS £10bn extra funding by 2020 and deteriorating NHS waiting times for A&E and cancer care and planned operations.

A key element will be an announcement of new measures to reduce the number of people taking their own lives. The number of suicides across the UK fell from 6,232 in 2013 to 6,122 in 2014. Although the rate of of suicide among men is going down, it is rising among women, although 45- to 59-year-olds of both sexes are the likeliest to take their own life.

Opposition MPs urged the premier to use Monday’s speech, in central London, to unveil meaningful plans to end long waits for mental health treatment and ensure patients did not become so unwell that they ended up in mental health crisis.

“Now is the time for the prime minister to demonstrate that the government’s actions match the rhetoric”, said Liberal Democrat MP Norman Lamb, who was the mental health minister in the coalition until 2015.

“Now they must end the intolerable discrimination which exists within the NHS. We can no longer tolerate people with mental ill health having to wait interminably for treatment or getting no treatment at all”, he added.

May should bring in maximum waiting times for mental health treatment to match those that already exist for physical health, such as A&E treatment, and make mental health a personal priority of her time in power, as her predecessor David Cameron did with dementia, he said.

Luciana Berger, a member of the House of Commons health select committee and president of the Labour campaign for mental health, said: “The inadequacy of our mental health services is one of the most perilous challenges our NHS and country faces. It can only be solved by tangible change felt in every school, workplace and community.

“It is vital that the prime minister breaks the tradition of broken promises which has so far characterised her party’s approach to mental health. The focus needs to be on early intervention and prevention – services which have been savagely cut since 2010”, she added.

Downing Street officials have been examining how to help schools cope with mental ilness. Jeremy Hunt, the health secretary, favours a system, being trialled in 225 schools in 22 parts of England, under which schools can seek advice from an expert working locally in NHS children and adolescent mental healthcare and ensure that pupils get seen more quickly. No 10 has also been looking at overhauling teacher training so that trainees are better able to spot telltale signs of distress and has been advised to ensure mental health is included on the secondary school curriculum to help prepare pupils for confronting what some experts say is an epidemic among under-18s.

May is expected to highlight the damaging role social media can have on young people’s mental welfare. Officials have been exploring potential curbs on the problem. Hunt recently called on mobile phone companies and firms such as Facebook and Twitter to stop under-18s sending sexually explicit images, including setting up parental blocks on their child’s account.

May’s speech will in part be the government’s formal response to the 58 recommendations made last year by NHS England’s mental health taskforce. She will acknowledge that many different departments have a key role to play in improving mental health, including the Department of Work and Pensions (welfare benefits), Ministry of Justice (offenders) and Department for Education (schools), not just the Department of Health and NHS, and pledge better pan-Whitehall action.

Mental health experts are keen to see if May accepts the taskforce’s plea for the Cabinet Office and Department of Health to create a body to provide “cross-government oversight” of how much progress ministers are making on improving care.

Privately, specialists in the field recalled the creation under Cameron on a Cabinet committee to oversee mental health policy, which was disbanded soon afterwards. One leading figure, who asked not to be named, said: “This focus on mental health is welcome and there’s potential for Theresa May to lead on mental health in a way no other prime minister has done. But is there something big she can do to help schools or is that just talk? And can she change the benefits system to help people, or is that just window dressing?”.

May will not announce any extra mental health funding beyond the £1bn extra for the sector generally and separate £1.4bn for children and young people’s care, both due to arrive by 2020. One Whitehall source with knowledge of the speech said: “This isn’t about providing new money. It’s about re-evaluating what the priorities in mental health are.”

PM to unveil measures to boost mental healthcare provision