'Hundreds die every year' from too-slow NHS stroke response

People who experience classic signs of a mini-stroke (known as a transient ischemic attack or TIA) are treated as a low priority, according to a UK audit of services from leading doctors.

Those with facial or arm weakness, speech problems or blurred vision, or a combination, are at risk of having a severe stroke if they do not receive surgery as soon as possible.

The operation, called a carotid endarterectomy (CEA), should be carried out within 48 hours but no longer than 14 days after symptoms appear.

It involves removing a diseased area of the main blood vessel supplying the brain.

This prevents small particles breaking off and passing into the brain – one of the major causes of stroke.

Today's audit found low public awareness of symptoms combined with poor knowledge among health staff about treatments meant patients were not treated as emergencies.

As a result, thousands wait weeks or sometimes months for an operation that may be of no benefit to them by the time they receive it.

If patients had surgery within two weeks, about 200 strokes could be prevented for every 1,000 operations, the experts said.

Some 10,000 operations should be carried out by the NHS each year and if every one of these patients got surgery within 14 days 2,000 strokes could be prevented, they continued.

Some 500 lives could therefore be saved each year, they said.

Today's audit, from the Vascular Surgical Society and carried out at the Royal College of Physicians, said guidance from the National Institute for Health and Clinical Excellence (Nice) set a timeframe of two weeks from symptoms to surgery. The Government's National Stroke Strategy said surgery should be carried out within 48 hours.

Yet only 3 per cent of patients met the 48-hour deadline and a third of patients made the Nice guideline, the audit found.

Currently, the average wait from symptom to surgery is 28 days and referral to surgery is 19 days.

Around one in five cases are delayed because patients fail to go to their doctor with symptoms but 40 per cent are caused by GPs delaying referral for treatment.

Some 18 per cent of patients miss the deadline owing to too few staff or no time to do the operation, and 9 per cent through a lack of scanning equipment.

Figures were obtained from 109 trusts in England, Wales, Scotland and Northern Ireland.

The authors said 10,000 patients each year might benefit from CEA yet only 4,500 operations were carried out.

Around 120,000 people have a stroke every year in the UK and 20 per cent to 30 per cent die within a month.

Professor Ross Naylor, consultant vascular surgeon at Leicester Royal Infirmary and a member of the UK Audit Steering Group, said: "Evidence shows that the best quality of care comes from those centres which are geared up to offer rapid access to TIA clinics which offer immediate access to imaging of the brain and its blood vessels."