2016 Annual Report

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2016 NHS patients needing vital surgery to prevent a major stroke are ‘not being operated on quickly enough’

Hundreds of patients are not having vital surgery quickly enough which could prevent them from having a major stroke, the Royal College of Surgeons and Vascular Society have warned today.

People who have suffered a mini stroke, or Transient Ischaemic Attack (TIA), are at risk of going on to have a major stroke which can lead to a serious brain injury and potentially life-changing disabilities. For some people, this risk can be reduced if they undergo surgery, and the National Clinical Institute for Health and Clinical Excellence (NICE) recommends that this surgery is performed within two weeks of patients experiencing the initial symptoms . The surgical procedure, known as Carotid Endarterectomy, involves removing plaque that has built-up in the carotid artery in the front of the neck. This prevents a further potential blockage of blood flowing to the brain – and a major stroke.

The National Vascular Registry 2016 Annual Report, which has been published today, shows that 1,830 (or 43%) of the 4,256 patients who had a mini stroke in 2015, did not undergo surgery within the 14-day target. It also reveals that while this was an improvement on 2009 – when 63% of patients did not undergo the procedure in the recommended time frame – there has been no improvement in the last four years. Today’s report also shows there was considerable variation in the times that patients underwent surgery across NHS Trusts in England and Welsh Health Boards; the average waiting time for patients in 2015 was 13 days, but at 10 vascular units the waiting time exceeded 20 days.

Professor Ian Loftus, a Consultant Vascular Surgeon, and lead clinician for the National Vascular Registry (NVR), said:

“Strokes remain the biggest cause of significant adult disabilities in the UK and they can have devastating consequences for patients and their families.

“The symptoms of a mini stroke and stroke are the same, but the difference with a mini stroke is that the patient does not suffer permanent damage. This is why it is so important that people are aware of the signs of a stroke which include blurred vision, slurred speech and weakness in the arms, legs or face.

“It is vital that patients who have a mini stroke or TIA, have rapid access to specialist vascular services so a swift decision can be made as to whether or not they should have surgery. Hospitals with longer times for diagnosis of carotid endarterectomy must review their practice to identify how these times can be reduced.

“The good news for patients is that when this procedure is carried out promptly, this surgery continues to be performed safely in the NHS – with low rates of stroke and other post-operative complications.”

Commissioned by the Healthcare Quality Improvement Partnership (HQIP)* as part of the National Clinical Audit Programme , the National Vascular Registry (NVR) 2016 Annual Report is carried out by the Royal College of Surgeons and The Vascular Society of Great Britain and Ireland. It was established in 2013 to measure the quality and outcomes of care for patients who undergo major vascular procedures in NHS hospitals.

Overall, the report shows vascular units are achieving good clinical outcomes and there are no outliers – performing outside the expected range – for the major surgical procedures. The good clinical outcomes reflect the shift towards centralising vascular services into larger centres where an experienced multi-disciplinary team of surgeons, stroke physicians and neurologists can assess patients presenting with stroke symptoms. The centralisation of services has been in response to growing evidence about the benefits of delivering major vascular surgery in hospitals with high caseloads.

The aim of the Registry is to provide comparative figures on the performance of vascular services in NHS hospitals to improve the quality of care patients receive. All NHS hospitals in England, Wales, Scotland and Northern Ireland are encouraged to participate in the Registry, so that it continues to support the work of the Vascular Society of Great Britain and Ireland (VSGBI) to improve the care provided by vascular services within the UK.

The results in this report are based primarily on vascular interventions that took place within the UK between 1 January 2014 and 31 December 2015.

*About HQIP, the National Clinical Audit Programme and how it is funded

The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the National Clinical Audit Programme, comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands. www.hqip.org.uk

Notes to editors

  1. The NVR captures data on adult patients undergoing emergency and elective procedures in NHS hospitals for the following patient groups:
    • patients with peripheral arterial disease (PAD) who undergo either (a) lower limb angioplasty/stent, (b) lower limb bypass surgery, and (c) lower limb amputation
    • patients who have a repair procedure for abdominal aortic aneurysm (AAA), both open and endovascular (EVAR); and
    • patients who undergo carotid endarterectomy or carotid stenting.
  2. For more information, please contact the RCS Press Office:
    Telephone: 020 7869 6047/6052; email: pressoffice@rcseng.ac.uk; or for out-of-hours media enquiries: 07966 486832