At the start of 2010, I collapsed at Euston Station. I was rushing to make a three-line whip vote, and at the top of the stairs by the taxi rank my body gave way beneath me and the world went black. I tumbled down the stairs and smashed into an advertising hoarding.
When I came around, I was confused and in pain, but not particularly worried. I was a young man and in relatively good health. I had had a very bad chest infection at Christmas, so put it down to that. I still made the vote. I had no idea how close I had come to dying.
The next morning, after chatting with my wife, I decided to go to the hospital, both to have a check over and to see if the reason for the collapse could be identified. I remember my state of utter confusion when I received the diagnosis – “a pulmonary embolism?! But I’m only 36.”
A pulmonary embolism is when a blood vessel in your lungs is blocked by a blood clot. My experience at Euston was a massive wake-up call for me, and since then I have fostered an interest in raising awareness of thrombosis – the formation of blood clots. I was proud to serve as chair of the all-party parliamentary group on thrombosis and continue to be interested in policy interventions related to it.
It is this interest that has led me to champion the pioneering technology of the endovascular thrombectomy. Simply put, a thrombectomy is the removal of a blood clot under image guidance and can be used to treat an arterial embolism. A doctor may recommend this treatment for certain ischaemic strokes or for specific mesenteric ischaemia (where the blood flow in your small intestine is restricted due to inflammation or injury).
Behind this technical language lies an exciting medical development. The Stroke Association has written extensively about thrombectomy and cites it as one of the most cost-effective treatments in specific cases. A thrombectomy can remove clots that are too big to be broken down via other methods and can prevent long-term disability in people with severe strokes.
Around 10,000 patients a year could benefit from thrombectomy in the UK, but it is thought that fewer than 10 per cent of those eligible receive it. So why on earth aren’t we rolling it out more?
The answer is, as with many medical developments relating to stroke and blood clots, a combination of funding, logistics and training. One key problem is that specialist neuroscience centres, where these kinds of procedures happen, are not evenly spread out across the UK. As the Stroke Association puts it: “Even the most basic stroke treatments are not being given to all stroke patients, let alone new cutting-edge procedures like thrombectomy.”
The funding and policy support for stroke treatment remains thin on the ground. This seems both counter-productive and extremely dangerous. Of course, the economic implications of funding stroke research are not the only considerations, but an ageing population means (as consultant stroke physician Martin James has written) that “the economic burden of stroke will almost treble within 20 years”. Cost of investment now then, however expensive, promises to make long-term policy sense.
We also don’t have enough trained specialists to carry out these complex operations, a fact that is very concerning and must be addressed by politicians and healthcare leaders. We need to encourage training programmes abroad to bolster our healthcare system, but also focus on retraining people with comparable and complementary specialisms already working within the NHS.
There seems to be a lack of urgency among policymakers to assist in the roll-out of this type of technology. I was particularly frustrated to read a government response to my colleague Rachael Maskell’s question relating to thrombectomy, in which a minister cited several reform goals, but no detailed time frame. The minister stated that there were currently 22 centres in England able to perform thrombectomy, and “another two non-neuroscience centres currently under development to provide access to thrombectomy”.
This, I’m afraid, will not cut it. Either healthcare is equally accessible, or it isn’t. We need an injection of funding, ingenuity and government willpower to ensure that those who suffer from thrombosis, and are eligible for a thrombectomy, can access the treatment in time for it to make a difference. Victims and their families need to see that their government is taking this seriously. I know how complex the issue is, but we should be getting more of a grip on this.
It just so happens that when I had my own experience with a blood clot, I would not have benefitted from a thrombectomy. But the fact that other people can have similar experiences, and potentially lose their lives or face long-term disability because of logistics and funding, terrifies me. We are the sixth-richest country in the world, and we should be leading the way on this kind of innovative healthcare.
All too often I feel like the government treats the NHS as if it is something to maintain; to fund just enough to keep it barely breathing, and then pump money into it in a blind panic when in crisis. If we are truly to protect and improve upon the NHS for future generations, policymakers must start to adapt to the needs of perpetually changing populations, support innovative care, and become much better at looking after a health service that is all too often taken for granted.
Andrew Gwynne MP is the former chair of the all-party parliamentary group on thrombosis.
