Morris Reddington

r~1:b1 

Nottingham 
University Hospitals 
NHS Trust 

,.,,:;;1 

East Midlands
Sherwood1  Forest Hosp1talSAmbulance Service
N HS Trust 
NHS Foundation Trust 

• 

~1•1:&1 

Please ask for the Medical  Director's Personal Assistant 

13th  July 2021 

Miss Laurinda Bower 
HM Assistant Coroner for Nottingham City and  Nottinghamshire 
HM  Coroner's Court 
The Council  House 
Market Square 
Nottingham  NG1  2DT 

Dear Miss Bower 

Medical Director's Office 
3rd  Floor, Trust Headquarters 
City Hospital Campus 
Hucknall Road
Nottingham 
NG51PB

www.nuh.nhs.uk 

Inquest:  Morris Reddington  - Prevention of Future Death  Report [PFDR]  Response 

Please  find  attached  a  joint  commentary  prepared  by  the  Medical  Directors  from  Nottingham 
University Hospitals  NHS  Trust  [NUH],  Sherwood  Forrest Hospitals  NHS  Foundation  Trust [SFH]  and 
the East Midlands Ambulance Service NHS Trust [EMAS].  This is  in  response to the Preventing  Future 
Deaths  Report  issued  to  the  aforementioned  organisations  following  the  inquest  into  the  death  of Mr 
Reddington. 

As  Medical  Directors  for  NUH,  SFH  and  EMAS  we  have  met  to  coordinate  the  associated  work 
following  receipt of the PFDR. 

Our response  to  the  concerns  identified  in  the  PFDR  have  been  informed  following  work  undertaken 
ICT, 
by  colleagues  across 
Transformation  Digital  Business,  Nottinghamshire  Health 
Informatics  Service  (NHIS),  Deputy 
Divisional  Directors for Quality/Safety and Trust leads for Patient Safety, Quality and  Governance. 

the  Caldicott  Guardian/Clinical  Lead 

the  system 

including 

for 

The  actions  either  taken  or  planned  in  response  to  the  learning  from  the  inquest  are  summarised 
below.  The  oversight of the  delivery of these  actions will  be through  our respective Quality and  Safety 
Governance  Committees,  with  Executive  oversight.  Sub  Committees  of  our  Boards  will  receive  a 
progress report. 

I hope that this commentary provides assurance that we are committed to learning from this,  and other 
incidents to significantly enhance the care of patients across the local  Integrated Care System (ICS). 

Yours sincerely 

Medical Director [NUH] 

 
 
 
 
 Medical Director [SFH] 

Executive Medical Director [EMASJ 

cc: 

,  CQC  Inspector  and  CQC  Freedom  to  Speak  up  Ambassador, 

,  Chief Nurse,  NHS  Nottingham and  Nottinghamshire Clinical  Commissioning Group. 

 
 
 
 Concerns identified through the PFDR 

I  heard evidence  that  the  Ambulance  SeNice  had  replaced  their paper-based  Patient  Report  Form 
with an electronic system,  many years previously. 

The  electronic  Patient  Report  Form  ('ePRF?  is  an  important  template  which  records  all of the  pre­
hospital interaction  with the patient.  It forms  a crucial part of the professional-to-professional handover 
of  care,  and  is  an  adjunct  to  the  concise  verbal  handover  that  takes  place  in  the  Emergency 
Department. 

The  Ambulance  SeNice  told me  they expect the  ePRF to  be  reviewed by ED  staff,  rather than  staff 
simply  relying  on  the  verbal  handover,  which  can  be  challenging  in  the  context  of a  busy hospital 
environment. 

At the  point of roll out of the  new electronic system,  Ambulance SeNice personnel attended the  local 
Emergency  Departments  to  install  software  that  allowed  ED  staff to  access  the  electronic  Patient 
Report Form  hub from  their hospital computers.  Further to  installing software,  the Ambulance SeNice 
had also  provided ED  staff with  personalised login  details  and training  to  ensure  they knew  how to 
access the patient information. 

I  heard evidence  from  ED  staff that  despite  having logins  and having received  training,  they did not 
routinely  access  the  system  to  review  the  electronic  patient  report  form.  The  rationale  for  this 
omission,  was  that the  software  was  "clunky" to  use  and in  some  cases it could take  up  5 minutes to 
isolate the  correct form;  time  that busy ED staff do  not have.  Both  Trusts accepted that it had become 
practice not to review the  ePRF but instead to rely upon the  verbal handover alone. 

In  this  case,  had ED  staff reviewed  the  ePRF  early in  the  admission,  they would  have  appreciated 
from  that  documentation  that Mr Reddington  had been  suspected  of having  a  stroke,  rather than  a 
simple a head injury.  His care  would then  have been provided in  accordance  with  the  stroke pathway 
much earlier in  the evening. 

I  am  concerned that ignoring  a  written  handover from  a  fellow medical professional is  not a  safe  or 
proportionate solution to the difficulties faced of accessing the electronic system. 

I am further concerned that this practice of ignoring the written handover appears to have persisted for 
a long time without the organisations reaching a sensible solution. 

While  the Ambulance SeNice are taking steps to  upgrade the system at another local hospital,  I heard 
evidence that there  was  no agreed plan or date  for seeking to  resolve  the  system  issues at Kingsmill 
or Queens Medical Centre. 

Whilst  ever this problem persists without resolution,  there  is  a risk of future  deaths  due  to  failures  in 
the handover of patient information at the point of transfer of care. 

 Response to the concerns identified through the  PFDR 

As  HM  Assistant Coroner identified from  the  inquest evidence,  the  key  reason  that regular use  of the 
information  in  Patient Report Forms had  fallen  away since the change from  paper to  electronic form  is 
that access became more cumbersome.  A new login  and  password  had  to  be  set up  and  maintained, 
another  Trust's  unfamiliar  system  navigated,  and  that  system  did  not  automatically  link  with  the 
existing  record  management systems used  by each  hospital Trust.  A further complication  is that often 
the ePRF is  not finalised  until after the EMAS crew have departed the receiving  hospital. 

However,  a technical solution  has  now been  identified and  is in the process of being  implemented. The 
details  are  set  out  below,  along  with  the  projected  timescale.  The  solution  involves  the  EMAS  IT 
system  automatically pushing  out drafts of the ePRF to the  receiving  hospital as  soon  as  it is  chosen. 
As  the  two  hospital  Trusts  do  not  use  identical  IT  systems  for  record  management,  each  will  handle 
this data in  different ways,  although the end  point - immediate access to the finalised  ePRF for clinical 
staff,  and filing  of the report within the  patient's hospital  record  - will  be achieved at both Trusts.  Once 
implemented EMAS intend offering this solution to other acute hospitals'  IT services. 

In  the  meantime,  each  hospital  Trust  has  implemented  a  less  automated  workaround  in  their 
Emergency  Departments  and  other  direct  receiving  areas,  and  ePRF  data  is  already  more  easily 
available to clinical  staff.  Staff at  both  hospital Trusts  have  been  informed of this and  reminded  of the 
importance of accessing the ePRF data in addition to receiving  a verbal  handover from  EMAS. 

Immediate Actions Taken: 

NUH 

•  The  importance  of  accessing  the  EMAS  ePRF  in  the  Emergency  Department  has  been 

reinforced with  all  staff receiving  patients. 

•  The  NUH  Digital  Services team  have  been  given  access to  create  EMAS  ePRF  logins directly 

for NUH  staff,  avoiding the need for this to be done by EMAS. 

•  EMAS  ePRF  logins have  been  issued  by the  NUH  Digital  Services Access  and  Training  Team 

to all  staff identified as  needing access. 

•  An  EMAS  ePRF  system  link  has  been  installed  on  all  clinical  PC  desktops  and  on  the 

Nervecentre system to  increase access to this system. 

•  The  NUH  Emergency  Department  is  virtually  paperless  (with  only  ECG's  and  prescriptions 
being  on  paper, with  prescriptions due to move over to  Nervecentre in  2022).  The clinicians are 
well  accustomed  to  viewing  information  electronically  and  printing  these  forms  would  not 
meaningfully improve the efficiency of the record viewing. 

•  All  Heads of Service have been  briefed on the importance of having a process for review of the 

EMAS ePRF system for any patients received directly from  ambulance crews. 

•  The NUH  Digital Services and  Clinical  Governance teams have continued existing engagement 
with  EMAS  to  work  towards  achieving  automated  availability  of  the  finalised  EMAS  ePRF 
documents in  core clinical systems (CareCentric and  DHR) - as detailed below. 

SFH 

•  The  importance  of  accessing  the  EMAS  ePRF  in  the  Emergency  Department  has  been 

reinforced to staff receiving  patients. 

•  Prior to the  inquest steps had already been  undertaken to  refresh the logins ED staff had to the 

EMAS system. 

 • 

Immediately after the inquest, as an  interim measure whilst awaiting  system  improvements,  ED 
reception staff were instructed to access the EMAS portal and  print the ePRF within  30 minutes 
of a patient's arrival,  and  place this with  the patient's ED  record.  This has since been  refined  to 
a PDF  print being  produced  and  saved  in  SystmOne,  which  is the  medical  record  system  used 
in  SFH  ED. 

NUH,  SFH,  EMAS 

•  NUH and  SFH  have formally requested data to be shared  by EMAS, which  has  been approved. 
A Data Protection  Impact Assessment (DPIA) is currently in the final stages of being  completed 
and  reviewed. 

•  Both  NUH  and  SFH  continue to receive all  images taken and  ECGs recorded from  EMAS. 
•  NUH and  SFH  continue to  have access available to view the ePRF and  ED  staff have accounts 
to  access this,  along  with  staff receiving  patients directly in  other admission  areas.  EMAS  has 
trained  two  staff from  NUH  in  the  EMAS  account  management,  so  new ones  can  be  created 
directly,  if required.  SFH  have implemented a print to  PDF  solution for all ePRFs. 

Implementation of Automated Solution and Timescales: 

An  automated  system  has  been  identified  by  the  three  Trusts  working  together,  along  with  their 
informatics  service  providers.  There  will  be  two  parts  to  this  which  are  detailed  below:  a  common 
process  whereby  EMAS  systems  automatically  push  the  draft  and  then  final  ePRF  data  to  the 
receiving  hospitals  so  that  it  can  be  made  available  to  clinical  staff  without  the  need  for  additional 
logins;  and  differing  processes  at  each  hospital  Trust  that  dovetail  with  the  record  management 
systems each  use. 

A visual summary of the solution is set out in  appendix 1 

Common process 

•  EMAS attend scene,  and  crew start to  record  ePRF data in  SIREN,  which  is transferred  in  real 
time  to  a  data  centre  run  for  EMAS  by  Leicestershire  Health  Informatics  Service  (LHIS)  and 
converted  to  Fast  Healthcare  Interoperability  Resources  (FHIR)  messages.  This  already 
occurs. 

•  Once  implemented,  as  soon  as  the  EMAS  crew  select  the  destination  hospital  LHIS  will 
automatically start pushing  the  data from  the draft ePRF at five minute intervals to the selected 
receiving  hospital  Trust's  informatics  service  where  it  will  be  automatically  placed  onto  the 
Trust  Integration  Engine  (TIE)  which  co-ordinates  transfer  of  data  between  systems.  Once 
marked  as finalised  by the  EMAS  crew there will  be  one  last push  of data,  which  will  include a 
PDF  version  of the  ePRF  (which  contains  the  full  data  already  available  through  the  portal 
system). 

•  Subject to  any unforeseen technical  challenges the  automatic push  of ePRF data by EMAS to 

NUH/SFH  is  in  test prior to full  implementation. 

NUH  process 

 •  NUH  will  use  the  final  PDF  document following  finalisation  of the  record  after  handover,  and 
not  any  of the  draft  data  entered  before  this  process.  This  removes  any  risk  associated  with 
viewing  a  record  that  has  not  been  finalised.  These  PDF  documents  will  be  automatically 
transferred to CareCentric.  This system  is  directly linked from  Medway (the  ED  clinical  system) 
and  is  used  over  10,000 times  per month  in  NUH  to  access  GP  record  summaries  and  other 
community information.  In  addition,  NUH  will  automatically 'push'  the  EMAS  ePRF documents 
into  OHR  (the  Trust's  scanned  electronic  document  management  system)  for  immediate 
clinical  review  and  longer  term  visibility  alongside  NUH  records.  The  OHR  element  of this  is 
anticipated  to  be  live  by  September  2021,  although  there  is  a  delay  with  the  CareCentric 
element.  This is anticipated to  be  resolved  before the end  of the calendar year. 

•  Weekly checkpoint  meetings with  relevant stakeholders  are  in  place,  supported  by 

  (the  Trust's  Chief  Clinical  Information  Officer).  When  the  automated  solutions  are  live 

there will  be Trust-wide communications about how to access this information. 

SFH  process 

•  SFH  uses  SystmOne  for  its  electronic  ED  record.  Upon  receipt  by  NHIS  (SFH's  informatics 
service  provider)  the  ePRF  data will  be  automatically added  to  the  SystmOne  record,  and  will 
be accessible to clinical staff without any additional login. 

•  As soon  as the finalised  version  of the  ePRF  reaches  SystmOne a patient status alert icon will 
be  added  to  the  SystmOne  ED  whiteboard  displayed  in  the  King's  Mill  Hospital  ED,  making 
clinical staff aware that the finalised ePRF is  available for viewing. 

• 

In  addition,  NHIS  are  developing  an  ePRF  web  viewer that will  be  accessible  from  SystmOne 
without additional login. This will  mean; 

o  ED  staff can  review  the  draft  ePRF  at  any  point  after  EMAS  select  the  hospital  - on 

occasions advanced  information  is  useful. 

o  ED  staff can  see  all  ePRFs,  even  those  not yet matched to  a patient (e.g.  unconscious 

patient,  no  personal details obtained). 

o  Clinical  staff outside  ED  (who  generally do  not  have  SystmOne access) will  be  able  to 
access the ePRF without additional  login,  via  a link to  be  placed  on  the  in-patient Orion 
system they use. 

•  NHIS  have  a  project team  working  on  implementation,  with  SFH  oversight.  Whilst there  is  an 
effective  non-automatic workaround  now  in  place  that  provides  ED  staff with  easy  access  to 
ePRFs,  the following  timescales for the automated  process are envisaged: 

o  SFH ePRF Web Viewer - end August 2021. 
o  Automatic  integration  into  SystmOne - this  is  dependent  on  NHS  Digital  (the  national 
NHS  IT  body)  completing  their  current  development  of  national  FHIR  standards  for 
document distribution,  before TPP (who supply SystmOne) can  add the ePRF to patient 
records.  Whilst this  is  outside  SFH's  control,  SFH  are  pushing  for the  earliest possible 
resolution  (but may well  not be  implemented for several months at least) .. 

•  As  each  stage  is  implemented  there  will  then  be  Trust-wide  communications  and  training  on 

when  and  how to access the EMAS information. 

 
 Patients who subsequently transfer between SFH and  NUH 

•  As  described  above,  NUH  will  be  using  the  Nottinghamshire  CareCentric  Portal  as  their  main 
conduit  for  ePRFs.  SFH  will  also  automatically  add  the  finalised  version  of the  ePRFs  they 
receive  to  CareCentric,  which  will  allow clinical  staff at each  hospital  Trust to  view ePRF  data 
for patients initially taken to the other Trust. 
In  addition,  it  is  standard  practice  for  a  printed  copy  of the  Emergency  Department  notes  to 
accompany any patients seen  in  an  Emergency Department who  are  subsequently transferred 
for ongoing care. 

• 

Summary 

The  actions set out above  are  intended  to  address the  matters of concern  identified  in  the  Prevention 
of Future  Deaths  report  in  relation  to  ensuring  that the  ePRF  record  is  more  easily accessible to  staff 
across the  respective  organisations  in  support of safe  handover,  and  for wider benefits.  We  hope this 
response  provides  both  you  and  the  family  of  our  joint  commitment  to  learning  from  this  case  to 
significantly enhance the care of our patients. 

 Appendix 1: Visual representation of automated process 

____,, 

SFH  Systems 
Consume &  display coded 
data &  PDF for SFH  only 

EMAS attends 
patient. Ambulance 
crew record data in 
SIREN  &  choose 
location of receiving 
Trust 

LHIS 
Data  held  at 
Leicester HIS  on 
behalf of  EMAS 

Data  pushed via 
FHIR  message 
every  >minutes 

'-

/ 

'-

NUHTIE 
PDF  &  Interim 
coded  data  & 
fi nalised version 
forNUH 
conveyances 

SFH  (NHIS) TIE 
PDF  &  Interi m 

coded data &  -

fi nalised version 
for SFH 
conveyances 

, 

'-----------o 
,----------t 

'" 

r 

'-

CareCentric Portal 
SFH/NUH & 
Partners view EMAS 
Finalised ePRF  PD F 

' 

,) 

'I 

1------o 

'-

'I 

CareCentric  Portal - EMAS 
Tenancy 
Consume Finalised  PDF  for 
SFH  &NUH 

NUH Data Warehouse 
Consume coded data fo r NUH 
only 

~ 

NUH Systems 
Consume &  display coded 
data &  PDF  for NUH Only 

'-

, 

" 

.,

Miss Laurinda Bower 

HM Assistant Coroner, 
Nottingham and Nottinghamshire 
HM Coroner's Service 
The Council House 
Old Market Square 
Nottingham 
NG1 2DT 

Dear Miss Bower, 

National Medical Directorate 
NHS England & NHS Improvement 
Skipton House 
80 London Road 
London 
SE1 6LH 

1st September 2021 

Re: Regulation 28 Report to Prevent Future Deaths – Morris REDDINGTON 
Date of Death – 29th October 2019.  

Thank you for your Regulation 28 Report to Prevent Future Deaths (hereafter “report”) 
dated 21 May 2021 concerning the death of Mr Morris Reddington on 29TH October 
2019. Firstly, I would like to express my deep condolences to Mr Reddington’s family. 

Your report concludes Mr Reddington’s ’s death was a result of: 
1a) Brain Stem& Cerebellar Infarction 
1b) Basilar Artery Thrombosis & Dissection of the Right Vertebral Artery 
1c) 
II) Systemic Hypertension

Following the inquest, you raised concerns in your Regulation 28 Report to 
NHS England regarding: 

In January 2018, NHS England published its Clinical Commissioning Policy on 
the  use  of  Mechanical  Thrombectomy  as  treatment  for  adult  acute  ischaemic 
stroke  (all  ages).    The  aim  of  the  Policy  reports  to  be  two-fold;  to  improve 
outcomes  for  adults  with  stroke,  and  to  improve  access  to  mechanical 
thrombectomy as soon as possible after the onset of stroke symptoms.  

Despite the publication of the policy some 3 years ago, there remains very limited 
access to 24/7 mechanical thrombectomy. Save for four Trusts in London, and 
the West Midlands Network, I am not aware of others providing a 24/7 service. 
There  certainly  is  no  24/7  service  in  the  East  Midlands.  There  is  clear 
geographical disparity in the access to this vital, life-saving service.  

NHS England and NHS Improvement 

 
 
 Mechanical  thrombectomy  would  likely  have  avoided  Mr  Reddington’s  death. 
Instead,  because  Mr  Reddington  was  unfortunate  enough  to  suffer  a  stroke 
outside of the service’s operational hours (Monday to Friday 8am to 4pm), his 
family  were  left  to  watch  his  deterioration,  knowing  that  a  treatment  had  the 
potential  to  save  his  life,  but  that  such  treatment  simply  was  not  offered  after 
4pm.  This is a situation that no family ought to be placed in.  

NHS England and Improvement National Specialised Commissioning team wish 
to provide the following response: 

Basilar artery  thrombosis is a devasting form  of  stroke  with  very high  rates of 
mortality  and morbidity.  Mortality  is above  85%  without  recanalisation  therapy 
(thrombolysis and thrombectomy) and just below 40% if recanalised (the process 
of  restoring  flow  to  or  reuniting  an  interrupted  channel  of  a  blood  vessel).  Of 
those that have recanalisation therapy 30-35% have a good functional outcome.  
Basilar  artery  strokes  account  for  only  1%  of  all  stroke  and  presentation  is 
extremely  non-  specific,  making  diagnosis  difficult1.  Unfortunately,  CT  scan  is 
notoriously  poor  at  evaluating  the  brain  stem  and  identifying  basilar  artery 
thrombosis.    As  well  as  this,  there  is  no  large-scale  study  to  determine  the 
treatment window for basilar artery thrombosis nor has demonstrated statistically 
significant  benefit  from  MT  when  compared  to  standard  medical  care.  NICE 
guidelines2  2019  confirms  that  MT  should  however  be  considered  for  such 
patients.  

Background  
NHS  England  and  Improvement  Specialised  Commissioning  commission 
mechanical  thrombectomy  for  acute  ischemic  stroke,  which  can  significantly 
reduce the severity of disability3, there is not yet enough evidence to suggest it 
reduces mortality. It involves the surgical removal of a blood clot in an artery, by 
an Interventional Neuroradiologist who is a senior doctor. It is used to treat some 
strokes caused by a blood clot (ischaemic stroke) and aims to restore blood flow 
to the brain. The group of patients that are likely to benefit from a thrombectomy 
are  those  with  proximal  (central)  occlusion  of  the  internal  carotid  or  middle 
cerebral arteries who present early after the stroke before there is irreversible 
damage to the brain. These patients, often with extensive thrombus, are much 
less  likely  to  respond  to  the  conventional  intravenous  thrombolysis  and  more 
likely  to  experience  severe  disability.  Around  40%  of  ischaemic  strokes  are 
caused  by  a  large  artery  occlusion.  The  National  Programme  ambition  is  to 
develop robust and sustainable pathways and to increase coverage over a 24/7 
period. 

The implementation of thrombectomy is now in year 4 and is  part of a multi-year 
development  programme  to  establish  24/7  access  to  the  entire  population  in 
England, this involves establishing a service in at least 22 of the 24 neuroscience 
centres across England with potential to expand into a selection of standalone 
units in regions where access and geography are significant challenges.  

1 Basilar Artery Thrombosis - StatPearls - NCBI Bookshelf (nih.gov) 
2 https://www.nice.org.uk/guidance/ng128/chapter/Recommendations#pharmacological-treatments-
and-thrombectomy-for-people-with-acute-stroke 
3 d04-mechanical-thrombectomy-for-acute-ischaemic-stroke-v2.pdf (england.nhs.uk) 

 
 
 
 
 
 
 Our overall ambition is to establish a service in at least 24 centres, this may not 
mean 24/7 in every single centre but there will be 24/7 access for every single 
patient  who  could  benefit  from  the  treatment.  Currently  there  are  5  centres  in 
England  providing  24/7  thrombectomy  services,  there  are  8  centres  providing 
extended hours, which in most cases include weekend and early morning and 
evening hours, but not overnight, and 9 services provide a 9-5, weekday service. 
The programme is supporting the establishment of the service in two standalone 
centres that are in the planning and development stage of establishing a service. 
In early 2020, the total number of thrombectomy had reached an annual target 
level of 2,500 but this decreased during the first wave of Covid-19. Since then, 
activity  has  now  returned  to  pre-pandemic  levels.  The  total  number  of 
thrombectomies performed in 2020/21 was 1,738.  The Long-Term Plan has a 
target of 8000 thrombectomies by year 6 (2023/24). It is expected that by the 
end of 2022 40% of this target will be achieved.  

Policy interventions 
As well as the above, the national thrombectomy programme is focussing on the 
following  five  priority  areas  that  will  support  the  expansion  of  thrombectomy 
services;  

▪  Revenue  and  capital  funding  There  are  sufficient  financial  revenue 
within the programme to support all services to deliver 24/7 thrombectomy 
pathways.  This has been allocated to incentivise services to expand and 
support  their  referral  pathways.  There  is a  bid  in  preparation  to  secure 
capital  funding  for  additional  equipment  which  will  support  services  to 
further  improve  their  scanning  machines  and  angio-suites,  where  a 
thrombectomy is performed.  

▪  Accountability  and  responsibility;  in  2020/21  NHS  England  has 
invested  in  20  Integrated  Stroke  delivery  Networks  (ISDNs),  that  have 
prioritised  thrombectomy  improvements  within  their  operational  plans. 
Developing  and  establishing  clear  stroke  management  pathways  will 
ultimately  improve  access  to  thrombectomy.  Improved  access  to 
thrombectomy  has  been  agreed  as  an  Integrated  Care  Systems  (ICS) 
priority and remains a high priority for the NHS overall. 

▪  Pathway optimisation; The National Stroke Service Model (NSSM) 4was 
published in May 2021, with a focus on hyper-acute stroke care, including 
thrombectomy,  to  support  service  development  and  optimise  existing 
services.  Further  improvements  of  services  will  address  the  health 
inequalities gap across the stroke pathway and ensure 24/7 access for 
the  entire  population.  The  NSSM  highlights  the  need  for  access  to 
appropriate  imaging  and  24/7  emergency  intra-hospital  thrombectomy 
transfer  pathways  which must  be  in place  for all  Acute  Stroke  Centres. 
The  thrombectomy  programme  is  undertaking  extensive  mapping  of 
current use of Artificial Intelligence (AI) solutions across stroke pathways 
which is used to support rapid decision making and speed up the transfer 
of essential brain scans from a stroke unit to a thrombectomy centre. This 
work  will  lead  to  an  ISDN  level  implementation  strategy  to  support  the 
widespread rollout of this technology.  

4 national-stroke-service-model-integrated-stroke-delivery-networks-may-2021.pdf (england.nhs.uk) 

 
 
 
 ▪  Workforce: The workforce deficit is that there are currently not enough 
clinicians who are able to perform a thrombectomy. This is one of the key 
contributory factors to being able to rollout the programme at a more rapid 
pace.  In  England,  a  thrombectomy  is  performed  by  an  Interventional 
Neuroradiologist  and  currently,  there  are  approximately  86  (whole  time 
equivalents).    It  is  estimated  that  around  150  will  be  needed  to  deliver 
24/7,  sustainable  services  across  England.  Since  January  2021  the 
Stroke programme has been engaging with the General Medical Council 
and  Royal  College  of  Radiologists  to  support  the  development  of  a 
thrombectomy  credentialing  programme  to  support  non  interventional 
radiologists, such as neuro surgeons, radiologists and cardiologists to be 
trained  and  supported  to  perform  thrombectomy  and  address  the 
workforce gap.  

▪  Data  gaps:  a  lack  of  robust  linked  data  has  presented  a  challenge  in 
ensuring a detailed understanding of provision of thrombectomy and the 
essential components of the referral pathway. The programme now has 
access to more detailed linked data and is working with the stroke national 
audit programme to pilot a thrombectomy dataset that will collect data that 
will better support ongoing transformation and expansion of services. 

Thank you for bringing these important patient safety issues to my attention and please 
do not hesitate to contact me should you need any further information. 

Yours sincerely, 

Medical Director for Professional Leadership and Clinical Effectiveness 
Lead Medical Director for Covid-19 Medical Workforce Cell 
NHS England & NHS Improvement