Prevention of Future Deaths reports · 2025

Michelle Mason

Regulation 28 report to prevent future deaths, reference 2025-0268, written 2 Jun 2025. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report2 Jun 2025
Reference2025-0268
DeceasedMichelle Mason
CoronerChristopher Long
Coroner areaLancashire and Blackburn with Darwen
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Organisation namedThe Walton Centre NHS Foundation Trust · Northern Care Alliance NHS Foundation Trust · Lancashire Teaching Hospitals NHS Foundation Trust
Sourcejudiciary.uk record · original PDF
Responses published5

The report

Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.

REGULATION 28:  REPORT TO PREVENT FUTURE DEATHS (1)

NOTE: This form is to be used after an inquest.

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO:

1. 

2. 

3. 

, Chief Executive, NHS England

Foundation Trust

, Chief Executive, Northern Care Alliance NHS

, Chief Executive, Lancashire Teaching Hospitals

1

CORONER

I am Christopher Long senior coroner, for the coroner area of Lancashire and Blackburn
with Darwen

2

CORONER’S LEGAL POWERS

I make this report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009
and Regulations 28 and 29 of the Coroners (Investigations) Regulations 2013.

3

INVESTIGATION and INQUEST

On 19 December 2024 I commenced an investigation into the death of Michelle Julie
Marie Michael MASON, 45 years old. The investigation concluded at the end of the
inquest on 28 May 2025. The conclusion of the inquest was:

Michelle Julie Marie Michaela MASON died on 1 June 2024 at Royal Infirmary,
Lancaster in Lancashire. After a sudden onset of lack of vision, vomiting and severe pain
an ambulance was called for Michelle, and she was taken to hospital. She was reviewed
by a doctor around 6 hours later, by which time it was too late to treat Michelle by
thrombolysis. Alternative treatment by thrombectomy was considered which would have
required Michelle to have been transferred to another hospital but no thrombectomy
service was available locally. Thought was given to transferring Michelle to another
hospital in the region, but it was considered to be too late by that stage for treatment.
She did not recover. Michelle's medical cause of death was found to be

1a. Ischaemic Stroke
1b Basilar Artery thrombus

4

CIRCUMSTANCES OF THE DEATH

Michelle Julie Marie Michaela MASON died on 1 June 2024 at Royal Infirmary,
Lancaster in Lancashire. After a sudden onset of lack of vision, vomiting and severe pain
an ambulance was called for Michelle, and she was taken to hospital. She was reviewed
by a doctor around 6 hours later, by which time it was too late to treat Michelle by
thrombolysis. Alternative treatment by thrombectomy was considered which would have
required Michelle to have been transferred to another hospital but no thrombectomy
service was available locally. Thought was given to transferring Michelle to another
hospital in the region, but it was considered to be too late by that stage for treatment.
She did not recover

1

 5

CORONER’S CONCERNS

During the course of the inquest the evidence revealed matters giving rise to concern. In
my opinion there is a risk that future deaths could occur unless action is taken. In the
circumstances it is my statutory duty to report to you.

The MATTERS OF CONCERN are as follows.  –
(1) NHS England national service specifications provide for a 24/7 thrombectomy service
which is not currently being delivered in Lancashire and there is no clear plan to deliver
that service
(2) There is a lack of understanding from non-stroke specialist clinicians in Lancashire
as to when and where thrombectomy services are available for patients in Lancashire
(3) There is no mutual aid regionally, even where thrombectomy is available, clinically
appropriate, it is known lack the procedure is likely to result in death and it is anticipated
resources are available to complete the procedure.

6

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and I believe you have the
power to take such action.

7

YOUR RESPONSE

You are under a duty to respond to this report within 56 days of the date of this report,
namely by 31 July 2025. I, the coroner, may extend the period.

Your response must contain details of action taken or proposed to be taken, setting out
the timetable for action. Otherwise you must explain why no action is proposed.

8

COPIES and PUBLICATION

I have sent a copy of my report to the Chief Coroner and to the following Interested
Persons: Family, University of Morecambe Bay NHS Foundation Trust and Northwest
Ambulance Service. I have also sent it to the Chief Executive of the Walton Centre NHS
Foundation Trust

I am also under a duty to send the Chief Coroner a copy of your response.

The Chief Coroner may publish either or both in a complete or redacted or summary
form. She may send a copy of this report to any person who she believes may find it
useful or of interest. You may make representations to me, the coroner, at the time of
your response, about the release or the publication of your response by the Chief
Coroner.

9

DATE 2 June 2025
                                                           Mr Christopher Long
                                                           HM Area Coroner

2

Responses

5 responses published against this report on judiciary.uk. A response is a body's written reply to the coroner's concerns; publication is at the discretion of the Chief Coroner's office, so an absent response does not mean nobody replied.

Response from Lancashire Teaching Hospitals (PDF)
Regulation 28 Response 

Thrombectomy 

Executive Summary 

The purpose of this paper is to provide a response to the Regulation 28 report issued to the Trust by HM Senior 
Coroner Mr Christopher Long on conclusion of the inquest of Ms Michelle Mason held on 2nd June 2025. 

Regulation 28  

The Regulation 28 report was issued to: 

NHS England. 
Northern Care Alliance NHS Foundation Trust. 
Lancashire Teaching Hospitals (LTHTR). 

The Coroner’s matters of concern are as follows: 

1.  NHS  England  national  service  specifications  provide  for  a  24/7  thrombectomy  service  which  is  not 

currently being delivered in Lancashire and there is no clear plan to deliver that service. 

2.  There is a lack of understanding from non-stroke specialist clinicians in Lancashire as to when and where 

thrombectomy services are available for patients in Lancashire. 

3.  There  is  no  mutual  aid  regionally,  even  where  thrombectomy  is  available,  clinically  appropriate,  it  is 
known  lack  the  procedure  is  likely  to  result  in  death  and  it  is  anticipated  resources  are  available  to 
complete the procedure. 

1.Background and context 

The LTHTR Mechanical Thrombectomy (MT) service has undergone significant development evolving from a 5-
day, in-hours service to a 7-day service with extended evening cover. The Trust acknowledges the coroner’s 
concerns that more could have been done sooner and recognises the importance of delivering a fully compliant 
24/7 service in line with national expectations. 

Initially,  the  service  operated  Monday  to  Friday  between  08:00  and  18.00,  with  expansion  constrained  by 
recruitment  and  job  planning  challenges.  Through  focused  recruitment  and  planning,  the  service  achieved 
reliable 7-day coverage from 3 August 2024 (although not for Bank Holidays), with the majority weekend shifts 
staffed either by substantive Neurointerventional Radiologists (NIRs) or supported by locum cover however there 
were some gaps until the 2nd January when all weekends have been covered. This marked a key milestone in 
improving access and resilience.  

Recognising the need to further extend hours, the Trust engaged in prolonged discussions with the NIR team 
and other speciality teams involved in delivering the service to support evening expansion. From 6th May 2025, 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 the service began operating into the evening delivering 7 days per week including Bank Holidays with cover until 
22:00  with  some  occasional  gaps  due  to  workforce  availability,  supported  by  collaborative  working  across 
Anaesthetics, Theatres, and Radiology. From 13 June 2025 cover have been consistently achieved from 08.00-
22.00 (referral cut off times are 20.00 for all sites with the exception of Barrow at 19.30). This has been achieved 
by flexible use of existing staff rotas, interim arrangements with Anaesthetic and Theatre teams, and a shared 
commitment across departments to maximise available NIR clinical time. 

As a result of these improvements, NHS England has confirmed that the current 7-day, 08:00–22:00 service at 
LTHTR enables the Northwest region to meet approximately 97% of clinical demand for thrombectomy.  

However,  a  gap  remains  in  overnight  provision  (22:00–08:00).  While  there  is  currently  no  formal  mutual  aid 
agreement  in  place  with  neighbouring  centres,  and  no  confirmed  rota  agreement  yet  from  the  NIR  team  for 
overnight cover, the Trust is actively addressing this through: 

•  Ongoing negotiations with the NIR team to agree a sustainable 24/7 rota. 
•  Finalisation of a business case to be agreed with NHSE to support the required infrastructure and 

workforce; 

•  Continued recruitment across Anaesthetics, Radiology, and Radiography; 
•  Development of operational readiness for overnight theatre and recovery services. 

These actions form part of a clear and accountable plan to implement a fully operational 24/7 thrombectomy 
service by 28 February 2026, ensuring equitable access for all patients across Lancashire and South Cumbria. 
There is a commitment to starting this sooner if staff can be recruited to enable this. 

2.Response to Regulation 28 

Coroner’s concern 1. 

NHS  England  national  service  specifications  provide  for  a  24/7  thrombectomy  service  which  is  not  currently 
being delivered in Lancashire and there is no clear plan to deliver that service. 

Response 

This  response  will  include  details  of  service  provision  prior  to  2nd  June  2025  when  the  inquest  took  place, 
progress from 2nd June to the current date, and proposed actions going forwards. 

Weekend service development 

Initially a weekend service from 08.00-18.00 was in place from July 2023 to April 2024, when the service was 
suspended due to concerns regarding the sustainability of the rota. Consistent weekend service was provided 
from 3rd August 2024, delivered by four substantive NIRs on a 1 in 6 rota, with two weekends requiring locum 
cover. Following the recruitment of a 5th and 6th NIR, the service has maintained full weekend coverage since 
January 2025, with bank holiday cover consistently in place since the 6th May 2025 with the hours extending 
until 22.00.  

Current job planning supports a 1 in 8 weekend rota, with two weekends out of eight not formally job planned. 
These gaps have been mitigated through a combination of internal flexibility and locum support, ensuring full 
weekend coverage throughout the published rota, which currently extends to the end of October 2025. 

Evening service expansion 

Prior to May 2025 the service concluded at 18:00. Following extended discussions with the NIR team, agreement 
was reached in April 2025 to extend the service to 22:00, with implementation beginning on 6th May 2025. Initial 

2 

 
 
 
 cover  was  limited  to 21:00  due  to  theatre  workforce  constraints,  but  since 13  June  2025,  the  service  has 
consistently operated until 22:00. 

This was made possible through collaborative working across Anaesthetics, Theatres, and Radiology, and 
interim arrangements to support later finish times. 

Progress since 2nd June to 18th July 2025 and forward planning  

While progress has been made with evening and weekend expansion, a 24/7 service is not yet in place. The 
barriers are multi-factorial and include: 

•  Ongoing negotiations with the NIR team, who have concerns around workload and sustainability with a 

high on-call frequency. 

Incomplete recruitment and rota changes for Anaesthetic and Theatre staff. 

•  Without confirmation of the NIR rota the 24/7 business case cannot be fully completed and approved. 
• 
•  Radiographer shift planning still in progress. 
•  Operational readiness of overnight theatre and recovery services. 

Recent work has focused on the following issues: 

•  Negotiation with NIRs to facilitate progression to a 24/7 service 
•  Business case considerations 
•  Collaborative working across specialties within our own trust (flexible anaesthetic working and theatre 

scheduling) 

•  Development of staffing and recruitment plan for anaesthetic cover 
•  Radiographer shift planning. 
•  Development of operational readiness of overnight theatre and recovery services. 

Collaborative working across LTHTR specialties 

The  agreement to  extend  service  hours to  22:00  came  earlier than  anticipated.  As  a result,  Anaesthetic  and 
Theatre teams were required to adapt at short notice. On 13th June 2025, it was agreed that any mechanical 
thrombectomy cases presenting outside scheduled hours or expected to run beyond 22:00 would be booked as 
Category 1 in emergency theatres, ensuring optimal use of NIR clinical time. 

NIR engagement and Business Case Development 

A meeting held on the 27th June with national stakeholders, including the Chair of the United Kingdom Neuro-
Interventional  Group  (UKNG),  explored  national  models  for  24/7  service  delivery  and  shared  sample  rota 
structures. The NIR team were asked to provide feedback on preferred rota models and job plan implications, 
with a response received in the week commencing 21st July 2025.  

In the response the NIRs have suggested a rota model which would allow for a 24/7 service on a 1 in 8 basis.  
As  the  proposal  involves  modifications  to  their  other  duties,  this  requires  evaluation  by  the  Radiology 
Management  Team  and  further  negotiation  with  the  NIRs  to  ensure  the  safe  and  sustainable  delivery  of  all 
radiology services involving the NIRs. This is expected to be completed by 31st August 2025. 

There are currently 6 NIR Consultants in post and a Vascular Interventional Radiologist in upskill training, which 
will bring the compliment to 7 in 12- 18 months.  

The Trust will aim to have the 24/7 service in place by 28th February 2026, with gaps supported with internal and 
external locum cover until a full complement of staff is achieved.  

3 

 
 
 
 The Trust acknowledges that any solution must be sustainable and safe and is committed to working with the 
NIR team to address the impact on other clinical duties. 

The business case for 24/7 expansion is being finalised and will include: 

NIR job planning 

As described above 

Radiographer shift planning  

Radiographer shift planning is underway with a planned go live date of 28th February 2026. A formal consultation 
process is in progress and is expected to be completed by 31st October 2025. 

Recruitment 

Recruitment to both Radiology and Anaesthetic posts is ongoing and is expected to be completed by December 
2025. 

Progress against these actions will be monitored on a monthly basis by the executive management team and 
an earlier start date will be considered if possible. 

Coroner’s concern 2. 

There  is  a  lack  of  understanding  from  non-stroke  specialist  clinicians  in  Lancashire  as  to  when  and  where 
thrombectomy services are available for patients in Lancashire. 

Response  

The Trust acknowledges this concern and has taken steps to improve awareness and clarity across the system. 
The  stakeholder  communications  policy  has  been  updated  to  reflect  the  current  operational  hours  of  the 
mechanical thrombectomy service. This update has been broadened to include non-stroke clinical teams across 
the region, ensuring that all relevant clinicians are informed of when and where thrombectomy is available. 

The  updated  document  was  issued  on  13th  June  2025  and  disseminated  through  formal  communications 
channels,  including  via  Chief  Operating  Officers  in  July  2025.  The  Trust  will  continue  to  reinforce  the 
communication  and    monitor  understanding  and  awareness  through  feedback  mechanisms  and  will  refresh 
communications as the service evolves. 

Coroner’s Concern 3.  

There is no mutual aid regionally, even where thrombectomy is available, clinically appropriate, it is known lack 
the procedure is likely to result in death and it is anticipated resources are available to complete the 
procedure. 

Response 

The Trust fully recognises the critical importance of regional aid to ensure timely access to thrombectomy for 
patients  in  Lancashire  and  South  Cumbria,  particularly  during the  overnight  period  (22:00–08:00)  when  local 
provision is not yet available. 

Following  receipt  of  the  Regulation  28  notice,  the  Trust  has  escalated  efforts  to  establish  regional  aid 
arrangements with neighbouring centres. Actions taken include Direct contact by the LTHTR Chief Operating 
Officer with Salford Royal Hospital, and CEO-to-CEO correspondence issued to both Salford Royal Hospital and 
The Walton Centre, formally requesting regional support. 

4 

 
 
 
 Progress to Date: 

Salford Royal Hospital responded positively, and a meeting was held on 15th July 2025, with participation from 
the  Northwest  Medical  Director  for  Commissioning.  This  was  a  constructive  discussion  that  outlined  the  key 
requirements and challenges for regional aid. 

Key areas discussed included: 

•  Risk assessment of the impact on Salford’s existing services, particularly anaesthetics (who also support 
major trauma), equipment availability, and the effect of additional out-of-hours activity on daytime elective 
capacity. LTHTR has provided modelled thrombectomy activity data, estimating an average of 2 cases 
per week, to support this assessment. 

•  Assurance that LTHTR is actively progressing toward its own 24/7 service, with a clear implementation 

plan. 

•  Referral pathway to be managed via the Stroke team, not directly through the NIR team. 
•  Access to imaging – discussions are ongoing to ensure timely and secure image sharing. 
•  Repatriation – LTHTR anticipates no issues with timely repatriation of patient’s post-procedure. 

The  Walton  Centre  also  responded  positively  on  15th  July  2025,  and  a  regional  meeting  involving  all  three 
organisations has been scheduled by 22 August 2025 to progress a coordinated regional aid approach. 

The  Trust  is  committed  to  working  collaboratively  with  regional  partners  to  ensure  that  no  patient  is  denied 
access to lifesaving thrombectomy due to geography or time of day. These discussions are being supported at 
the highest levels and will continue to be prioritised until a formal agreement is in place. Progress against this 
will be monitored by the Trust Chief Executive on a monthly basis. 

Action Plan 

Actions outlined above are summarised in Table 1 at Appendix 1. 

3.Governance and Risk Management 

LTHTR  has  worked  with  Governance  Teams  and  Medical  Examiners  from  neighbouring  trusts  to  develop  a 
robust reporting system to ensure that all cases which would have been referred to LTHTR for consideration of 
thrombectomy out of hours if the service was available, are entered onto incident management systems and 
communicated across organisations. This allows such cases to be subject to a specialist LTHTR panel review 
supported by stroke specialists and NIRs to establish the level of harm for each patient and allows for monitoring 
and reporting to relevant Trust committees. 

The absence of a 24/7 thrombectomy service is formally recorded on the Trust Risk Register and is subject to 
regular review and oversight by the Trust Risk Management Group which is chaired by the Trust Chief Executive 
Officer.  

4.Summary 

The current arrangements at LTHTR provide mechanical thrombectomy services to the population of Lancashire 
and South Cumbria between the hours of 08:00 – 22:00 seven days per week. NHS England has confirmed that 
the current 7-day, 08:00–22:00 service at LTHTR enables the Northwest region to meet approximately 97% of 
clinical demand for thrombectomy.  

5 

 
 
 
 
 
 
 
 Outside of these hours, owing to the fragility of services and logistical challenges across the North West, there 
is currently no agreement to provide mutual aid from Manchester or Liverpool. There has been an initial meeting 
chaired by the Medical Director for North West specialised commissioning at NHS England and a further date 
has been agreed to discuss progressing this further on 22nd August 2025.  

The Trust has issued updated communications regarding current mechanical thrombectomy service hours to all 
referring organisations across Lancashire and South Cumbria. 

A target date of 28th February 2026 has been set for the provision of a 24/7 mechanical thrombectomy service 
at LTHTR. Once rota and job plans are confirmed with the NIR team, supporting actions across Anaesthetics, 
Radiography, and Theatres are in place to enable a smooth transition. This date will be brought forward if we 
are able to recruit suitably trained staff earlier than plan.  

The plan outlined will continue to be monitored by the Chief Executive on a monthly basis through the Executive 
Management Team meeting.  

6 

 
 
 
 Appendix 1 - Action Plan  

Action Plan – Regulation 28 (Thrombectomy service)    

Version 
1 

Updated by 

Date 
17/07/2025 

Diagnostics and Clinical Support (DCS)  

2 

3 

Director DCS 

manager DCS 

 Divisional Nurse 

21/07/2025 

Clinical Business 

21/07/2025 

Note: This action plan combines the actions in response to the Prevention of Future death regulation 28 order and the actions agreed with key stakeholders. 

Ref 

Area of Concern 

Key Actions 

Lead  

Deadline 

Progress Update 

for action 

Current 
Status 

1 

2  3  4 

1. 

1) NHS England national service 
specifications  provide  for  a  24/7 
thrombectomy  service  which  is 
not  currently  being  delivered  in 
Lancashire and there is no clear 
plan to deliver that service 

Confirm 24/7 Mechanical 
Thrombectomy Service Start Date 
within LTHTr  

NIR rota and job plan to be developed 
and agreed 

Divisional 
Management 
Team (DMT) 
DCS  

Clinical 
Director (CD) 
for radiology  

31st  August 
2025 

Target date for implementation 
confirmed as 28th Feb 2026 

31st August 
2025 

Rota model to be finalised to 
support the planned 28th Feb 
2026 date of 24/7 service 
provision with NIR’s, 

Consultation process with 
Radiography Team to progress to 24/7 
service provision  

Professional 
lead for 
radiology  

31st  October 
2025 

The radiographer shift 
planning process, along with 
the corresponding consultation 
activities, is currently in 
progress in preparation for the 
scheduled go-live date on 28th  
February 2025 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Current 
Status 

1 

2  3  4 

Ref 

Area of Concern 

Key Actions 

Lead  

Deadline 

Progress Update 

Agree Consultant Rota and proposed 
job plans 

Recruit to vacant Radiology posts 

Recruit to Anaesthetic posts 

CD for 
radiology / 
DMT DCS 

DMT for 
DCS  

DMT for 
Surgery    

Issue clear procedural communications 
to key clinical stakeholders 

Trust 
communicati
ons team 

for action 

31st  August 
2025 

31st 
December 
2025 

31st 
December 
2025 

13th June 
2025 

Issue follow up communication for 
assurance through Chief Operating 
Officers network 

21st July 
2025 

Chief 
Operating 
Officers 
(COO) 
communicati
ons   

Agreement to be reached with 
the consultant workforce to 
implement 1:8 rota is currently 
being negotiated   

Recruitment ongoing  

Recruitment ongoing 

The stakeholder 
communications policy has 
been updated to reflect the 
current operational hours of 
the Mechanical Thrombectomy 
(MT) service. 

 Communication issued on 
13th June 2025 and 
disseminated through formal 
communications channels via 
Chief Operating Officers in 
July 2025. 

2. 

non-stroke 

There is a lack of understanding 
specialist 
from 
clinicians  in  Lancashire  as  to 
when  and  where  thrombectomy 
for 
services 
patients in Lancashire 

available 

are 

3. 

is  no  mutual  aid 
 There 
where 
regionally, 
available, 
thrombectomy 
clinically appropriate, it is known 

even 
is 

Initiate  COO  level  contact  to  seek 
potential regional support options from 
Salford. 

LTHTR COO 

20th June 
2025 

Direct  contact  by  the  LTHTR 
Chief  Operating  Officer  with 
Salford Royal Hospital. 

8 

 
 
 
 
 
 
 
 
 
 
 
 
 
 Current 
Status 

1 

2  3  4 

Ref 

Area of Concern 

Key Actions 

Lead  

Deadline 

Progress Update 

lack  the  procedure  is  likely  to 
in  death  and 
result 
is 
are 
resources 
anticipated 
available 
the 
procedure. 

complete 

to 

it 

Initiate  regional  Chief  Executive  level 
contact 
regional 
to  seek  potential 
support  options  from  Salford  Royal 
Hospital and The Walton Centre. 

Trust CEO 
contact  

initial 
Mobilise 
Salford  Royal  Hospital 
regional aid options 

conversation  with 
to  scope 

DMT for DCS 

for action 

10th July 
2025 

15th July 
2025 

CEO-to-CEO. Correspondence 
issued to both Salford Royal 
Hospital and The Walton 
Centre, formally requesting 
regional support 

Meeting held on 15th July 
2025 with Salford Royal and 
participation from the North 
West Medical Director for 
Commissioning.  Impact 
assessment for Salford service 
undertaken.  

Convene regional stakeholder scoping 
meeting  with  Salford  Royal  Hospital 
and The Walton Centre 

DMT for DCS 

By 22nd  
August 2025 

Agreement for engagement 
gained – meeting to be 
convened 

9
Response from Lancashire Teaching Hospitals (PDF)
Regulation 28 Response 

Thrombectomy 

Executive Summary 

The purpose of this paper is to provide a response to the Regulation 28 report issued to the Trust by HM Senior 
Coroner Mr Christopher Long on conclusion of the inquest of Ms Michelle Mason held on 27th & 28th May 2025. 

Regulation 28  

The Regulation 28 report was issued to: 

NHS England. 
Northern Care Alliance NHS Foundation Trust. 
Lancashire Teaching Hospitals (LTHTR). 

The Coroner’s matters of concern are as follows: 

1.  NHS  England  national  service  specifications  provide  for  a  24/7  thrombectomy  service  which  is  not 

currently being delivered in Lancashire and there is no clear plan to deliver that service. 

2.  There is a lack of understanding from non-stroke specialist clinicians in Lancashire as to when and where 

thrombectomy services are available for patients in Lancashire. 

3.  There  is  no  mutual  aid  regionally,  even  where  thrombectomy  is  available,  clinically  appropriate,  it  is 
known  lack  the  procedure  is  likely  to  result  in  death  and  it  is  anticipated  resources  are  available  to 
complete the procedure. 

1.Background and context 

The LTHTR Mechanical Thrombectomy (MT) service has undergone significant development evolving from a 5-
day, in-hours service to a 7-day service with extended evening cover. The Trust acknowledges the coroner’s 
concerns that more could have been done sooner and recognises the importance of delivering a fully compliant 
24/7 service in line with national expectations. 

Initially,  the  service  operated  Monday  to  Friday  between  08:00  and  18.00,  with  expansion  constrained  by 
recruitment  and  job  planning  challenges.  Through  focused  recruitment  and  planning,  the  service  achieved 
reliable 7-day coverage from 3 August 2024 (although not for Bank Holidays), with the majority weekend shifts 
staffed either by substantive Neurointerventional Radiologists (NIRs) or supported by locum cover however there 
were some gaps until the 2nd January when all weekends have been covered. This marked a key milestone in 
improving access and resilience.  

Recognising the need to further extend hours, the Trust engaged in prolonged discussions with the NIR team 
and other speciality teams involved in delivering the service to support evening expansion. From 6th May 2025, 

 
 
 
 
 
 
 
 
 
 
 
 
 the service began operating into the evening delivering 7 days per week including Bank Holidays with cover until 
22:00  with  some  occasional  gaps  due  to  workforce  availability,  supported  by  collaborative  working  across 
Anaesthetics, Theatres, and Radiology. From 13 June 2025 cover have been consistently achieved from 08.00-
22.00 (referral cut off times are 20.00 for all sites with the exception of Barrow at 19.30). This has been achieved 
by flexible use of existing staff rotas, interim arrangements with Anaesthetic and Theatre teams, and a shared 
commitment across departments to maximise available NIR clinical time. 

 As a result of these improvements, NHS England has confirmed that the current 7-day, 08:00–22:00 service at 
LTHTR enables the Northwest region to meet approximately 97% of clinical demand for thrombectomy.  

However,  a  gap  remains  in  overnight  provision  (22:00–08:00).  While  there  is  currently  no  formal  mutual  aid 
agreement  in  place  with  neighbouring  centres,  and  no  confirmed  rota  agreement  yet  from  the  NIR  team  for 
overnight cover, the Trust is actively addressing this through: 

•  Ongoing negotiations with the NIR team to agree a sustainable 24/7 rota. 
•  Finalisation of a business case to be agreed with NHSE to support the required infrastructure and 

workforce; 

•  Continued recruitment across Anaesthetics, Radiology, and Radiography; 
•  Development of operational readiness for overnight theatre and recovery services. 

These actions form part of a clear and accountable plan to implement a fully operational 24/7 thrombectomy 
service by 28 February 2026, ensuring equitable access for all patients across Lancashire and South Cumbria. 
There is a commitment to starting this sooner if staff can be recruited to enable this. 

2.Response to Regulation 28 

Coroner’s concern 1. 

NHS  England  national  service  specifications  provide  for  a  24/7  thrombectomy  service  which  is  not  currently 
being delivered in Lancashire and there is no clear plan to deliver that service. 

Response 

This  response  will  include  details  of  service  provision  prior  to  27th  May  2025  when  the  inquest  took  place, 
progress from 28th May 2025 to the current date, and proposed actions going forwards. 

Weekend service development 

Initially a weekend service from 08.00-18.00 was in place from July 2023 to April 2024, when the service was 
suspended due to concerns regarding the sustainability of the rota. Consistent weekend service was provided 
from 3rd August 2024, delivered by four substantive NIRs on a 1 in 6 rota, with two weekends requiring locum 
cover. Following the recruitment of a 5th and 6th NIR, the service has maintained full weekend coverage since 
January 2025, with bank holiday cover consistently in place since the 6th May 2025 with the hours extending 
until 22.00.  

Current job planning supports a 1 in 8 weekend rota, with two weekends out of eight not formally job planned. 
These gaps have been mitigated through a combination of internal flexibility and locum support, ensuring full 
weekend coverage throughout the published rota, which currently extends to the end of October 2025. 

Evening service expansion 

Prior to May 2025 the service concluded at 18:00. Following extended discussions with the NIR team, agreement 
was reached in April 2025 to extend the service to 22:00, with implementation beginning on 6th May 2025. Initial 

2 

 
 
 
 
 cover  was  limited  to 21:00  due  to  theatre  workforce  constraints,  but  since 13  June  2025,  the  service  has 
consistently operated until 22:00. 

This was made possible through collaborative working across Anaesthetics, Theatres, and Radiology, and 
interim arrangements to support later finish times. 

Progress since 28th May 2025 to 18th July 2025 and forward planning  

While progress has been made with evening and weekend expansion, a 24/7 service is not yet in place. The 
barriers are multi-factorial and include: 

•  Ongoing negotiations with the NIR team, who have concerns around workload and sustainability with a 

high on-call frequency. 

Incomplete recruitment and rota changes for Anaesthetic and Theatre staff. 

•  Without confirmation of the NIR rota the 24/7 business case cannot be fully completed and approved. 
• 
•  Radiographer shift planning still in progress. 
•  Operational readiness of overnight theatre and recovery services. 

Recent work has focused on the following issues: 

•  Negotiation with NIRs to facilitate progression to a 24/7 service 
•  Business case considerations 
•  Collaborative working across specialties within our own trust (flexible anaesthetic working and theatre 

scheduling) 

•  Development of staffing and recruitment plan for anaesthetic cover 
•  Radiographer shift planning. 
•  Development of operational readiness of overnight theatre and recovery services. 

Collaborative working across LTHTR specialties 

The agreement to  extend service  hours to  22:00  came  earlier than anticipated.  As  a result,  Anaesthetic  and 
Theatre teams were required to adapt at short notice. On 13th June 2025, it was agreed that any mechanical 
thrombectomy cases presenting outside scheduled hours or expected to run beyond 22:00 would be booked as 
Category 1 in emergency theatres, ensuring optimal use of NIR clinical time. 

NIR engagement and Business Case Development 

A meeting held on the 27th June with national stakeholders, including the Chair of the United Kingdom Neuro-
Interventional  Group  (UKNG),  explored  national  models  for  24/7  service  delivery  and  shared  sample  rota 
structures. The NIR team were asked to provide feedback on preferred rota models and job plan implications, 
with a response received in the week commencing 21st July 2025.  

In the response the NIRs have suggested a rota model which would allow for a 24/7 service on a 1 in 8 basis.  
As  the  proposal  involves  modifications  to  their  other  duties,  this  requires  evaluation  by  the  Radiology 
Management  Team  and  further  negotiation  with  the  NIRs  to  ensure  the  safe  and  sustainable  delivery  of  all 
radiology services involving the NIRs. This is expected to be completed by 31st August 2025. 

There are currently 6 NIR Consultants in post and a Vascular Interventional Radiologist in upskill training, which 
will bring the compliment to 7 in 12- 18 months.  

The Trust will aim to have the 24/7 service in place by 28th February 2026, with gaps supported with internal and 
external locum cover until a full complement of staff is achieved.  

3 

 
 
 
 
 The Trust acknowledges that any solution must be sustainable and safe and is committed to working with the 
NIR team to address the impact on other clinical duties. 

The business case for 24/7 expansion is being finalised and will include: 

NIR job planning 

As described above 

Radiographer shift planning  

Radiographer shift planning is underway with a planned go live date of 28th February 2026. A formal consultation 
process is in progress and is expected to be completed by 31st October 2025. 

Recruitment 

Recruitment to both Radiology and Anaesthetic posts is ongoing and is expected to be completed by December 
2025. 

Progress against these actions will be monitored on a monthly basis by the executive management team and 
an earlier start date will be considered if possible. 

Coroner’s concern 2. 

There  is  a  lack  of  understanding  from  non-stroke  specialist  clinicians  in  Lancashire  as  to  when  and  where 
thrombectomy services are available for patients in Lancashire. 

Response  

The Trust acknowledges this concern and has taken steps to improve awareness and clarity across the system. 
The  stakeholder  communications  policy  has  been  updated  to  reflect  the  current  operational  hours  of  the 
mechanical thrombectomy service. This update has been broadened to include non-stroke clinical teams across 
the region, ensuring that all relevant clinicians are informed of when and where thrombectomy is available. 

The  updated  document  was  issued  on  13th  June  2025  and  disseminated  through  formal  communications 
channels,  including  via  Chief  Operating  Officers  in  July  2025.  The  Trust  will  continue  to  reinforce  the 
communication  and    monitor  understanding  and  awareness  through  feedback  mechanisms  and  will  refresh 
communications as the service evolves. 

Coroner’s Concern 3.  

There is no mutual aid regionally, even where thrombectomy is available, clinically appropriate, it is known lack 
the procedure is likely to result in death and it is anticipated resources are available to complete the 
procedure. 

Response 

The Trust fully recognises the critical importance of regional aid to ensure timely access to thrombectomy for 
patients  in  Lancashire  and  South  Cumbria,  particularly during the  overnight  period  (22:00–08:00)  when local 
provision is not yet available. 

Following  receipt  of  the  Regulation  28  notice,  the  Trust  has  escalated  efforts  to  establish  regional  aid 
arrangements with neighbouring centres. Actions taken include Direct contact by the LTHTR Chief Operating 
Officer with Salford Royal Hospital, and CEO-to-CEO correspondence issued to both Salford Royal Hospital and 
The Walton Centre, formally requesting regional support. 

4 

 
 
 
 
 Progress to Date: 

Salford Royal Hospital responded positively, and a meeting was held on 15th July 2025, with participation from 
the  Northwest  Medical  Director  for  Commissioning.  This  was  a  constructive  discussion  that  outlined  the  key 
requirements and challenges for regional aid. 

Key areas discussed included: 

•  Risk assessment of the impact on Salford’s existing services, particularly anaesthetics (who also support 
major trauma), equipment availability, and the effect of additional out-of-hours activity on daytime elective 
capacity. LTHTR has provided modelled thrombectomy activity data, estimating an average of 2 cases 
per week, to support this assessment. 

•  Assurance that LTHTR is actively progressing toward its own 24/7 service, with a clear implementation 

plan. 

•  Referral pathway to be managed via the Stroke team, not directly through the NIR team. 
•  Access to imaging – discussions are ongoing to ensure timely and secure image sharing. 
•  Repatriation – LTHTR anticipates no issues with timely repatriation of patient’s post-procedure. 

The  Walton  Centre  also  responded  positively  on  15th  July  2025,  and  a  regional  meeting  involving  all  three 
organisations has been scheduled by 22 August 2025 to progress a coordinated regional aid approach. 

The  Trust  is  committed  to  working  collaboratively  with  regional  partners  to  ensure  that  no  patient  is  denied 
access to lifesaving thrombectomy due to geography or time of day. These discussions are being supported at 
the highest levels and will continue to be prioritised until a formal agreement is in place. Progress against this 
will be monitored by the Trust Chief Executive on a monthly basis. 

Action Plan 

Actions outlined above are summarised in Table 1 at Appendix 1. 

3.Governance and Risk Management 

LTHTR  has  worked  with  Governance  Teams  and  Medical  Examiners  from  neighbouring  trusts  to  develop  a 
robust reporting system to ensure that all cases which would have been referred to LTHTR for consideration of 
thrombectomy out of hours if the service was available, are entered onto incident management systems and 
communicated across organisations. This allows such cases to be subject to a specialist LTHTR panel review 
supported by stroke specialists and NIRs to establish the level of harm for each patient and allows for monitoring 
and reporting to relevant Trust committees. 

The absence of a 24/7 thrombectomy service is formally recorded on the Trust Risk Register and is subject to 
regular review and oversight by the Trust Risk Management Group which is chaired by the Trust Chief Executive 
Officer.  

4.Summary 

A target date of 28th February 2026 has been set for the provision of a 24/7 mechanical thrombectomy service 
at LTHTR. Once rota and job plans are confirmed with the NIR team, supporting actions across Anaesthetics, 
Radiography, and Theatres are in place to enable a smooth transition. 

The Trust has issued updated communications regarding current mechanical thrombectomy service hours to all 
referring organisations across Lancashire and South Cumbria.  

5 

 
 
 
 
 
 
 
 
 Some progress has recently been made regarding regional agreements to provide regional aid during the interim 
period with no foreseeable difficulties in LTHTR complying with the requirements set by Salford Royal Hospital. 
A regional meeting is scheduled for the 22nd August to consider this further. 

Lancashire  Teaching  Hospitals  (LTH)  remain  the  provider  of  the  mechanical  thrombectomy  service  for 
Lancashire and South Cumbria (L&SC) and remain wholly committed to providing a 24/7 service, by working 
with all relevant specialties within the Trust and collaborative working with colleagues across the NW region. 

6 

 
 
 
 Appendix 1 - Action Plan  

Action Plan – Regulation 28 (Thrombectomy service)    

Version 

Updated by 

1 

2 

3 

Diagnostics and Clinical Support (DCS)  

Director DCS 

manager DCS 

Date 

17/07/2025 

21/07/2025 

21/07/2025 

Note: This action plan combines the actions in response to the Prevention of Future death regulation 28 order and the actions agreed with key stakeholders. 

Ref 

Area of Concern 

Key Actions 

Lead  

Deadline 

Progress Update 

for action 

Current 
Status 

1 

2  3  4 

1. 

1) NHS England national service 
specifications  provide  for  a  24/7 
thrombectomy  service  which  is 
not  currently  being  delivered  in 
Lancashire and there is no clear 
plan to deliver that service 

Confirm 24/7 Mechanical 
Thrombectomy Service Start Date 
within LTHTr  

NIR rota and job plan to be developed 
and agreed 

Divisional 
Management 
Team (DMT) 
DCS  

Clinical 
Director (CD) 
for radiology  

31st  August 
2025 

Target date for implementation 
confirmed as 28th Feb 2026 

31st August 
2025 

Rota model to be finalised to 
support the planned 28th Feb 
2026 date of 24/7 service 
provision with NIR’s, 

Consultation process with 
Radiography Team to progress to 24/7 
service provision  

Professional 
lead for 
radiology  

31st  October 
2025 

The radiographer shift 
planning process, along with 
the corresponding consultation 
activities, is currently in 
progress in preparation for the 
scheduled go-live date on 28th  
February 2025 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Current 
Status 

1 

2  3  4 

Ref 

Area of Concern 

Key Actions 

Lead  

Deadline 

Progress Update 

Agree Consultant Rota and proposed 
job plans 

Recruit to vacant Radiology posts 

Recruit to Anaesthetic posts 

Issue clear procedural communications 
to key clinical stakeholders 

Issue follow up communication for 
assurance through Chief Operating 
Officers network 

for action 

31st  August 
2025 

31st 
December 
2025 

31st 
December 
2025 

13th June 
2025 

21st July 
2025 

CD for 
radiology / 
DMT DCS 

DMT for 
DCS  

DMT for 
Surgery    

Trust 
communicati
ons team 

Chief 
Operating 
Officers 
(COO) 
communicati
ons   

Agreement to be reached with 
the consultant workforce to 
implement 1:8 rota is currently 
being negotiated   

Recruitment ongoing  

Recruitment ongoing 

The stakeholder 
communications policy has 
been updated to reflect the 
current operational hours of 
the Mechanical Thrombectomy 
(MT) service. 

 Communication issued on 
13th June 2025 and 
disseminated through formal 
communications channels via 
Chief Operating Officers in 
July 2025. 

2. 

non-stroke 

There is a lack of understanding 
specialist 
from 
clinicians  in  Lancashire  as  to 
when  and  where  thrombectomy 
for 
services 
patients in Lancashire 

available 

are 

3. 

is  no  mutual  aid 
 There 
where 
regionally, 
available, 
thrombectomy 
clinically appropriate, it is known 

even 
is 

Initiate  COO  level  contact  to  seek 
potential regional support options from 
Salford. 

LTHTR COO 

20th June 
2025 

Direct  contact  by  the  LTHTR 
Chief  Operating  Officer  with 
Salford Royal Hospital. 

8 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Current 
Status 

1 

2  3  4 

Ref 

Area of Concern 

Key Actions 

Lead  

Deadline 

Progress Update 

lack  the  procedure  is  likely  to 
in  death  and 
result 
is 
are 
resources 
anticipated 
available 
the 
procedure. 

complete 

to 

it 

Initiate  regional  Chief  Executive  level 
contact 
regional 
to  seek  potential 
support  options  from  Salford  Royal 
Hospital and The Walton Centre. 

Trust CEO 
contact  

initial 
Mobilise 
Salford  Royal  Hospital 
regional aid options 

conversation  with 
to  scope 

DMT for DCS 

for action 

10th July 
2025 

15th July 
2025 

CEO-to-CEO. Correspondence 
issued to both Salford Royal 
Hospital and The Walton 
Centre, formally requesting 
regional support 

Meeting held on 15th July 
2025 with Salford Royal and 
participation from the North 
West Medical Director for 
Commissioning.  Impact 
assessment for Salford service 
undertaken.  

Convene regional stakeholder scoping 
meeting  with  Salford  Royal  Hospital 
and The Walton Centre 

DMT for DCS 

By 22nd  
August 2025 

Agreement for engagement 
gained – meeting to be 
convened 

9
Response from NHS England 1 (PDF)
Mr Christopher Long  
Senior Coroner 
Lancashire with Blackburn & Darwen 
Coroner’s Court 
2 Faraday Court 
Faraday Drive 
Preston 
Lancashire 
PR2 9NB  

National Medical Director  
NHS England  
Wellington House 
133-155 Waterloo Road  
London 
SE1 8UG 

4 August 2025  

Dear Mr Long, 

Re: Regulation 28 Report to Prevent Future Deaths – Michelle Julie Marie 
Michaela Mason who died on 1 June 2024  

Thank you for your Report to Prevent Future Deaths (hereafter “Report”) dated 2 June 
2025 concerning the death of Michelle Julie Marie Michaela Mason on 1 June 2024. 
In advance of responding to the specific concerns raised in your Report, I would like 
to express my deep condolences to Michelle’s family and loved ones. NHS England 
is  keen  to  assure  the  family  and  yourself  that  the  concerns  raised  about  Michelle’s 
care, both during the inquest and as set out within your Report, have been listened to 
and reflected upon.   

Your  Report  raised  concerns  that  there  is  no  24/7  thrombectomy  service  currently 
available in Lancashire, that there is a lack of understanding from non-stroke specialist 
clinicians in Lancashire as to when and where thrombectomy services are available, 
and that there are no regional mutual aid arrangements.  

NHS  England  has  liaised  with  Lancashire  &  South  Cumbria  Integrated  Care  Board 
(ICB)  regarding  your  Report.  Stroke  thrombectomy  services  are  now  a  delegated 
specialised  service  and,  since  1  April  2024,  Lancashire  &  South  Cumbria  ICB  has 
been the responsible commissioner for the region rather than NHS England.  Whilst 
NHS  England  was  previously  responsible  for  commissioning  (funding)  stroke 
thrombectomy  services,  the  responsibility  for  providing  this  service  rests  with  the 
Trusts in each region. 

It  remains  a  priority,  both  nationally  and  regionally, 
for  all  commissioned 
Comprehensive  Stroke  Centres  (CSCs)  to  provide  a  24/7  thrombectomy  service, 
regardless of a patient’s location. This has proved challenging in certain areas for a 
variety of reasons. In particular, the ability of services to expand and operate 24/7 is 
heavily  reliant  on  recruiting  the  necessary  specialist  workforce  with  appropriate 
competencies.   

Before responding to each of the concerns in your Report, it is relevant to note that 
not all ischaemic stroke patients are suitable for thrombectomy. The NHS Long Term 

                                                                                                                       
 
 
 
 
 
 
 
  
 
 
 
 
 
  
 Plan, published in January 2019, previously set an ambition for 10% of stroke patients 
to receive thrombectomy treatment (based on there being approximately 80,000 stroke 
admissions per year, and up to 8,000 of these patients potentially being eligible for 
thrombectomy). For those eligible patients with a large vessel occlusion to the anterior 
circulation, there is generally a 6 hour time interval from the onset of stroke symptoms 
to perform thrombectomy. Delivering treatment successfully depends on a number of 
factors, including timely diagnosis, conveyance to a CSC within the 6 hour timeframe, 
and the CSC’s operating hours and available workforce to perform the procedure. 

Availability of a 24/7 thrombectomy service in Lancashire 

As  your  Report  references,  the  national  service  specification  for  mechanical 
thrombectomy  recognises  a  requirement  for  sufficient  clinical  staff  with  appropriate 
competencies  to  be  in  place  to  achieve  a  24/7  service  at  centre  level.  It  also 
acknowledges that an extended 7 day service is acceptable as a developmental step 
towards full 24/7 coverage, recognising that most eligible stroke patients present for 
treatment between 8am and midnight. 

The  key  challenge  from  a  workforce  perspective  is  having  a  sufficient  number  of 
Interventional  Neuroradiologists  (INRs)  in  place  to  deliver  the  service,  alongside 
Specialist  Radiographers  and  Stroke  Consultants.  The  role  of  an  INR  previously 
involved working from 9am to 5pm on weekdays only, and therefore the workforce was 
initially  much  smaller  than  that  required  to  achieve  a  fully  operational  24/7  service 
nationally.  

Stroke  care  in  England  is  delivered  via  20  Integrated  Stroke  Delivery  Networks 
(ISDNs), of which Lancashire & South Cumbria is one, which have been in place since 
2021/21.  The  work  of  the  ISDNs  is  primarily  focused  on  quality  improvement  and 
monitoring performance across the whole of the stroke management pathway. ISDNs 
report into their regional Stroke Board and work closely with the Stroke Association 
and colleagues across the health system. ISDNs are hosted in provider Trusts.  

Currently, 12 of the 24 CSCs across the 20 ISDNs have a 24/7 thrombectomy service 
in  place.  In  the  North  West,  NHS  England’s  Regional  Specialised  Commissioning 
Team  have  been  focused  on  work  with  Lancashire  Teaching  Hospitals  NHS 
Foundation  Trust  (LTH)  on  the  sustainable  delivery  of  a  7  day  service.  LTH  had 
previously been delivering a 7 day service until April 2024 when, due to staffing issues, 
they  regressed  to  a  Monday  to  Friday  weekday  service,  moving  back  to  7  days  in 
August  2024  on  a  six  weekend  in  eight  basis.  The  Regional  Specialised 
Commissioning  Team  have,  through  dialogue  and  formal  contractual  levers,  been 
following this up with LTH to improve this position and, as a result, the service has 
gradually expanded. From May 2025, the service has operated consistently on a 7 day 
basis (between the hours of 8am and 10pm) and NHS England continues to work with 
LTH in sustaining this service. Work is also ongoing to achieve 24/7 coverage for the 
region and two alternative delivery options are being pursued to achieve this. These 
approaches are:  

(i) 
(ii) 

LTH extends their service operating hours to cover the 10pm-8am gap;  
Delivery of a 10pm-8am thrombectomy ‘out of hours’ service is undertaken 
in one centre, covering the three ISDN footprints in the North West region. 

 
  
 
 
 
 
 Awareness of non-stroke clinicians 

LTH implemented a Standard Operating Procedure (SOP) for communication about 
the availability of thrombectomy services with stakeholders in September 2024, and 
this was a clinician-led communication.  

Upon reflection, it appears that the cascade mechanism for this communication is not 
as  effective  as  it  needs  to  be.  NHS  England’s  North  West  Regional  Specialised 
Commissioning  Team  have  suggested  that  LTH  should  engage  their  internal 
communications to ensure the robustness of this communication, and to link with the 
Regional Communications Team for support as needed.  

Mechanical  Thrombectomy  as  a  treatment  for  Ischaemic  Stroke  formed  part  of  the 
portfolio  of  specialised  services  which  were  delegated  to  ICBs  in  the  North  West 
Region on 1 April 2024.  Under delegation arrangements, ICBs are responsible but 
not directly accountable for the planning and commissioning of specialised services. 
They exercise their delegated functions through a single specialised commissioning 
team for the region, which at present is still hosted by NHS England. Assurance that 
the above has been actioned will be gained through regional assurance meetings.  

Mutual aid  

In order to ensure equal access for the population across the North West region, the 
North West’s Medical Director for Commissioning is supporting an options appraisal 
to consider the best model that supports outcomes for patients, whilst making the most 
effective use of resources. As set out above, the options currently being considered 
are  for  LTH  to  move  to  a  24/7  service  or  for  the  population  of  Lancashire  &  South 
Cumbria to have access to the service elsewhere in the region during nighttime hours 
(10pm to 8am). 

National service development and improvements 

Since  January  2021,  the  national  stroke  programme  has  been  engaging  with  the 
General  Medical  Council  (GMC)  and  Royal  College  of  Radiologists  to  support  the 
development  of  a  thrombectomy  credentialing  programme,  including  enabling  non-
INRs, such as Neurosurgeons, Stroke Physicians and Cardiologists, to be trained and 
supported  to  perform  thrombectomy  and  address  the  workforce  gap.  The  GMC 
credential was published in June 2023. A substantial amount of revenue funding has 
since been made available to deliver the credentialing programme and the first cohort 
of  trainees have  already  been enrolled  and started  the  credential. The  trainees are 
completing  the  credential  alongside  their  full-time  NHS  employment  in  their  main 
speciality, but it is hoped that some will be signed off within the next year. There have 
also been non-INRs, such as Interventional Radiologists, who have developed the skill 
of delivering mechanical thrombectomy and have joined the workforce in some units 
outside of this new route / credential. 

I  would  also  like  to  advise  you  that,  alongside  the  national  quality  improvement 
programme, further work to ensure the ongoing service development of mechanical 
thrombectomy  services  has  been  supported  by  a  programme  of  NHS  England  site 

 
 
 
 
  
 
 
 
 
  and our National 
visits, led personally by my predecessor 
Clinical Director for Stroke Medicine, 
. During 2024, they visited every 
CSC  in  England  to  understand  the  local  barriers  and  successes,  support  quality 
improvement,  bring  together  the  wider  thrombectomy  stakeholders  to  discuss 
collaborative opportunities and provide specific, jointly agreed, measurable actions for 
each centre. Each CSC was given a list of recommended actions in order to improve 
access  to  thrombectomy,  focusing  on  pre-hospital  video  triage,  ensuring  timely 
diagnostic  pathways,  encouraging  training  for  non-INRs  and  optimising  all  training 
opportunities generally to increase the workforce, developing repatriation policies to 
ensure  that  centres  always  have  free  beds,  collaborating  between  units,  and  data 
accuracy. 12 CSCs have received second visits during 2025, to reflect on the uptake 
of actions. 

Following  their  visit  to  the  CSCs  at  Royal  Preston  Hospital,  Salford  Royal  and  the 
 issued 
Walton Centre in April 2025, 
a letter in June 2025 to LTH, the Northern Care Alliance NHS Foundation Trust, and 
the Walton Centre NHS Foundation Trust. This outlined their recommendation that an 
urgent  review  of  mechanical  thrombectomy  provision  within  the  North  West  is 
undertaken  by  commissioners,  and  set  out  their  expectation  that  a  fully  operational 
24/7 service is achievable at the Preston site by October 2025.   

 and 

I  would  also  like  to  provide  further  assurances  on  the  national  NHS  England  work 
taking  place around  the  Reports  to  Prevent Future  Deaths.  All  reports  received  are 
discussed  by  the  Regulation  28  Working  Group,  comprising  Regional  Medical 
Directors,  and  other  clinical  and  quality  colleagues  from  across  the  regions.  This 
ensures  that  key  learnings  and  insights  around  events,  such  as  the  sad  death  of 
Michelle, are shared across the NHS at both a national and regional level and helps 
us to pay close attention to any emerging trends that may require further review and 
action.   

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,  

National Medical Director 
NHS England
Response from Northern Care Alliance NHS Foundation Trust (PDF)
Chief Executive Office 
NCA Headquarters 
3rd Floor 
Mayo Building 
Stott Lane 
Salford 
M6 8HD 

Telephone: 

Email : 

29 July 2025  

Mr Christopher Long 
HM Senior Coroner for Lancashire with Blackburn and Darwen 

Sent via email to: 

Dear Mr Long 

Inquest into the death of Michelle Mason 

Thank you for bringing your concerns about the availability of thrombectomy services across 
Lancashire and Cumbria to my attention in your Preventing Future Deaths Report, dated 2 June 2025. 

I was saddened to read the circumstances of Ms Mason‘s death and would like to start by offering my 
condolences to her family. I would also like to emphasise our commitment to working collaboratively 
with partners across the Northwest (NW) to ensure 24/7 provision is available for all patients across 
the region. 

Matters of Concern 

The matters of concern that you raised are: 
“(1) NHS England national service specifications provide for a 24/7 thrombectomy service which is not 
currently being delivered in Lancashire and there is no clear plan to deliver that service 
(2) There is a lack of understanding from non-stroke specialist clinicians in Lancashire as to when and 
where thrombectomy services are available for patients in Lancashire 
(3) There is no mutual aid regionally, even where thrombectomy is available, clinically appropriate, it 
is known lack the procedure is likely to result in death and it is anticipated resources are available to 
complete the procedure. ” 

Response 

Matters of Concern 1 and 2: 

The Northern Care Alliance NHS Foundation Trust (“the Trust”) is commissioned to provide 
mechanical thrombectomy services across Greater Manchester. The Trust is not in a position to 
respond to the first and second areas of concern. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Matter of Concern 3: 

I understand that evidence was given to the Inquest that a transfer to Salford Royal Hospital for a 
thrombectomy was not an option for Ms Mason, as she was unfortunately outside of the time critical 
clinical window for the procedure.  

Geography and transfer times are a critical consideration for thrombectomy services.  Every hour of 
delay from stroke onset to treatment equates to a 10% loss of function and the geographical 
catchment for services takes this into consideration. Transfer times from Lancashire and Cumbria 
make the provision of thrombectomy at Salford Royal Hospital within the clinically required timeframes 
for this population challenging to achieve, with potential impact on patient outcomes. Access to 
imaging is critical to facilitating the rapid clinical decision-making required for safe, timely care. For 
patients in the Lancashire and South Cumbria catchment, this is not currently available to our 
clinicians. I believe this also applies to provision by the Walton Centre for Neurology and 
Neurosurgery NHS Foundation Trust in Liverpool. 

These challenges are recognised by NHS England (“NHSE”) and are the subject of ongoing 
discussions. It is our understanding that the service provided from Royal Preston Hospital now covers 
7 days per week, 8am – 10pm. The team here at Northern Care Alliance will continue to work with 
NHSE, Lancashire Teaching Hospitals and the Walton Centre to explore options to provide the 
Lancashire and South Cumbria catchment with access to this service overnight. A meeting between 
the Trust, NHSE and Lancashire Teaching Hospitals took place on 15 July 2025 to discuss this, 
where possible options for providing aid overnight were explored. Follow-up meetings will include 
representation from all NW thrombectomy providers to ensure all possibilities are thoroughly explored 
and will aim to progress plans and clarify timelines. We will work with our clinicians to support this 
process. 

Our thrombectomy service is based at Salford Royal Hospital and is an integral part of stroke services 
for the population of Greater Manchester. It has developed over many years to ensure quality and 
resilience; and is the largest service in the country outside London. We are working closely with 
Professor Stephen Powis (National Medical Director of NHSE England) and Dr David Hargroves 
(National Clinical Director for Stroke) to further expand capacity and to improve the resilience of 
equipment infrastructure.  

As Chief Executive of the Northern Care Alliance NHS Foundation Trust, I commit to continuing to 
support the discussions with other key stakeholders to help improve access to thrombectomy services 
for all patients across the North-West, while maintaining quality and long-term sustainability.  

Yours sincerely 

Chief Executive Officer 

Copy to : 

, Chief Executive, NHS England 
, Chief Executive, Lancashire Teaching Hospitals  

Ms Mason’s family:
Response from University Hospitals of Morecambe Bay NHS Foundation Trust (PDF)
From: 
To: 
CC: 
Sent: Fri Jun 27 2025 16:11:08 BST 
Subject: RE: Your ref: 

 Our ref: 

, 

, 

(Attachments:) 1000184966.jpg, 1000184968.jpg 

Dear Mr Long 

Thank you for granting the Trust a short extension to respond to your request for confirmation as to the 
steps being taken to ensure that staff clearly understand what thrombectomy services are available.  
Please accept this message as the further information requested. 

The Clinical Lead for Emergency Medicine at Royal Lancaster Infirmary (RLI) has advised that learning 
from Michelle’s case and feedback from the inquest have been shared with the team by email and on the 
WhatsApp group.  The RLI Emergency Department (ED) Service Manager has confirmed that the case 
was also discussed at the ED monthly clinical governance meeting. 

Royal Preston Hospital (RPH) provides details of thrombectomy service hours via a weekly email.  For 
UHMB, this has previously been sent to the Stroke Service Manager and the Matron for the Emergency 
Department at RLI but the RLI ED Service Manager has spoken with RPH to request a wider distribution 
to ensure everyone is sighted.  The operational hours are shared with the WhatsApp group.  It is also 
printed and added to the doctors’ huddle folder and the daily ED huddle sheet for sharing with the team 
every morning.  The huddles are short meetings held for communication purposes.  The handover sheets 
are a structured record of the key issues in relation to patient care and staffing. Copies are attached 
above for reference. The RLI ED Service Manager, or deputy, also sends the thrombectomy service 
hours along with the weekend staffing lists, which are emailed out to the team every Friday.  

From a nursing perspective, the service times have been shared with all staff and each individual member 
of the team is being spoken to and a record kept of the date and time when this is done. It has also been 
added to the nursing handover. Since the inquest, a "Thrombectomy hours" wipe clean board in the ED 
has been implemented, which the stroke nurses have agreed to update daily.  

The UHMB Stroke team is available from 08:00 to 20:00 to facilitate access to thrombectomy and UHMB 
stroke nurses are on duty when the service is operational and are familiar with the arrangements.  

I hope this information provides the reassurance required but if you would like anything further, please do 
not hesitate to contact me. 

Yours sincerely 

From: 
Sent: 25 June 2025 18:26 
To: 
Cc: 

Subject: Re: Your ref: 

 Our ref: 

Granted 

Mr Christopher Long  
HM Senior Coroner 
Lancashire and Blackburn with Darwen 

; 

; 

 
 
 
 
 
 
 
 
  
  
  
  
  
  
  
 
  
  
 
 
 
 
  
  
 
 From: 
Sent: Wednesday, June 25, 2025 6:14:01 PM 
To: 
Cc: 

Subject: Your ref: 

 Our ref: 

Dear Mr Long 
I was informed that following the inquest touching the death of MM, you had some outstanding concerns 
about how clearly staff at University Hospitals of Morecambe Bay NHS Trust (UHMB) understood what 
thrombectomy services are available.  I understand that witnesses gave evidence that the Trust was 
taking steps to address this and you asked that the Trust confirm what steps were being taken, within 28 
days. 

I have been provided with some relevant information to share with you but am waiting for clarification on a 
couple of points that weren’t entirely clear to me as a non-clinician, so I write to ask if you would be kind 
enough to agree to the extension of the 28 day deadline until the end of this week please? 
Yours sincerely  

Head of Legal Services 
University Hospitals of Morecambe Bay NHS Foundation Trust 
Phone: 
Email: 
Web: http://www.uhmb.nhs.uk 

Work-life balance is important, so while this is a good time for me to email, I do not expect 
a response outside normal working hours 

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The content may be personal or contain personal opinions and unless specifically stated or followed up in writing, the content cannot be taken to form a 
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