Debate contribution: Thrombectomy Service

Debate contribution by Mr Mike Nesbitt on 10 February 2026.

MLA

Mr Mike Nesbitt

Party at the time

Ulster Unionist Party

Date

10 February 2026

Type

Debate contribution (made as a minister)

Business

Opposition Business

Heading

Thrombectomy Service

Assembly identifier

Official Report component 5435857

Read the official Assembly record

Text

Deputy Speaker, thank you. Thank you to the Opposition for tabling the motion, and to everybody who has contributed to the discussion. Stroke is a major health issue. Approximately 3,000 people are admitted to hospital every year after a stroke and more than 40,000 survivors of stroke live in our community. As Members have noted, my Department's 'Reshaping Stroke Care' action plan was published in June 2022. It sets out a range of commitments to improve services across the entire pathway from prevention to rehabilitation. At the time it was published, it was clear that we can and must do better, and I provide an assurance that I and my Department remain committed to so doing. I am aware of the benefits of thrombectomy. It is a life-saving treatment for some. The evidence is clear: thrombectomy significantly reduces the impact of a large, disabling stroke. Evidence also suggests that thrombectomy is highly cost-effective. The savings as a result of thrombectomy are realised through reductions in hospital length of stay, demand for rehabilitation and longer-term care, either at home or in a residential or nursing home setting. There will also be wider savings at a societal level with, for example, improved outcomes reducing economic inactivity as a result of a stroke. As Members have noted, it is estimated that up to 10% of stroke patients could benefit from thrombectomy and our current rate is just over 5%. While the service can be provided up to 24 hours after the presentation of stroke symptoms, it is clear that the benefit is maximised if it is provided within six hours of having a stroke. In 2020, my predecessor, Robin Swann, took the important step of extending provision to a seven-day-a-week service. As such, thrombectomy is now available at the Royal Victoria Hospital from 8.00 am to 5.00 pm, seven days a week. However, I acknowledge that there is more to be done, especially as the absence of a 24/7 service means that not everyone who could benefit from a thrombectomy in Northern Ireland can access the procedure. I agree with Mr Donnelly: that is an inequality and an inequity that needs to be addressed. It is important to recognise that, in the absence of a 24/7 service, innovative solutions have been put in place to maximise equitable access to thrombectomy within the current hours of operation, but it does not close that gap. It includes the introduction of artificial intelligence in stroke imaging in all stroke-receiving units, which helps to identify patients who are suitable for thrombectomy and avoids futile transfer of patients from any of the other seven stroke-receiving units. An out-of-hours thrombectomy assessment protocol has also been developed, which will ensure that patients who present out of hours have the appropriate assessments in their local stroke-receiving hospital, and that steps are taken to facilitate an early morning transfer to the Royal Victoria Hospital for treatment where appropriate. In addition, a revised repatriation protocol has been introduced to ensure repatriation from the Royal Victoria takes place as soon as possible. The time frame for repatriation has moved from 24 hours to some patients now being eligible for repatriation from six hours post-procedure. That, of course, improves patient flow and increases bed capacity at the Royal. I take this opportunity to pay tribute to the team here in Northern Ireland for their achievements in maximising access to thrombectomy. Priority 4 in the action plan makes a specific commitment to expand the current thrombectomy service in Northern Ireland to 24/7 availability by the end of 2024, as Members have noted. I understand the frustration at that timescale not being met. The collapse of the institutions shortly after the action plan was published, combined with the unprecedented budgetary position, has, regrettably, had an impact on that delivery. However, let me be clear: the implementation of the 24/7 service remains a key focus for me and my Department. The case for investment in services like thrombectomy to support a 24/7 service is compelling. The cost-effectiveness and the potential savings as a result of the intervention are well recognised. The expansion of the current service will require significant additional investment. A costed model has been completed, and the estimate is that it would cost just over £5 million in recurrent funding to deliver a 24/7 service. That funding could achieve a 10% thrombectomy rate and deliver up to 160 additional procedures per year. As Members will know, it is £5 million, but it is £5 million that I do not have. That does not necessarily mean that it will not happen. The investment would also address pressures in other areas, such as diagnostic radiology and aesthetics and TIA services. As such, my officials are working to refine that estimate further and quantify what additional system capacity that investment would achieve.

Consideration is also being given to phasing a 24/7 service. We are aware that it will take time to reach 10% activity once a 24/7 service commences, and a phasing of costs might be possible. I have been advised that a 24/7 service could be delivered within months of funding being made available. I am glad to say that the Belfast Trust has expressed strong interest in making that happen as soon as the funding is approved and will make every effort to support the adoption of any new service. Work is ongoing to draft a business case that reflects the costs, the phasing and the capacity in addition to thrombectomy, which will be generated by the investment. That should be completed in a number of months. I give way to Mr Donnelly.

The societal savings from people not being economically inactive are stark. It is also about the quality of people's lives, and that should be the priority over the money. As Members should know, we started the year with a deficit in the health service budget of some £600 million. That is unprecedented, and, as I warned, it has turned out to be unmanageable. Paula Bradshaw asked what the obstacle is. Well, the obstacle is money. I am surprised that any Member does not recognise that the funds are the obstacle. Yes, I am the Minister, but I am not master of the money: the permanent secretary is the accounting officer. He has legal obligations. He has a duty, apart from anything else, not to endorse a spend that he knows the Department cannot afford. I will return to the money in a moment. It is important to recognise that, while thrombectomy is potentially life-saving for the 10% of patients who can benefit from it, the stroke action plan sets out a range of commitments to improve services across the pathway for the benefit of all. While capacity and funding constraints have impacted on the pace of delivery, progress in key areas has been made. In terms of prevention, that includes the development of a regional model for TIA, or mini-stroke, services. There is also an ongoing focus on improving thrombolysis treatment rates, with the aim of achieving a rate of 16%. To that end, Altnagelvin Area Hospital has been selected as one of a number of sites in the UK to participate in the thrombectomy and thrombolysis in acute stroke collaborative. That is an NHS Elect quality-improvement initiative to improve thrombectomy and thrombolysis rates. As regards support for stroke survivors, models have been developed for stroke services and spasticity services that are integrated in the community. Analysis is also ongoing on the sustainability of our current stroke units, which includes consideration of future demand up to 2040. That will be informed by a stroke workforce review that is under way and is currently focused on the hyper-acute and acute stroke workforce. I return to funding constraints and the £600 million gap. The health and social care system, as it stands, is financially unsustainable. People are waiting too long to access vital services, and we have been unable to take forward all of the developments that we would want to take forward, including those in relation to thrombectomy. I am clear that the way to address that is to work differently and to try to deliver services and improve health outcomes with the resources that we have available. I have taken a number of decisive steps to progress that. The reset plan focuses on a new model of care that is a neighbourhood-centred, preventative and integrated service, prioritising investment in primary and community care, where we can deliver better outcomes at lower costs. Within my Department, a system financial management programme has been established. That programme contains a series of projects that are intended to reduce costs and drive value across all aspects of our system. A number of Members referenced cooperation with the Republic of Ireland, and I want to touch on that. I begin by repeating what I have said from the get-go: I have no ideological or political objection to cross-border cooperation on health — in fact, quite the opposite — where it makes sense.

We have begun conversations with the Department of Health in Dublin about a 24/7 thrombectomy service; in fact, on 16 September 2025, officials commenced discussions on opportunities for all sorts of cross-border collaboration. The potential for a 24/7 thrombectomy service at the Royal Victoria Hospital that would serve some residents of the Republic of Ireland was on the agenda. We are waiting for the assessment of those potential opportunities. I say to Mr McGrath that the history of cross-border cooperations suggests that, while the Government of Ireland will invest, they tend to wait until the service is up and running and proven before they will get involved, rather than investing in the establishment of the service. I do not think that Mr McGrath mentioned the Shared Island Fund, but, so that it is not an elephant in the room, I say that I do not believe that it would be an appropriate vehicle, because the service would require recurrent resource funding, which the Shared Island Fund does not provide. It would be more of a service-level agreement between the two Health Departments.

I absolutely agree that, in principle, we would look at a graduated or evolving roll-out of the service. I am keen on that. It makes sense in the current financial situation, because it is not all or nothing. Let us see whether we can find something in-between that is manageable, affordable and sets the direction of travel. The Member knows that, in the months remaining to me, hopefully, as Minister through to 6 May 2027, I hope to set directions of travel that the next Minister of Health will feel they want to follow over the five years of the next mandate, and that is where we really should see significant improvements.

I am intent on trying to address rurality where it becomes an issue. It becomes an issue across Health and Social Care delivery: absolutely. I go back to the point that you cannot have an acute hospital at the end of every street. There has to be a bit of common sense and pragmatism in how we deal with the matter. However, I certainly do not want any disadvantage to fall on somebody who chooses to live in a rural community. There should not be a particular advantage given to someone because they live in an urban area and are close to an acute hospital that provides stroke services.

My plan is to look at hospitals as a network. The big issue will not be that people are not prepared to travel but that people who need to travel do not have easy access to transportation. It would be a significant minority of people — at least 10% and possibly higher — and it needs to be addressed. I recognise how impactful thrombectomy can be. For our stroke patients, the impact on outcomes is profound, and that has been clearly demonstrated in all the documentary evidence. I also recognise the impact that the lack of a 24/7 service has on our dedicated and committed workforce. I get the sense of moral injury that Mr Donnelly referred to, and I see it when I am out and about every week. Engagement with stroke clinicians has highlighted the concerns of the workforce about the inability to deliver time-critical treatments for stroke patients. This morning, I had a good meeting about clinical priorities for the next financial year, and thrombectomy was on the list. If I turned it into a mental wish list of my own, a 24/7 thrombectomy service —

— does not come out badly.

2,101 words. Text as published by the Northern Ireland Assembly.

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Assessed 21 October 2026 at 14:52 UTC by jev-1.13.0 (requested as typesafe/jev) under rubric 2026.10-r9, methodology 1.9.

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