Thousands of people who have had a stroke are ending up severely disabled or dying because the NHS has too few specialists to treat them quickly enough, senior doctors are warning.
A chronic shortage of stroke consultants across the NHS means that patients are suffering horrendous consequences because of delays in getting clot-busting drugs and surgery, they said.
“People are either dying or living with disability unnecessarily because they’re not getting the correct evaluation and treatment by the right expert at the right time,” Prof David Werring, the past president of the British and Irish Association of Stroke Physicians (BIASP), told the Guardian.
Many hospitals cannot urgently diagnose stroke patients and give them time-critical treatment to maximise their chances of a full recovery “because we haven’t got enough consultants”, Werring said. “The shortage means that when people have an acute stroke, they cannot be sure of receiving an expert consultant opinion to get the right diagnosis and the right treatment at the right time.”
About 100,000 people across the UK have a stroke each year. Between 10,000 and 20,000 of them died or sustained a serious disability because of treatment delays linked to staff shortages, said Dr Sanjeev Nayak, a senior stroke specialist at Royal Stoke hospital.
“It is heartbreaking to see the real and avoidable impact that workforce shortages have on patient outcomes. In my experience workforce shortages directly lead to avoidable disability and, in some cases, avoidable death,” said Nayak, a consultant interventional radiologist.
“It is reasonable to estimate that around 10-20% of stroke patients each year are left avoidably dead or more disabled than they otherwise would have been because of delays in the system. Those delays are multifactorial, but workforce shortages – in stroke physicians, nurses [and other staff] – are a major, repeatedly identified contributor.
“Given that stroke affects around 100,000 people a year in the UK, this translates into many thousands of patients annually whose outcomes could have been materially better with timely access to adequately staffed stroke teams.”
Nayak pointed to the annual reports produced by the Sentinel Stroke national audit programme team based at King’s College London, which assess the NHS’s performance in England, Wales and Northern Ireland against official guidelines for stroke care.
Its most recent report found that it took four hours and 11 minutes to get someone who had had a stroke to hospital in 2024-25, longer than in 2023-24 and more than 90 minutes longer than a decade ago.
And just 46.5% of stroke patients last year were admitted to a specialist stroke unit within four hours of their arrival in hospital, about level with the previous year but down more than 10 percentage points on a decade ago.
New research undertaken by BIASP has shown that longstanding gaps in the stroke medical workforce are getting worse, despite the ageing population and unhealthy lifestyles leaving more people needing hospital treatment after a stroke.
Its survey of the 100 hospitals in England that provide acute stroke care found that:
70% of stroke units are short of at least one consultant in stroke care, and many are two down.
53 of 84 hospitals that responded had vacancies for a total of 96 consultants.
The NHS relies heavily on locum doctors to fill holes in the workforce caused by the difficulty in recruiting new consultants.
10% of the NHS’s 423 substantive (permanent) consultants are due to retire in the next five years, exacerbating the existing shortage.
Together the results revealed “a significant worsening in the workforce position in the NHS in England”, with more unfilled vacancies than previously thought, Werring said.
The lack of consultants meant that some smaller hospitals did not have a senior specialist on duty around the clock to decide on the care of stroke patients who arrived in the evenings, overnight or at the weekend, said Dr Louise Shaw, BIASP’s current president.
“That’s very unacceptable,” Shaw said. “All patients admitted to a hospital with an acute stroke should have access to an immediate stroke consultant opinion and advice on their care. And at the moment that’s not available.”
Key stroke treatments such as thrombolysis (using clot-busting drugs) and mechanical thrombectomy – surgery to remove a blood clot from the brain – were extremely time-critical, Nayak said. “When services are understaffed, patients miss treatment windows altogether or are treated too late, resulting in far worse neurological outcomes that could have been prevented … Delays in specialist assessment or transfer to a thrombectomy centre can mean the difference between independent recovery and devastating, lifelong disability – or not surviving at all.”
Werring said hospitals in rural, coastal and more deprived areas were most likely to have a shortage of stroke consultants.
Patients were being denied “time-critical, life-changing” treatment because of staff shortages, the Stroke Association said. “We know harm is happening because there simply aren’t enough stroke specialist staff.”
The situation revealed by BIASP’s audit threatens Labour’s chances of fulfilling its pledge to cut deaths from heart disease and stroke by 25% by 2035. Labour’s plan for change last year said: “We want to see fewer lives being lost to the biggest killers, including cancer, cardiovascular disease and stroke, and suicide. This means diagnosing and treating patients earlier.”
The Department of Health and Social Care (DHSC) is drawing up a plan, which will be published this year, to deliver the 25% ambition. England-wide guidelines say stroke patients should receive “seamless, joined-up care at every stage” of their NHS treatment.
The DHSC did not respond directly to BIASP’s findings. A spokesperson said the NHS had 7,000 more doctors than the same time last year. “And our upcoming workforce plan will set out how we ensure the NHS has the right people in the right places, with the right skills to care for patients when they need it.
“We are committed to improving stroke prevention, treatment and recovery, including by setting new national standards for how cardiovascular disease care should be delivered across the NHS.”
The number of people in the UK who have a stroke is expected to rise from 100,000 to 151,000 a year by 2035, Stroke Association analysis has found.
