If you experience a heart attack or serious head injury in Northern Ireland, you can rightly expect to receive emergency treatment day or night. A stroke is just as urgent, but access to one of the most effective emergency stroke treatments still depends on the time of day.

Every three hours in Northern Ireland, someone has a stroke and it remains a leading cause of death and disability. Most strokes are caused by a blood clot blocking an artery in the brain. As long as the clot remains, brain tissue is deprived of blood and oxygen.

Thrombectomy is an acute treatment in which a specialist doctor manually removes the clot, allowing blood to flow again. It is highly time-sensitive and the quicker the procedure takes place, the more brain tissue can be saved. Around 10 to 15% of stroke patients are estimated to be eligible for the treatment. Yet too many people who could benefit still miss out because the service is currently only available between 8am and 5pm. The Stroke Association’s Saving Brains campaign is calling for every eligible patient in Northern Ireland to have access to thrombectomy, no matter when they have their stroke.

When delivered, thrombectomy can restore blood flow within minutes, prevent severe lifelong disability, increase the chances of recovery and reduce the risk of death. Many countries are investing in access to it, and the World Health Organisation has identified thrombectomy as an effective intervention in cardiovascular disease care. It is also highly cost-effective. It is estimated that each patient who receives thrombectomy saves around £47,000 over five years by reducing disability, bed days and long-term care costs.

Delivering a previous commitment and advancing reform

Northern Ireland has a relatively high thrombectomy rate compared to other parts of the UK, reflecting years of work by the stroke team at the Royal Victoria Hospital (where the unit is based) and across the wider stroke pathway. However, the service remains restricted to daytime hours, meaning that for most of the day patients who could benefit are unable to receive treatment. As a result, around 140 people every year miss out on access to thrombectomy.

The current position falls short of a commitment already made in the 2022 Stroke Action Plan, which promised to move to a 24/7 thrombectomy service by the end of 2024. It is now 500 days since that deadline passed, and the service has not yet been delivered.

Thrombectomy is exactly the kind of reform that Northern Ireland’s health system should prioritise. The Health and Social Care Reset Plan is focused on stabilising services, improving productivity and delivering visible improvements for patients at pace. Moving to a 24/7 thrombectomy service is a clear opportunity to demonstrate that ambition in action.

The wider picture across these islands provides an interesting comparison. In the Republic of Ireland, 24/7 thrombectomy is already available at Beaumont Hospital in Dublin and Cork University Hospital. Dublin began with a 24/7 model and scaled the staffing structure over time as the service developed. This experience shows that round-the-clock provision is achievable and can be built sustainably.

Westminster is also moving on a commitment to establish 24/7 thrombectomy provision across England. Northern Ireland has already shown leadership in thrombectomy, but without renewed investment and delivery it risks losing momentum and more people missing out.

The wider picture: the emergency stroke pathway

A 24/7 thrombectomy service is essential, but it will only deliver its full benefit if the wider emergency stroke pathway is optimised around it. There are practical improvements to build on, such as the PITSTOP pilot at Altnagelvin, developed with the Northern Ireland Ambulance Service. Under the usual pathway, an ambulance may hand over a stroke patient and leave, with a second ambulance later required if scans show that the patient may be suitable for thrombectomy. Under PITSTOP, the original ambulance waits while eligibility is assessed and, where appropriate, transfers the patient directly to the thrombectomy unit at the Royal Victoria Hospital. This reduces avoidable delay in inter-hospital transfer and shows how pathway optimisation can help patients access thrombectomy faster.

Ambulance capacity is also key. Stroke falls within Category 2 calls, which have an 18-minute mean response target. In 2024/25, that target was not met in any month, and the longest mean response time during the period was 1 hour 50 minutes and 2 seconds. For patients who may be eligible for thrombectomy, these delays can mean the treatment window is narrowing before they even reach hospital.

The ask of the Saving Brains campaign is clear: fund 24/7 thrombectomy and the pathway that makes it work. Northern Ireland’s stroke teams have already shown what can be achieved. They have built a service with the highest thrombectomy rate in the UK despite significant workforce and resource pressures. But full access for all eligible patients cannot rely on goodwill. It requires Executive backing and recurrent funding.

Addressing campaigners on 19 May, the Health Minister said that moving to a 24/7 thrombectomy service is a priority, but that this is subject to Executive agreement on the Department of Health budget.  If confirmed, this would be a major achievement and an important moment for stroke care in Northern Ireland. The focus would then move to delivery through supporting stroke teams with a clear timetable for expansion and the pathway improvements needed to help patients reach treatment as quickly as possible.

Stroke is a medical emergency and should be treated with the same urgency as other life-threatening conditions. When someone has a stroke, their chance of recovery should not depend on the time of day, their postcode, or whether a specialist team can be assembled out of hours. Northern Ireland has already shown what better stroke care can look like. We now need the Department of Health as well as the wider Executive to back the stroke workforce, fund a 24/7 service, improve the pathway and make sure no eligible patient misses out on thrombectomy simply because of when their stroke happens.

Lauren Shaw, is the Policy and Influencing Lead for the Stroke Association in Northern Ireland. Working alongside stroke survivors, clinicians and decision makers, she is campaigning for better stroke care and support, including 24/7 access to thrombectomy.

You can find out more about the Stroke Association’s services and campaigns in Northern Ireland here.