World Stroke Day, on Thursday 29^th October, raises awareness of the signs of stroke and the need for urgent action. With the World Stroke Organisation estimating that one in four adults will have a stroke in their lifetime, this year’s campaign urges everyone to #ActFAST. Every minute without treatment may mean further loss of brain tissue, while prompt emergency assessment can preserve access to treatments that may materially improve the prospects of recovery.

For clinicians, time is central to stroke care. For solicitors investigating potential negligence in stroke care, it is often a crucial issue for their legal analysis too: when symptoms began, how quickly they were recognised, whether appropriate investigations and referrals were made, and whether time-critical treatment should have been offered within a clinically effective window.

Why every minute counts

Access to time-critical stroke treatment is improving but still falls well short of what is possible. The latest Sentinel Stroke National Audit Programme (SSNAP) State of the Nation report, covering care between April 2024 and March 2025, found that:

• the proportion of stroke patients receiving thrombolysis rose to around 12%, the highest rate recorded since SSNAP began
  
• 4.4% of stroke patients received mechanical thrombectomy, up from 3.9% the previous year, but still below the European average
  
• door to needle times increased marginally, as eligibility for thrombolysis has extended to later time windows
  
• the median time from stroke onset to hospital arrival rose again, to 4 hours 11 minutes, compared with 2 hours 25 minutes in 2013/14
  

The Stroke Association has noted that thrombectomy rates remain well below the 10% national target, with wide regional variation. Recent quality improvement work has shown what can be achieved: a national collaborative supporting 18 stroke teams delivered relative increases in thrombolysis rates of around 50%.

For solicitors, these figures demonstrate why chronology and clinical evidence are so often central to stroke claims. Delays in recognising symptoms, obtaining and interpreting imaging, referring for thrombectomy or starting treatment may affect a patient’s eligibility for treatment. Establishing whether a delay affected eligibility is only part of the assessment. The key questions also include breach of duty, the treatment the patient would probably have received without the delay, and whether earlier intervention would have made a material difference to the outcome.

An expert perspective

Dr Neil Hunter, Consultant in Stroke, Geriatric and General Internal Medicine and expert witness with McCollum Consultants, explains:

“Rapid identification of stroke allows patients to be considered for thrombolysis and mechanical thrombectomy, two treatments that can dramatically reduce disability when delivered within the right time window. With appropriate advanced imaging, the window for thrombolysis can now be extended from the traditional 4.5 hours to 9 hours, and thrombectomy can be performed up to 24 hours after symptom onset in suitable patients. Equally important is the timely assessment of patients with TIA or minor stroke. Early aspirin reduces the risk of recurrent ischaemic stroke over the following six weeks by about 60%, while anticoagulation for atrial fibrillation reduces the annual risk of stroke by around two-thirds.

“From a medico-legal perspective, delays at any stage of the pathway can have significant consequences. Delayed recognition of symptoms, delays in imaging, failure to refer for thrombectomy assessment, or failure to initiate secondary prevention may all increase the likelihood of avoidable recurrence or preventable disability.

“The advances seen in stroke outcomes over recent decades are not solely due to new treatments. They are the result of streamlined systems that ensure patients are assessed, investigated and treated quickly. On World Stroke Day, it is important to recognise that timely intervention remains one of the most powerful tools we have to reduce the burden of stroke and improve long-term outcomes for patients.”