Stroke: Aftercare

Covid-19 and Health Inequalities: West Yorkshire – in Westminster Hall at 4:57 pm on 21st April 2021.

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Photo of Bob Neill Bob Neill Chair, Justice Committee, Chair, Justice Committee 4:57 pm, 21st April 2021

I beg to move,

That this House
has considered the National Stroke Programme and aftercare and rehabilitation services for stroke patients.

It is a pleasure to serve under your chairmanship, Sir Edward, and bring this debate to Westminster Hall. It is an important topic in which, as will become apparent, I have a personal interest. However, it is worth setting out the national significance of stroke and in particular stroke aftercare, because over recent years we have made huge advances in public awareness of the symptoms of stroke—the messages to look out for the signs of it, and to get urgent help, have cut through. The acute treatment of stroke has vastly improved, and many more people, thank heavens, are able to survive it. All those are good things. There have been real advances in medical science and technology in that regard.

The area where, I am sorry to say, we lag behind is what happens next. The NHS is brilliant at lifesaving and acute work, but it is in the follow-up for those who survive stroke and are left with the consequences where, it seems to me, we have more to do. In this debate, I want to concentrate on that and draw it to the attention of the House—and, I hope, to the attention of the wider public too.

I mentioned that I had a personal interest in this, Sir Edward. As some hon. Members may know, in July 2019 my wife, Ann-Louise, suffered a severe stroke—15 on the national stroke scale. We were fortunate that we had brilliant acute treatment at the Princess Royal University Hospital in Bromley and some good aftercare. She came through, but the truth is that she was left with a number of impairments thereafter because of the position of the stroke. Like so many stroke survivors I have met since, she continues to fight bravely and determinedly to come back from the stroke, and to get back to where she wants to be. It can be done, but it is a long and hard road. It requires courage and patience, but also consistent professional support, and it is that last thing that I think we need to do more to achieve.

In our case, Ann-Louise was unconscious for about three days. We were fortunate that the Princess Royal University Hospital at Farnborough Common is a regional centre of excellence, as part of the King’s College Hospital NHS Foundation Trust, and therefore she received superb treatment. However, she of course needed rehabilitation, which she received at the Ontario unit of Orpington Hospital, again provided by excellent and dedicated people.

However, the sad truth was that the unit was not resourced to deliver the level of consistent rehabilitation that it would wish to provide for Ann-Louise and other patients. For example, during the several weeks she spent there, it was not possible to deliver the therapies per week to the level set out in the National Institute for Health and Care Excellence clinical guidelines. I am sorry to say that is by no means an unusual state of affairs.

Frankly, there was a difficulty with the availability of therapists because of an inability to cover maternity leave, sick leave and so on, and there were shortages, particularly of speech and language therapists. It was never possible for Ann-Louise or the other patients to consistently receive the hours for five days a week that are set out in the NICE guidelines.

In the end, we were able to get private treatment and private rehabilitation for Ann-Louise at the Wellington Hospital in London. Again, dedicated people did great work there. However, the truth is that many families are not in a position to do that. I was very struck by one lady who was in the same bay as Ann-Louise in Orpington Hospital. She was only in her mid-40s, I think. She had a 16-year-old daughter and the consequences of the stroke that she suffered were much more severe than those of Ann-Louise’s stroke. She was there when we arrived and she was still there when we left, and frankly it was not possible to see any significant improvement in her condition. It is for people like her that one worries even more, because they are not in a position to seek some of the help that we were able to seek.

Ann-Louise eventually came home the day after the general election in 2019, so we are talking about a period of some weeks. As people may know, she was then entitled to a measure of aftercare in the community—it works out at about six weeks of occupational physiotherapy, and speech and language therapy—but thereafter it stops. I think that what we manage to do very often is to get people fit enough to be discharged back to their home, and to establish themselves initially at home. However, I do not think that we deliver on what is recognised by all the clinicians and well set out by the Stroke Association and others—consistent, long-term, programmed care over a longer period of time. That is what we want to see, and it is what is envisaged in the various programmes and plans that the Department of Health and Social Care has put in place for stroke. I think that is the area that we need to draw attention to.

After a period of time in our trust, which is a well-run trust, in effect one bids for further speech and language therapy. After another period and after a referral, hopefully one will get about three sessions, spread over a number of weeks. If targets are met, one may be in a position to seek a referral for perhaps three further sessions. However, if some of the targets are not met, and not everyone can meet them the first time around, then, because the resources are limited, very often that therapy will stop. That does not seem to me to be right or fair to people who are working terribly hard to come back from a life-changing experience.

Therefore, although there are dedicated professionals—nothing I say is to take away from the dedication of the professionals involved—we are not delivering on what we set out to do. That is a tragedy, because two-thirds of stroke survivors leave hospital with a disability. Stroke is the leading cause of adult disability in the UK. It affects about 1.2 million people in this country. Nearly 100,000 strokes happen in the course of a year. It is therefore a major issue, which needs to be addressed.

We have had in the past a national stroke strategy. There is a stroke plan, as part of the national plan. And now being developed—it is the subject of this debate—is a national stroke programme. All those plans and strategies are laudable but, as I have said, we are not actually able to deliver consistently on the targets that are set out in them, and if we cannot meet what is in the current plans, the concern is how we will meet the more ambitious targets for much more integrated stroke care that are set out in the strategy beyond that.

What we are looking at, according to all the clinicians whom I have talked to over the past 18 months or more, is really this: we have to provide effective support and rehabilitation. A lot of people think, and there is of course some evidence, that improvements are made in the first few weeks and months. Those weeks and months are critical, but there is also growing evidence that people can continue to improve, and improve significantly, beyond that, and actually we can find improvements going on over a number of years. But for people to achieve that, they must have the support.

Stroke is not a simple type of brain injury, which is essentially what it is. It varies according to the severity, where in the brain it has occurred and many other factors, and it will have varying consequences for each individual. Therefore, if we are truly to enable people to recover from stroke, they must have a personalised programme of care, rehabilitation and support, and that must be long term. Long-term personalised care is essential, but at the moment that is not happening. Sadly, the Stroke Association research suggests that some 45% of stroke survivors feel abandoned after their stroke. What is important in that context is not just the physical consequences of stroke; there are real psychological consequences as well, because it is life-changing.

My wife was a professional opera singer and a director of music at her local school. One can imagine what it has been like for her to have an impairment of speech; it weighs immensely heavily. We have met many other people who have had things that have, in effect, changed the nature of who they are. If they are to get back to who they are and can be, they need the really significant help that I have described, but they also need help with morale and the psychological impacts that there can be. That is one of the areas in which we have not been able to deliver to the level that our aspirations set out.

We are to move to the integrated national stroke service model. I am told that it is to be published imminently, but I hope that my hon. Friend the Minister will update us on that. Can we know when that is signed off? Can we know when it will come into force? If there are to be pilot schemes, where will they be? How long will that take to happen? What resourcing will be made available to support that integrated strategy? What is the plan to seek to recruit more specialist therapists, from all the disciplines, to stand behind it? All those are things that we need to have, and I hope that the Minister will be able to help us on that. Otherwise, the danger is that it becomes an aspiration, rather than a reality, for stroke survivors and their families.

Clearly, early supported discharge and integrated community stroke services are the aspiration, but at the moment, in an area such as mine, people will find that some services are provided through the hospitals. If people have more than one impairment, they may have to go to different hospitals—some for ocular work, some for vocal rehabilitation and some for physical rehabilitation. Some services will be provided through the GP, the networks and the clinical commissioning group—in Bromley, we have Bromley Healthcare, which does an excellent job—but others will be provided through a different hospital trust or health trust under contract; yet others will be provided through the local authority, social services and sometimes charities and voluntary groups. We have several stroke clubs and stroke groups in our area that do great work—the voluntary sector is amazing—but we cannot and should not depend on them to deliver part of the core service.

That is quite a minefield to negotiate. If it is difficult to negotiate for a professional family such as ours, think how difficult it is for people who may not have the resource and experience of the system, if I may put it that way, that we and others in our position have to fall back on. Pulling things together meaningfully, so that there is almost a one-stop shop that people can go to as a single point of reference and where they can call in expertise, seems to me and many experts in the field to be critical.

I referred to the importance of psychological rehabilitation. The psychologists I have met believe that much more needs to be done. I also referred to the importance of meeting our targets and the difficulties in some areas, such as speech and language therapy. For speech and language therapy nationally, the figures for meeting the NICE stroke guideline of

“45 minutes of each relevant…therapy for…5 days per week” stand at 55.2%—just over half—and in some places they fall below that. There is a huge amount more to do on that issue, and a deal more also seems to be required in supporting early discharge. The proportion of patients treated by a stroke-skilled early discharge team nationally is 41%, and in some trusts the percentage drops into single figures. That is just not acceptable, as I know the Minister will recognise. What are we going to do to get those numbers up, so that we can move on to the next stage securely?

We need to think longer-term about this. We had the great good fortune to be introduced to the National Hospital for Neurology and Neurosurgery at Queen Square in London, which does amazing work. One programme there, an intensive aphasia course, is headed up by Professor Alex Leff. It is really full on, but that proves the point—this is one of the things that our current system does not deliver—that rehabilitation has the best outcomes when it is very intensive. Spreading it out to an hour one week, an hour the next and maybe another hour in two or three weeks does not come anywhere near to delivering the level of intensity necessary to enable stroke survivors to relearn skills for the neuroplasticity that is so important for recovery of the brain to kick in. Frequent use, repetition and intensity of the therapy is so critical.

That programme is funded as part of a research project, but as far as I know it is the only one of its kind in the country. That does not seem fair. If it is that good and well documented—it is; I have seen it—surely we should seek to roll out that type of intensive treatment across the piece. Somebody should not have to go privately to get the intensiveness necessary for their loved ones to get the level of recovery that they can achieve. I hope that we can look at that, too.

I hope that that is a start to the debate. We have an hour, and I know that several hon. Members wish to participate—I am grateful to them for coming—so I hope that I have set the scene. I look forward to the Minister’s response, but I hope that once we have considered the debate we will not leave it at that. We could have a greater awareness of the topic in Parliament—I was struck by how little debate there has been in the House and how few questions have been asked on it. When I looked at the list of all-party parliamentary groups, I noticed that there is no group on stroke, although there are groups on very many other serious, life-threatening and life-changing conditions. Perhaps that is a call for hon. Members who might be interested to think about the subject and keep it in mind as parliamentarians.

Having opened the debate, I will perhaps leave it there. I might say something at the end after the Minister has finished, but I have endeavoured to stress the importance of this, because it does change lives. People with the right support can come back. So much can be got back. There is always hope afterwards, and if people have the support to achieve that hope, they can restore their lives in huge measure. It is surely our responsibility as a society to enable them properly, with the aid of the skilled clinicians that we have, to do just that.

Photo of Navendu Mishra Navendu Mishra Labour, Stockport 5:15 pm, 21st April 2021

It is a pleasure to serve under your chairship, Sir Edward. I congratulate Sir Robert Neill on securing this important debate and, in doing so, helping to shine a light on the need for greater funding for our stroke services. I associate myself with his earlier comments about a one-stop shop for support for patients and families who have suffered from strokes. I also pay tribute to the work of the Stroke Association, which has done so much to tackle this issue, including vital research and support for survivors of strokes, as well as its core role alongside NHS England in delivering our national programme.

I am proud that my local hospital, Stepping Hill, has consistently been recognised for its stroke provision. Since 2015, Stepping Hill’s stroke unit has been rated the best in England, Wales and Northern Ireland on three occasions in a report compiled by the Royal College of Physicians. There are many other charities and organisations that play an important part in providing support within our communities, including Stroke Information in my constituency of Stockport, run by Nick Clarke, who set up that organisation almost a decade ago.

In England, one in six people will have a stroke in their lifetime. New statistics released by Public Health England reveal that roughly 57,000 people each year suffer their first stroke. Unfortunately, the trauma does not end there for many survivors, with around 30% of people going on to experience another stroke. Strokes are a leading cause of death and disability in the UK, and there are around 32,000 stroke-related deaths in England alone each year. Although many associate the condition with older people, Public Health England research has shown that almost 40% of first-time strokes occur in middle-aged adults—as in, those between the ages of 40 and 69.

Furthermore, the average age for a stroke has fallen by three years over the past decade and, worryingly, most first-time strokes are now occurring at an earlier age than at the same stage 10 years ago. It is highly likely, therefore, that colleagues taking part in the debate will know someone who has been affected by this condition. Indeed, a close friend of mine suffered a major stroke last year, so this is an issue close to my heart. I am pleased that he has made a full recovery, with the incredible care and support of our NHS. My special thanks go to the entire team at Salford Royal Hospital for looking after him.

Despite the ever-present threat of strokes, the reality is that for many years research has been underfunded in comparison with other devastating and debilitating conditions such as cancer. In 2016, research by the Stroke Association revealed that just £48 is spent on stroke research per patient compared with £241 on cancer research. We need more funding for both those serious conditions. The already challenging situation has now been compounded by the devastation that the covid pandemic has had on many charities’ fundraising capabilities, meaning that millions of pounds have been lost. That has reduced their ability to continue their work and carry out critical research.

Strokes are incredibly prevalent in the UK, with one striking every five minutes, meaning that it is a leading cause of adult disability. It is therefore vital that sufficient funding is in place not only to research the causes behind the condition and help to identify preventative measures, but to support our national stroke programme, including the aftercare and rehabilitation services.

Research such as the recent study announced by the Stroke Association—the largest of its kind in the world—to investigate a possible link between covid-19 and life-threatening strokes is crucial. In particular, the report states that stroke patients who have had coronavirus may be younger and experience more severe effects of the stroke as a result, including death. It is an incredibly timely and important study that will need to be supported, given that the charity’s own research director said that the research was

“just the tip of the iceberg.”

Now more than ever, the national stroke programme needs to be given the support and funding that it requires to ensure that it can continue its vital work and deal with the rising number of cases in the UK. I therefore urge the Minister to do all she can to look again at this issue and to push her Department to ensure that the national stroke programme and associated aftercare and rehabilitation services receive increased funding that will help to meet both existing and growing demand on NHS stroke provision.

Photo of Duncan Baker Duncan Baker Conservative, North Norfolk 5:19 pm, 21st April 2021

I am grateful to my hon. Friend Sir Robert Neill for securing this important debate.

North Norfolk, I believe, had the highest incidence of strokes in the UK in 2019. I imagine that even on more recent data, that statistic has not improved a great deal. But why? We have the oldest constituency demographics in the country and, as we all know, stroke prevalence increases with age. That, however, is not the only issue. Our rural and isolated communities in North Norfolk, where many elderly people live, suffer from dreadfully slow ambulance response times. In the beautiful, picturesque area of Wells-next-the-Sea, we have the worst response times in the entire country.

Making a recovery from a stroke is all about getting that speed of treatment. There is no point having all the care in place if we simply cannot reach our residents in anything like a timely fashion. Early treatment not only saves lives, but results in that greater chance of recovery, as well as the likely reduction in permanent disability from a stroke.

We continue to work hard in North Norfolk, in particular on the local ambulance response time work group, to get patients to hospital in time for thrombolysis treatment, but it must get even better. Encouragingly, we have seen a research trial by the East of England Ambulance Service Trust, using a stroke ambulance which can scan and start thrombolysis if necessary. In rural and hard-to-reach areas, why can we not roll that out even further?

Even in 2021, there are about 100,000 strokes a year. It is a devastating and cruel condition. In July 2019, my stepfather, who was entirely my inspiration to become an MP, suffered a devastating stroke. To everyone who met him, he was a tower of energy, who shaped the community around him for some 45 years as a leading businessman in our close community of North Norfolk. Within a week of suffering a stroke, however, he passed away. I paid tribute to him in my maiden speech, wishing he could have been present to support me in this place. Instead, he passed just five months before we ever got to share that moment. That is exactly why I take such an interest in this debate.

My story is not unique. We need to do more to stop this happening again, and I think that we can. It is about investment in prevention, treatment and care. In my constituency and, I am sure, in many other rural areas, it would be achievable to invest in more early diagnosis and treatment. We need good prevention, so that TIAs—transient ischaemic attacks—and blood clots can be spotted early. We have to be proactive. In turn, of course, that pays for itself, because early prevention lessens the load on the NHS.

The two main issues that we have in Norfolk remain the lack of thrombectomy services and the unequal provision of post-stroke care and support, in particular affecting my constituents in North Norfolk. I have campaigned for more services at Cromer Hospital—an early diagnosis ward would help enormously—but such services could be improved in so many of our community hospitals throughout the country. There is simply little point in my constituency having an ambulance that will take more than an hour to get to Norwich. We have to put in place the processes and procedures to treat in that precious golden hour in which recovery chances are so improved. I understand that Cambridge is to receive a mechanical thrombectomy trial—why not Norwich?

I would love to see real investment in physiotherapy, occupational therapy, and speech and language therapy for early supported discharge. A lot of encouraging work is under way nationally, in the national stroke programme and in the rehabilitation space, and I thank the Minister for that. I hope that the suggestions in this debate will be helpful and driven forward, so that we may level up pockets of the country where people are behind the curve to ensure that everyone has the same level of success after suffering a stroke.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 5:24 pm, 21st April 2021

It is a pleasure to speak in this debate, Sir Edward, and I congratulate Sir Robert Neill on securing it. I can remember when he requested the debate during business questions—I believe it was in January—so it is good to know that the system works. We have in place two of the participants in a Westminster Hall debate on heart valves, which I think was held on a Thursday in February. This Minister responded, and the shadow Minister also made a significant contribution. I do not want to pre-empt what the Minister will say, but I think the hon. Member for Bromley and Chislehurst will be pleased with the response, because she certainly gave me a good response to my debate on heart valves. We will take the Minister up on her invitation for the all-party parliamentary group to speak to her about these matters.

This is an issue that has become very real for me, although probably not as real as it is for Duncan Baker, and for people whom I know who have had a stroke. Over a period of time, I have been greatly encouraged by those who have improved. Some improve almost back to where they were—about 80% to 85%—and others not as well, which is probably to do with age and the severity of the stroke.

I want to make three quick points to the Minister, and I am quite sure that the reply will be positive and helpful. I believe there is a need to increase the availability of clot-removing treatment—thrombectomy—to enable all hospitals to carry out the procedure. We should have a target of delivering a tenfold increase in the proportion of patients who receive a clot-removing thrombectomy in order to end their strokes, so that 1,600 more people can be independent after a stroke each year. If we are to do that in reality, we have to address some of the reasons why strokes happen. Perhaps our health conditions have not been as good as they should have been, and it is about improving people’s health. Can the Minister tell us what has been done to deliver that across every region?

Back home in Northern Ireland—I presume it is the probably the same here—we have regular adverts. Chest, Heart & Stroke has an advert on UTV that tells people what to watch out for, and it is really helpful. Can the Minister confirm whether the mainland has the same number of adverts? They tell people what to look out for. To take up the point made by the hon. Member for North Norfolk, time is of the essence when someone has a stroke. It is what people do in those minutes afterwards, regardless of whether they have the qualifications or just want to do something that helps, because time is absolutely critical.

I recently watched something on TV. It was a clip of a darts match in which a player is having a stroke. His face distorts, and he loses all power in his arm. Seeing that take place in real time has shocked me, because it really brought home the issue that pertains to those who have had a stroke, as well as what can be done in that short time. We need to incorporate a greater awareness of the warning signs. Getting help quickly makes the difference between a fast recovery and a slow one. Can the Minister tell us what has been done to raise awareness among the general public?

I said that I know people who have had strokes and who have recovered quite well. Indeed, a friend of mine had one a while ago and is now back to almost 95%. It is incredible that someone can have a stroke and recover so quickly. In Northern Ireland, over a third of strokes happen to people over the age of 69, and 50% to people over the age of 60. However, it is not uncommon, unusual or unique for those under that age to have a stroke. What has been done among all those groups? Those who are most at risk must be aware of the signs and symptoms.

The hon. Member for Bromley and Chislehurst was absolutely right to refer to long-term personalised care. I am asking things that have perhaps been asked before, but I am quite sure that the Minister will be able to reiterate and to assure us on that, and on the national stroke programme and the lessons learned and the changes that can provide better protection, raise awareness and ensure that we improve health for everyone in this great United Kingdom of Great Britain and Northern Ireland. I know that the Minister has no responsibility for Northern Ireland, but I look to her, as always, for a response to the queries we have all put forward. It is important, not only for me, as my party’s spokesperson on health issues, but for all of us to know that we are improving long-term care and help following strokes for those who need it.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Digital, Culture, Media and Sport) 5:30 pm, 21st April 2021

Thank you for calling me, Sir Edward. I extend my gratitude to Sir Robert Neill and wish his wife well on her stroke journey. I was a physio in the NHS for 20 years and worked in stroke rehabilitation, so I obviously know this issue well from a practitioner’s point of view. I echo much of what I have heard in the debate as the reality of clinical practice. During the course of the debate, about 12 more people in the UK will have had a stroke, which is why urgency in getting things right is so important.

Public health measures are absolutely crucial, because smoking and poor diet and exercise contribute extensively to the risk of having stroke. Above and beyond that, once somebody has entered that journey, we need to make sure that they get the optimum care. In acute care, thrombectomy processes are improving people’s chances of good recovery, which is fantastic, but a significant postcode lottery still loiters around that, which we have to address.

My first question to the Minister is therefore whether, as the NHS goes through significant change over the next couple of years, integrated care systems will be charged to set up their own clinical networks for strokes and to ensure that they have the specialism for that acute phase of stroke placed in each one and also spread through the network. It is really important that we bring this to the fore, and that, as the NHS changes, we make sure that the right services are in place.

All too often, as patients were discharged from my care, I would fret about where they went. If they went to a specialist rehabilitation centre, I knew that all would be well, but if they went to a more generalist step-down facility, or were discharged into the community, without that specialist input—speech and language therapists, occupational therapists, clinical psychology as well as neuro physio—I would worry. It is a specialism in and of itself; indeed, neuro physio diverts into stroke rehab. Making sure that people have the up-to-date specialist skills makes all the difference. They take a long time to train, but they change the way somebody with a stroke is approached.

One challenge I always found was the pressure to get people out the hospital door and discharged quickly. To actually re-educate somebody’s mind and body to synchronise and work together in a new way takes time, and therefore ensuring that there is that investment in time is really important. We also cannot push somebody because they become tired, so we have this really delicate balancing act of timing.

It is different for absolutely every patient, but as they go through that journey, they need that specialist support. I will give an example. They may be discharged home, but we know that so many people, once they go home, will just sit in a chair, as opposed to carrying on their rehabilitation. Or perhaps, even when getting up from the chair, they will take the short cut of pulling themselves up, increasing their muscle tone, which is detrimental, as opposed to, say, using a proper Bobath method of facilitating their muscles. That makes a real difference how this issue is approached, and therefore the paucity of stroke rehab specialists must be addressed, making sure that that skill mix is there, but also with the right level of training. That is crucial.

I ask for more training around stroke rehab for GPs and in the community in particular. A community physio may deal with respiratory patients, musculoskeletal patients, neuro patients. We want neuro physios in the community through an extension of specialist rehab centres moving into the community while keeping that clinical case load. We also want the same clinicians along a patient’s rehab journey. It is not easy for clinicians to relay information about a patient simply, so following them into the community could be a different way of doing that as opposed to the silos of our institutions that we currently see.

One other thing is really important. We know that stroke is for life, and therefore we need to ensure that the services are there for a substantial amount of time. I have raised the issue of the six-month review, which is far too long to wait—an individual may plateau or even regress in their care. Regular intervention is really needed and, if someone has plateaued or regressed when they could have been progressing, they should be brought back into more specialist care, even if that is residential care, to help them take that step forward again and get that continuity that is needed. If we do not put in those interventions, clearly the impairments experienced by someone will deepen, which will create pressures that will show themselves elsewhere in the NHS or the social care system. Therefore, that investment is so important for people as they are recovering from stroke.

There is clearly so much to be done. I really welcome the call for an APPG and would be happy to serve on such a group should it arise, but as we are currently reimagining healthcare, this is a real opportunity to put the patient’s need at the centre of a stroke service and ensure that we sustain that for the rest of their life.

Photo of Joy Morrissey Joy Morrissey Conservative, Beaconsfield 5:36 pm, 21st April 2021

I thank my hon. Friend Sir Robert Neill for securing the debate and you, Sir Edward, for allowing me to speak. Many hon. Members have spoken so eloquently about the problems of rehabilitation and post-stroke care. I must declare an interest: a close family member had a severe stroke over the last lockdown, and I can only describe the post-rehabilitation care as a hell that I would not wish on anyone. As an educated person, I understand the pathways—we have someone there to advocate full time for this person who has had a severe and debilitating stroke—the care pathways out of hospital, however, are broken.

I cannot praise enough the wonderful doctors and the nurses—Dr Joseph Kwan is an excellent stroke specialist—and I cannot say enough good things about the hospital care we now receive through the NHS and privately; it is wonderful. However, it breaks down in rehabilitation—the post-stroke care. As any doctor, OT or speech and language therapist will say, it is how intensive the rehabilitation efforts are in those crucial months after a stroke that will determine the outcome and recovery. In those first six months, a stroke patient will need intensive speech and language OT, physical therapy and perhaps the recovery of basic skills, depending on the severity of the stroke, but it breaks down as we simply do not have the workforce capacity to manage the needs of our population. It is not the fault of anyone. It is simply that we do not have the skillset at our disposal.

Will the Minister consider meeting me and a Department for Education representative to see whether we can have a strategic recruitment drive, perhaps starting in secondary schools, to encourage young people to go into professions such as occupational therapy, physical therapy and speech and language therapy or to become a district nurse, psychologist or neuro physical therapist? We need that specialist support in so many things, but we simply do not have the qualifications or the workforce available, and yet we have young people interested in science and interested in helping in their local community. What better way, as we are restructuring and bringing new changes to the NHS, to incorporate a recruitment drive that would allow young people to enter these specialist professions? We desperately need people in those professions, to help make the difference between someone dying a terrible and painful death in their home and having the additional support they need for a recovery to make their life liveable.

I praise and pay tribute to all the silent carers of covid, who have been helping their loved ones who have suffered a stroke, and who have had to negotiate through the care pathways alone. I thank them for everything they have done. I thank all the carers and health professionals who have done everything they possibly can during covid to help those who have been suffering in silence in their homes, in out-of-hospital care.

I ask that we look at strategic, long-term recruitment for these professions to meet the needs and demands of England, and that we look at how we can develop a much more joined-up and cohesive post-stroke recovery plan, because where the process also breaks down is where someone who is in a hospital in a local authority is discharged into another local authority, where the care pathway has to pass from one council to another and from one NHS trust to another. It is very difficult to maintain a pathway that delivers and communicates that, even to your GP, so those complex pathways tend to break down at the rehabilitation level. I ask that we look at having a stroke passport that those who have recovered might take with them—a physical copy that they can take to any healthcare professional, so that they can see their records and so that there is a clear understanding of where that survivor has come from. That would ease and speed the process of recovery as new carers take on the rehabilitation of that survivor.

I thank hon. Members for being here today and for considering the complex nature of the debate. I hope that we start an all-party parliamentary group—I would have to join as well—to continue raising this important issue in the House.

Photo of Justin Madders Justin Madders Shadow Minister (Health and Social Care) 5:42 pm, 21st April 2021

It is a pleasure to see you in the Chair, Sir Edward. I thank Sir Robert Neill for securing the debate and for his detailed introduction. He highlighted that there is increased awareness of the symptoms of strokes, and that acute care has certainly been on an upwards trajectory. The point that he made so eloquently and so personally was that there is still a long way to go on aftercare. He spoke of courage, patience and consistent professional care being needed, and that is something that we all want to see. A number of hon. Members added their personal perspectives to the debate. I believe we always do better when we hear those perspectives.

We also heard a professional perspective, from my hon. Friend Rachael Maskell, who set out clearly the importance of specialist services. The question she asked about the future of those in the new structures was very important.

As we heard from various Members, strokes are very prevalent in this country—100,000 a year, or one every five minutes. We also know that two-thirds of stroke survivors leave hospital with a disability, and it is the fourth-largest cause of death in the UK. It is perplexing, as the hon. Member for Bromley and Chislehurst said, that it does not get more of our attention. As my hon. Friend Navendu Mishra said, it is also something of a mystery why the level of research funding is not as high as in other areas, even before the challenges of the pandemic that all voluntary fundraising organisations have faced.

Members will know that the national priority in the NHS long-term plan is the national stroke programme. It is intended to deliver better prevention, treatment and care. It is an ambitious programme, but if it is to succeed, it needs adequate funding. I hope the Minister will be able to set out briefly how that funding is being allocated and what progress is being made to meet the targets and aims set out in the plan. A recent report by the Stroke Association found that thousands of stroke survivors are being let down—in various ways, as we heard in the debate, but particularly in the current provision of post-stroke support and rehabilitation.

The most recent Sentinel Stroke National Audit Programme data for April 2019 to March 2020 shows that only 41% of patients received a recorded six-month post-stroke review, and just over a third of applicable patients received recommended levels of physiotherapy or occupational therapy. Less than a fifth received the recommended levels of speech and language therapy. As hon. Members put it in different ways, those figures are clearly not good enough. It needs to be emphasised that that poor record is from before the pandemic.

There were concerns before the pandemic about the shortage of specialist stroke consultants. Figures from Kings College London showed that almost half of hospitals had a shortage of specialist stroke consultants, with 48% of hospitals in England, Wales and Northern Ireland having at least one consultant vacancy in the previous 12 months or more. To pick up on the comment by Joy Morrissey, the Stroke Association called on the Government and NHS England to make stroke medicine a more attractive proposition for junior doctors to specialise in, as well as the other specialities, and drew attention to the need for nurses and rehabilitation. Can the Minister update us on the number of consultant vacancies and say what steps are in place to introduce a plan to deliver the staffing levels that we so clearly need?

It is clear, from what everyone said, that we need to go further and faster to provide support for stroke survivors. Further investment is vital to ensure equitable access to services, avoid digital exclusion and improve health outcomes, to stop the kind of disparities that we have heard about. We must end the postcode lottery. It is so important that, no matter where you live, you get access to the same quality stroke support services, which are consistent with clinical guidelines. I hope the Minister will address the issues that Members have raised, and will set out what steps the Government intend to take to support more survivors of strokes.

Photo of Jo Churchill Jo Churchill The Parliamentary Under-Secretary for Health and Social Care 5:47 pm, 21st April 2021

It is a pleasure to serve under your chairmanship, Sir Edward. I thank my hon. Friend Sir Robert Neill not only for giving us all the opportunity to discuss this issue, but for sharing his and Ann-Louise’s journey and experience. I wish her well in her future recovery, but he articulated very well what some of the challenges are, as did many other Members.

The debate has made clear how stroke touches so many lives. I can feel an APPG coming, and I would welcome it, because the Stroke Association is a fantastic charity which does great work, and I am sure that they will be listening and keen to support an APPG. I thank all those at the Princess Royal and all those—in Stockport and throughout the country—who work in stroke services in the acute sector and out in the community. As has been articulated, it is a team game to give people the proper, consistent support so that they can achieve the optimum recovery.

I am so pleased that the friend of Navendu Mishra made a fully recovery, but as hon. Member for York Central (Rachael Maskell) explained clearly, using her vast expertise, why it is a different journey for different people. Some people need a much more needs-based approach, which is obviously where we hope to head. That will hopefully be music to the ears of my hon. Friend Joy Morrissey. I hope to assure Duncan Baker that we, too, are driving services in his area.

I do not have many minutes to speak, so if there are further questions I will be happy to go over them with individual Members. We have made enormous progress but, as many hon. Members said, that progress still needs work. We need to do better and we need to go faster. One of the ambitions of the long-term plan is the inclusion of a national stroke programme that looks to improve services, including better rehab services and increased access to specialist stroke units through a flexible and skilled workforce. We heard more than once about the challenges on the workforce front.

The prevention and treatment of stroke is a key priority for the NHS. Despite the many challenges presented by covid, the stroke programme has continued to support regional delivery. In some areas, we have accelerated implementation because it is such an important area. As of 1 April, there are now 20 integrated stroke delivery networks operating to support the national stroke service model. Those networks have patient voices and public voices, which it is quite important to let everybody know, because this does need to be patient-driven, and people need to know that they are being heard. ISDNs bring together key stakeholders in stroke to deliver a joined-up, whole pathway transformation through the integrated care systems.

I am sure that my hon. Friend the Member for Bromley and Chislehurst knows that such an ISDN is now operational in his constituency. They will be responsible for delivering optimal stroke pathways based on best evidence, which he referred to. They will ensure that patients who experience a stroke and, so very often, quite debilitating outcomes from it, receive excellent care from pre-hospital, through to rehabilitation and then life after stroke.

There is good evidence that stroke units delivering hyper-acute stroke care 24/7 enable the NHS to achieve ever-improving outcomes. Receiving high-quality specialist care in well-equipped, well-staffed hospitals is the optimum, and 90% of stroke patients will receive care in a specialist stroke unit. More patients will have access to disability-reducing treatments of mechanical thrombectomy and thrombolysis; combined with increased access to rehabilitation, that will, hopefully, deliver long-term improvement and a more seamless pathway.

As we heard from my hon. Friends the Members for Bromley and Chislehurst and for Beaconsfield, navigation of all the different systems is really part of the challenge as well. My hon. Friend the Member for North Norfolk will be pleased to hear that Norfolk and Norwich is one of the new pilot areas for non-neuroscience centres that will work towards the delivery of thrombectomy.

Delivering the right treatment quickly will lead to the best outcomes. We see that with ischemic strokes: busting the clots has become increasingly effective using the right drugs and treatments. All stroke units in the UK can deliver intravenous thrombolysis. Early diagnosis by stroke specialists, followed by early thrombolysis, has been transformative in stroke care.

Thrombectomy is a procedure used to treat some stroke patients, and there is evidence that, where used appropriately, it will reduce the severity of disability. Thrombectomy is available in 22 centres, with two further non-neuroscience centres under development, of which the Norfolk and Norwich centre is one. The expansion of these services is in the long-term plan, with plans to increase the workforce who are able to perform the procedure. Owing to training requirements, that is currently restricted to neuroradiologists, which is a challenge, so we have worked with the General Medical Council to develop a credentialling programme. That will hopefully enable the acceleration of training to a wider cohort of medical professionals, such as radiologists, cardiologists and neurosurgeons.

On rehabilitation services, if the stroke patient has had a hyper-acute treatment they will need early therapy, as we have heard from so many hon. Members. That needs to be delivered by physio, speech and language therapist specialists, and should be accessible within 24 hours. We have heard of the challenges. Long-term rehabilitation is also best undertaken locally, so that people do not face the challenges of chasing around for the service—that also supports the family, who are often vital in a patient’s journey—and to enable the assessment of the appropriateness of homes by occupational therapists and others. We do not want reviews every six weeks, every six months and annually. We want reviews to be patient-led, which I think is what the hon. Member for York Central was driving at.

The integrated community stroke service model has been developed by clinicians, experts and charities, whom I thank for the help that they have given us. To ensure that evidence-based care is being delivered, we have worked with them to address the variation across the country, which is a problem. The stroke rehabilitation pilots mobilised in 2020 are implementing an integrated community stroke service that will enhance care path- ways, including psychological support and vocational rehabilitation. Recognising that everybody’s needs are different is very important, as is delivering personal, needs-based stroke rehabilitation to every stroke survivor, in their home or place of residence.

We have funded the Stroke Association during the pandemic to provide the Stroke Association Connect service. Stroke rehabilitation pilot sites are also testing improved data collection.

The hon. Member for Stockport will be pleased to hear that we have turbocharged research, calling for more research into stroke areas, because evidence-based research is really important. Building on the rehabilitation pilot initiative, we will launch the new stroke quality improvement for rehabilitation later in 2021. Working closely with integrated stroke delivery networks, that will help address variation. Combined with funding for quality improvement projects and expansion of community data, we will then expand. In addition, the national stroke service model, due for publication in late spring, will support that service. The Government have initiated the biggest recruitment drive for allied health professionals in decades, including speech and language therapists and occupational therapists.

I want to give my hon. Friend the Member for Bromley and Chislehurst a couple of minutes to respond, but in conclusion, I hope I have demonstrated that this is a serious issue. I know the stroke community will have heard our discussion. I would welcome the opportunity to discuss the subject more fully, when there is time for me to go over some of the developments and ambitions we have to ensure that we impact the lives of people with strokes. We can give them significant benefits, we can benefit the NHS and, as my hon. Friend said, we can bring people back the best way that we can.

Photo of Bob Neill Bob Neill Chair, Justice Committee, Chair, Justice Committee 5:56 pm, 21st April 2021

I am grateful to all hon. Members who have participated in the debate. I know that time is short. I am grateful to the Minister for the tone of her response. We will want to press her, in the most constructive way, on some of the detail of the funding, how we actually get the nuts and bolts done and how we deliver services on the ground. The aspiration is clearly there—we all share it—but we want to see that delivered. We are very happy to work with her on that; perhaps we can speak offline on how we might be able to achieve that.

I am grateful for all the expertise and the experience that hon. Members have laid out. I conclude by thanking everyone who takes an interest in stroke care, above all the carers. We ought to remember the informal carers—the families—who do so much, as well as the professionals. They need their recognition at the end of this debate too.

Motion lapsed, and sitting adjourned without Question put (Standing Order No. 10(14)).