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World Stroke Day

Volume 741: debated on Thursday 23 November 2023

I beg to move,

That this House has considered World Stroke Day.

As ever, it is a pleasure to serve under your chairmanship, Mr Hollobone. I am grateful for the opportunity to raise this important topic. This year, World Stroke Day fell on 29 October. We had hoped to have this debate a little nearer to then, but the date we were originally given had to be vacated because of the Prorogation of Parliament. I am grateful to the Chairman of Ways and Means for so swiftly rescheduling it.

I refer Members to my interest as co-chair of the all-party parliamentary group on stroke. I am delighted to see one of the vice-chairs, the hon. Member for York Central (Rachael Maskell), in her place. I also declare a personal interest. My wife Anne-Louise suffered a stroke four years ago, as many in this House know. She made a courageous fight to recover, and I think we have discovered a number of areas where much more work needs to be done because stroke is very often, to a degree, a hidden condition. It does not receive as much publicity as heart attack or cancer, for example. Although we have made improvements and advances in recognising early stroke symptoms so that swift treatment can be given, the thrust of the debate is to say that much more needs to be done.

The hon. Member is making a powerful speech, and I appreciate his passion. He spoke of awareness, understanding and education about strokes. We need much more work on that; many people are unaware of stroke symptoms. They should be aware of what might be happening to a family member or friend before their very eyes.

That is right and that is why I commend the Stroke Association for raising awareness and recognition of symptoms. It promotes the Act FAST campaign, which details the symptoms that should be looked out for: if someone shows facial weakness, arm weakness or speech problems, then it is time to call 999. That has been important in raising awareness. I thank the Stroke Association for the briefing it has provided, as well as others who have assisted in the preparation of my comments, including the Royal College of Radiologists and, from the private sector, Ipsen UK, a biopharmaceutical company that works in this field. I will refer to its research.

The essence of the matter is this: stroke is not often recognised, but even when it is, the quantity is not talked about enough. In the UK, stroke strikes every five minutes and more than 100,000 people have strokes every year. It is a leading cause of adult disability; two thirds of stroke survivors leave hospital with a disability. Sadly, it is also a leading cause of death in the UK. Leaving aside the human cost, there is also an economic cost. Too many survivors are unable to return to work. A conservative estimate of the cost to the economy is some £26 billion a year. Some would suggest that it is even more. Never mind the care costs and the burdens on unpaid carers, which some of us know all too well.

Stroke is preventable. In about 80% of cases, it can be treated by changing risk factors, checking for high blood pressure and atrial fibrillation, but we still lag behind other countries on stroke outcomes. The Stroke Association told me that, for every minute a stroke is left untreated, nearly 2 million brain cells die. The brain is both extraordinary and fragile, which is why fast treatment and swift responses are so important. That means getting somebody to a specialist stroke unit as soon as possible. In Anne-Louise’s case, we were lucky that that was not far away, but sadly there will always be disability thereafter. However, that can be reduced through investment in treatments, such as mechanical thrombectomy. If a patient gets mechanical thrombectomy swiftly, their level of impairment is greatly reduced.

Sadly, access to mechanical thrombectomy greatly varies across the country. In Greater London, where my constituency is, the percentage of patients given a thrombectomy in 2021—there may be updated figures, but this is the latest one the Stroke Association had—was 7.8%. In the east of England, it was 0.3%. In most other parts of the country, it hovers around 2%. Even if that has grown somewhat, it is still far less than we would wish to see. I welcome the Minister and am grateful to see him in his place, and I am sure that he is aware that investment across the piece would greatly improve people’s outcomes. That needs to be mainstreamed into investment plans, and we certainly seek to do that. I hope the Minister will commit to removing that postcode lottery in survival according to where a person is when they have the misfortune of having a stroke. If we do not do anything about this, the cost I referred to is predicted to increase to about £75 billion by 2035. We cannot afford for that to happen, either economically or in human terms.

We have talked about prevention and thrombectomies, which can be a game changer, but we do not have anything like the numbers accessing them that other countries do and the figures are not in line with the Government’s own targets. Perhaps the Minister could tell us what is being done to catch up and spread availability across the piece, because at the moment only about a third of the people who need that treatment receive it. That is simply not good enough for the two thirds that were unlucky enough to be in the wrong place at the wrong time. That is important, but there is also the issue of the workforce. I am indebted to the Royal College of Radiologists on this point. Early diagnosis, of course, can help through either thrombectomy or other interventions, but we have a shortfall in the number of clinical radiology consultants of some 30%. They are needed to do the imaging—the MRIs and all the other things—that could enable those other treatments to take place swiftly. Without further action, that shortfall of consultants in radiology is forecast to increase to 41% by 2027—2,890-odd posts. What is being done to address the shortfall in that specialism and, indeed, others?

Only 48% of hospital trusts can provide adequate 24/7 interventional radiology services, largely because of that workforce shortage. I am sure the Minister will once again agree that that is not satisfactory. The use of interventional radiology—image-guided surgical treatments, effectively—is critical in the modern treatment of strokes. When we look at the national health service’s workforce plan, what are the plans specifically to recruit the workforce—the skilled specialists we need to support those new procedures, which will save lives and improve lives for survivors?

As well as the key issues of intervention and treatment, the other issue I want to touch on is what happens thereafter, because the outcomes can vary greatly. Some people, as we all know, are fortunate enough to be out of hospital quite quickly, whereas others—my wife included—spend much longer there. What troubled me was when Anne-Louise eventually left the rehabilitation unit in Orpington, where she had excellent care, we were lucky enough to be able to continue care at a proper level, through our own resources as a family. There was a young woman in there, probably in her mid-40s, who was a single parent. She lived on her own and had no one to take care of her. She was there before Anne-Louise arrived in the unit; she was still there when Anne-Louise left. What happens to someone in that condition is a real worry to us.

I am sure the Minister will rightly observe that the percentage of patients discharged into community stroke services has risen from 53% to 61% in 2022-23, but the quality and consistency of the community service provision is very variable. There are real shortfalls in the number of specialists—again—so we have a workforce problem in the community as well when it comes to physiotherapists, speech and language therapists and neuropsychiatrists.

We sometimes forget that, as well as the very real physical impacts of stroke—which can be a lack of mobility or balance, a level of paralysis, speech impairment and post-stroke spasticity, as it is called, which I will come back to in a moment—there is very frequently a degree of mental ill health associated with such a life-changing event. Many stroke survivors suffer from varying degrees of depression, and the lack of neuropsychiatrists and psychologists to assist them is very stark.

We know that nearly half of stroke survivors experience some degree of post-stroke spasticity within six months of having a stroke, and some will be classed as severely disabled. We then find that some 80% of survivors may develop it at some point unless they get that proper and consistent treatment. At the moment, we do not deliver the recommended levels of community care in the therapies, of all kinds, that are recommended by the nationally accepted guidelines. What is being done to improve that?

At the moment, in the community setting, post-stroke patients experiencing post-stroke spasticity may have to wait four to seven months to be seen for a multi- disciplinary-team assessment. That is far too long. I have a constituent who has been waiting for nearly a year to be assessed to receive the multidisciplinary treatment that she needs. Accessing that support surely should not be done on such a fragile basis.

Ipsen has recently published a report, “Neuro- rehabilitation: State of the Nation”, which discusses this issue. It found that there is a lack of foundational awareness about spasticity and that it is not picked up often or soon enough. In fact, there are issues with the sporadic nature of treatment and a five to six months average waiting time for spasticity services. One in four NHS sites in England do not have access to specialist services for spasticity—there are only 0.26 consultants per 1,000 in prescribed specialist services in England and Wales compared with two to three in most European countries. Something like two in three stroke survivors do not receive a six-month review of their care, and that is one of the fundamental targets set out in the national guidelines. If two thirds are not receiving it, then clearly something is failing us badly.

We would like the Government to designate stroke as a major condition, and they also ought to consider post-stroke spasticity management as an integral part of the major conditions strategy. Perhaps the Minister will take that away and consider it. What can be done to level up the commissioning and provision of those rehabilitation services? What can be done to look at the high-level priority areas for stroke research that have been identified? These are important matters and we would hope that that could be done. There are other things that I hope the Minister will take a look at. Can we continue to improve availability at community level? Can we ensure that everybody receives the treatment set out in the National Institute for Health and Care Excellence guidelines? As I say, at the moment we are falling significantly short.

In conclusion, having set out those points—I could go on for much longer if we wanted—I hope that my speech highlights some of the real areas of concern. I also want to say a word about the voluntary groups; most of us in the field have become aware of the work of the very well-established Stroke Association, but we have a number of other groups, and in some cases entirely survivor-led groups give each other mutual self-support without any support from public funding.

I want to pay tribute to one group—frankly, the one that helps my wife and that she has received a great deal of assistance from being a member of. It is called Sidcup Speakability Group, and, as the name implies, it operates in our part of south-east London. It is the group’s 10th anniversary, so I just wanted to put on the record what it has done. It works entirely off its own back, and the level of conditions that people have varies greatly. But it proves that there is willingness. It is also worth remembering, as any senior consultant in the field will say, that there is sometimes a myth that a patient gets to a stage where they can never improve any more. Obviously, a patient has the best improvement earlier on. That is why early treatment and interventions are so important, and why the waiting times are so unacceptable. But even if the rate might be less, if people work continually, gains can still always be made incrementally. That is what the people at Speakability have found. To do that, we cannot expect the burden to fall simply upon friends and families. We need specialist treatment to be consistently available. That can turn people’s lives around. In our case, it may not be enough to turn it around in time, but it will be for others. That will be worth our while. The more people we can get back into work, as they wish, the more people can lead enriching lives, to a greater or lesser extent, as many stroke survivors do. There is light at the end of the tunnel, but we have to give them those fundamental services to start with.

I am very grateful to the Minister for paying great attention to the issue, and I hope he will take away those specific asks. Perhaps he could keep in touch with us, as a group, on how we could roll out services much more consistently and give people the level of treatment they deserve. I know a number of us in this room have been affected by stroke within our families, and I think we all want to work together—there is no party political issue in this—to have a proper strategy to sort it out.

The debate can last until 10 minutes past 3. I am obliged to call the Scottish National party spokesperson no later than 2.37 pm. The guideline limits are 10 minutes for the SNP; 10 minutes for His Majesty’s Opposition; 10 minutes for the Minister; and then Sir Bob Neill will have three minutes to sum up at the end of the debate. We have half an hour of Backbench time, and I have to decide which of two stellar Members I should call first. I will go on the principle of ladies first, but also because I understand that the hon. Member for York Central (Rachael Maskell) is vice-chair of the all-party parliamentary group on stroke, so is probably far more qualified to talk about these issues than the delightful hon. Member for Strangford (Jim Shannon).

Thank you for those kind words, Mr Hollobone. I will open by saying that I used to be a physiotherapist working in acute care, specialising in stroke care, so I bring other experience to the debate as well. I serve on the all-party parliamentary group on stroke, and I am indebted to the hon. Member for Bromley and Chislehurst (Sir Robert Neill) for securing today’s debate. We work assiduously on this issue here in Parliament, and it is so important for all our constituents. We believe there is real scope for change within the Government’s approach to help our constituents not only to prevent stroke, but to survive stroke, and to benefit from that.

As the hon. Member for Bromley and Chislehurst said, every single five minutes, somebody will experience a stroke. For some people, it will be brief—a transient ischaemic attack. For other people, it will clearly be very serious indeed, and for some people it will lead to mortality. To bring that home, during the course of the debate another 18 people will have experienced strokes. The urgency is now, and we cannot lose time. Over the course of a year, around 100,000 individuals experience stroke, but that means that 100,000 families also come into contact with the NHS. As a result, it is really important that the Government renew their focus. Although we welcome the major conditions strategy, it is simply not enough. Of course, the major conditions strategy is so major that the necessary focus needs to be brought to the fore. I suggest that we make 2024 a year of stroke, so that we really bring that focus down to deliver. If we had that focus across the system, we could make such a difference.

I will not go into all the statistics that my hon. Friend the Member for Bromley and Chislehurst did, but I just want to say that stroke is very avoidable. Of the people who experience it, 80% will have risk factors that can be controlled. We must talk about prevention. As a vice-chair of the Health and Social Care Committee, I must mention our inquiry into prevention in health and social care, which I am sure the Minister will pay much attention to. We must look at how we prevent individuals having stroke. Of course, we can undertake monitoring, for instance around blood pressure, with high blood pressure being an indicator and also atrial fibrillation. This is also about lifestyle choices; it is really important that we remember that smoking is still a major cause of stroke. We must ensure that individuals have early help, not least if there is a familial issue with stroke, to see how we can avoid that.

I also want to talk about health checks. It is really important to make those early interventions. We heard today about a 41-year-old who experienced a stroke, and one in four people who experience a stroke are under retirement age, so we must remember that it is often younger people who experience the need for this process. As a result, we should monitor people. The health checks that came in for those aged 40 are not often applied within integrated care board areas. We need a real sea change there, because monitoring things such as what is happening with blood pressure as early as we can, with really quick tests, can make a sizeable difference.

The Health and Social Care Committee has just returned from Singapore, where we heard about the early healthcare interventions being made there and, of course, saw the outcomes. If the Minister is determined to make a difference in his short time in the role before my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) takes charge, introducing those interventions to monitor what is happening could be a life-changer.

I also want to highlight how we need to respond. Response is too slow, and I want to challenge the system. For ambulances, a stroke is currently a category 2 call. I would like it to be made a category 1 call and the response expedited, because every minute that passes in the golden hour can make a difference to somebody’s future and whether they will experience severe disability—or, indeed, die—or receive interventions that could prevent such disability. Changing the categorisation would save both money and lives. It is important to look at that again. It could make a difference, not least because the time lags for the ambulance service on category 1 and category 2 calls at the moment mean that categorisations are insufficient to get patients to the right place at the right time in order to get the right interventions. I hope that the Minister will take that away and carry out some work in that area to expedite the process towards diagnosis and treatment.

I turn to diagnosis. In a country like Germany, individuals are diagnosed at the kerbside, at home, or wherever they have their stroke, and the process will start immediately. At the point that the patient is experiencing deficits—perhaps they are still going through a cerebral event—or as soon as the ambulance is called, the clock starts on the diagnostic process and then treatment. Using the best diagnostic techniques to scan at the kerbside, using AI to help, we know—[Interruption.] It looks like the Minister is in some pain; perhaps he needs my physio skills.

Being able to undertake the diagnostic process really early means being able to get the information into the stroke unit of the hospital as early as possible, so that when the patient arrives at the door, they are whipped through the system and interventions can start. The problem is that we have such a time lag that intervention is often too late. Will the Minister look at what is happening on a global scale with interventions that could really make a difference?

Of course, there are two types of stroke: some people have a cerebral bleed and some have an infarct, or a blockage, where the brain is starved of oxygen. As a result, different treatments are undertaken. There is thrombolysis, which is a medical intervention to blast a clot through, and mechanical thrombectomy, which the hon. Member for Bromley and Chislehurst talked about, where a wire is fed through the femoral artery into the brain, captures the clot and withdraws it. As a result, the brain can receive the oxygen it needs so that it does not experience the damage that we have heard about.

We need to increase the specialist interventional neuroradiologist workforce. It is a highly trained specialism; we need enough of them, and a sufficient supply. We should have a workforce plan for the specialism to ensure we are training sufficiently and expanding the workforce. In other countries, there has been a real increase in the number of people able to access this treatment. As we have heard, the average across the UK is 3.3%, but in other countries it is 10%. Not all patients can benefit from this life-saving treatment, but of those who can, only about a third get access to it.

We need to think about where the centres are based. It is important that they are in major centres because doctors need to do a lot of these procedures to be expert in them. We need people to be expert in them, but we also need more centres. I ask the Minister to look at the mapping of that, and at specialist commissioning through NHS England to ensure provision right across the country. Will he also work with the ICBs in this area?

We need a specialist workforce. It is positive that we are training more people in stroke specialisms, but in physiotherapy, for example, significant further training is needed on Bobath—a technique used in stroke rehabilitation—and we need to ensure that it is easily accessible. Other professionals do not get the same access to training budgets as medics, so there is often a lag in getting people through the specialist training that is needed. I ask the Minister to look at that to ensure that the workforce is trained in the best techniques to treat stroke, and to carry that specialism.

This is all about investing to save money, because the better the intervention, the better the outcome for the patient. We need physios, occupational therapists, speech and language specialists—there is a significant shortage of them—and clinical psychologists to work as a team around the patient. They often work together. To give hon. Members an idea of how long it takes, a physio can spend an hour a day with a patient, because they have to break down and rebuild their tone and spasticity, which takes time. But as they are sitting the patient up, the speech therapist often comes along and does a swallow test, and an OT may do some function work. That team needs to come together. Unfortunately, the gaps in the workforce mean that it is hard to have the quality of treatment that will benefit the patient, from the most acute phases of the stroke right through to rehabilitation.

Of course, we want patients to go to stroke units—specialist rehabilitation places—where they can benefit from therapeutic intervention and get the best outcomes possible to optimise their baseline before they are discharged back home. Being in that environment is really important, but at the point of discharge, after all that cost—we have talked about diagnosis, intervention and therapy—what happens? Well, experiences are very varied, and 45% of survivors feel abandoned, so we know something is going wrong. Individuals can easily lose confidence and function.

If an individual is on a pathway to a care home, the care home should be properly trained in supporting people who have had a stroke. Everything matters: the person’s positioning, how they lie in bed, how they sit in a chair and how their hand rests can make a real difference to their function, and their hygiene and personal care. It is necessary to ensure that, if they are mobilising, it has an impact. How patients are transferred can make a difference to those outcomes, so it is important that a person is discharged not just to a care home, but to a care home that has undergone proper training. If someone is moving to the community, we need to ensure that the family around them are trained in how to support them, just as carers who provide domiciliary care must be.

I want to pick up on what the hon. Member for Bromley and Chislehurst said about people seeing improvements in their baseline functioning. It is possible that individuals do and will. Through the process of neuroplasticity, a person’s brain changes and can make alterations and repair, so we need to ensure that, when somebody gets home, there is ongoing therapeutic intervention. It is easy to slip into bad ways and take shortcuts, which can undo some of that good work, and those interventions to top people up can make a difference and keep people functional, mobile and independent. If people miss out on those interventions, they will rapidly require more acute care.

I draw the Minister’s attention to that and ask him to look at the whole pipeline. The lack of support is clear: only 37% of patients got their six-month check last year, which is completely insufficient. We need the figure to be 100%, so there is clearly some work for the Government to do. We are talking about 40,000 people who missed out altogether, which affects ongoing care and support. In the same way that a cancer care navigator works with patients, we need somebody who co-ordinates care and individual support on the stroke pathway, as a permanent process.

As I have already said, we have an opportunity next year to make a seismic difference to individuals by focusing on stroke. I hope that the Minister will take that opportunity, with a laser focus on a new stroke strategy across the country. If he does not, I will badger my hon. Friend the Member for Denton and Reddish to take that on, whenever he gets the first opportunity. It is important that we do that.

Finally, research in this area could be improved, and investment in research is needed. As we have seen in recent times, investment in thrombectomy has been a game changer. It gives people who experience a stroke real hope. Other interventions can and will be made: we need to understand more about our brain health, therapeutic interventions, and how to use new technologies to help people to be independent and live full and comprehensive lives. I trust that the Government will look at the research base and at investment in research as an opportunity. I trust that they will also work with the voluntary organisations that work so hard in this area—they are real experts—to ensure that we have the best stroke strategy and stroke outcomes that any country could ever have.

You are most kind, Mr Hollobone; thank you for calling me. May I say what a pleasure it is to follow the hon. Member for York Central (Rachael Maskell)? Her contribution was truly magnificent. It was full of the detail, knowledge and experience that the hon. Lady brings to these debates. To be honest, I am a bit in awe of her contribution, because it was exceptional. We thank her for it.

I thank the hon. Member for Bromley and Chislehurst (Sir Robert Neill) for leading the debate. He has spoken on these matters in the main Chamber and in Westminster Hall, and he speaks from personal knowledge and experience. We all have him and his wife in our thoughts. I mean that sincerely and honestly; I cannot begin to understand the difficulties and experiences that he has had. He should be assured that he is in our thoughts.

As my party’s spokesperson for health, it is great to be here to mark World Stroke Day. I am sure that everyone present has been touched by the impact that strokes can have on families and friends. Over the years, I have had a number of friends who have had strokes, and they have been greatly physically disadvantaged. It is not just that; there is also an emotional aspect.

I was recently made aware of the “Neurorehabilitation: State of the Nation” report, published in October by Ipsen UK—which the hon. Member for Bromley and Chislehurst referred to—and Different Strokes. The report outlines the state of UK stroke rehabilitation services, with a focus on post-stroke spasticity, and uses 2022 data to assess the extent of post-pandemic recovery. Post-stroke spasticity is pain and muscle stiffness caused by stroke and nerve damage. Almost half of people who survive a stroke experience it within six months, and it quickly forms part of their physical disability and contributes to the loss of their ability to have a normal life. It interferes with someone’s normal physical function, speech and daily activities, and it is linked to poor health outcomes, including anxiety and depression. People are not able to do what they once did or follow their normal routine—that is the reality of their new physical condition.

The report’s findings demonstrate that many of the needs resulting from the impact of the covid-19 pandemic still have not been actively addressed. Its recommendations include levelling up neurorehabilitation service infrastructure across the United Kingdom of Great Britain and Northern Ireland. It is so important that we all do the same thing everywhere. The report also recommends the adoption of a standardised commissioning framework for those services to balance out regional health inequalities. We do not want to find that there is a postcode where services are good, but that in our postcode they are not so good. Other recommendations include better continuity of care after patients are discharged into the community, to ensure that they have access to rehabilitation and treatments needed to manage their spasticity, and better integration of post-stroke spasticity needs into wider stroke policy, such as the upcoming major conditions strategy.

Every three hours, someone has a stroke in Northern Ireland. There are more than 40,000 stroke survivors in Northern Ireland. Northern Ireland Chest Heart & Stroke is an active charity, and I put on record my thanks to it. The hon. Member for Bromley and Chislehurst referred to charities and volunteers. There are so many groups that do such great work; it is purely voluntary, but it really affects, challenges and helps people.

Stroke is one of the biggest killers in Northern Ireland and a leading cause of adult disability. In addition, we have the second-highest incidence of stroke in the UK and the second-highest mortality rate; in Northern Ireland, whether it is because of our lifestyle or the anxieties and problems of the last 40 years, we have a high mortality rate. For my constituency of Strangford, which is fairly rural, transforming stroke services is crucial in ensuring that patients have immediate access to the care that they need. The hon. Member for York Central outlined the necessity of stroke patients going to the right place and the right home. If they receive at-home care, it should be of a level that can give the necessary assistance.

The recommendations in the major conditions strategy are also applicable to Northern Ireland. While this debate is probably GB-specific, the recommendations and the way forward are clear, and they are things that we would wish to replicate in Northern Ireland. In summer 2022, the Northern Ireland Department of Health published its stroke action plan, detailing future steps in stroke care in Northern Ireland. However, progress implementing the plan is slow, with many stroke patients still not receiving treatment. The hon. Members for Bromley and Chislehurst and for York Central both mentioned that. It is so important, whenever someone’s life is changing physically and emotionally—and family weighs on top of that—that they have all the help they need to ensure that they can deal with their new condition and circumstances.

There is no doubt that there is still work to be done nationwide in our NHS. This debate will raise awareness of that and ensure that we move forward in a positive fashion. We must ensure that stroke patients are able to access the care and aftercare support that they require.

I look forward very much to hearing what the two shadow Ministers, the hon. Members for Denton and Reddish (Andrew Gwynne) and for Motherwell and Wishaw (Marion Fellows), have to say; I do not think there has been any Westminster Hall debate about health that the hon. Member for Denton and Reddish and I have not been in together—in most cases, we say the same thing. As I say, I also look forward to what my friend and colleague the hon. Member for Motherwell and Wishaw, who speaks for the Scots Nats, says. I especially look forward to hearing from the Minister. He is a man of compassion and understanding. I am quite confident that he will endorse what we are requesting.

One thing that we can all take away from this debate is knowledge of the earliest signs of a stroke, not only for ourselves individually but for the people around us—those whom we love and have been good to us, as we have been good to them, and our friends. With the right specialist support, research and campaigning, it is possible—this is the ambition—to rebuild even more lives and support people through their post-stroke treatment. That is my wish. I am sure it is also the wish of the hon. Members for Bromley and Chislehurst and for York Central, who spoke before, and the two who will speak after, the hon. Members for Denton and Reddish and for Motherwell and Wishaw.

I am pleased that we have been able to revisit this topic after Parliament was prorogued. I thank the Stroke Association and Ipsen in particular for their delightful and helpful insights into this debate.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Bromley and Chislehurst (Sir Robert Neill) on securing this debate. It is always better in any debate if there is a degree of experience and I think we all benefited from his. It is very good of him to share it.

The Scottish Government recently published their Stroke Improvement Plan 2023. In many cases Scotland is more fortunate because we have our own NHS and a smaller area to cover; there are only seven health boards, so there is less difference across the country. I am not saying there is not any difference, but it is much easier for the Government to work with individual health boards and organisations and produce a plan that everyone has bought into.

Unfortunately, strokes remain a leading cause of death in Scotland. The Scottish Government’s new stroke improvement plan seeks to minimise strokes. It is difficult to imagine that anyone in this room will not have had contact with someone who has had a stroke or who knows of someone still suffering. It is still the leading cause of death and disability in Scotland.

I hate to say this, but age is the most important factor. A stroke is most likely to occur after the age of 55 —I will say no more on that at the moment—but younger people can be affected as well. It is the fourth single leading cause of death in the UK.

Some good news is that the number of deaths from stroke is going down, partly due to a reduction in the incidence of strokes, but also thanks to the greater awareness of symptoms. As the hon. Member for Bromley and Chislehurst told us, the FAST programme was the first advertising campaign. It was really useful: most people can now recognise what a stroke is, what the factors are and can try their very best to get people into hospital much more quickly.

I will not go down the path of describing the treatments available because that was done in an exceptional manner—in a way that even I can understand—by the hon. Member for York Central (Rachael Maskell). But it is really important that we are all aware of what we and Governments can do to help people have better health in general. If someone has high blood pressure, high cholesterol, an irregular heartbeat or diabetes, that makes them more likely to have a stroke.

One of the things the Scottish Government are trying to do is reduce health inequalities across Scotland. It is really important that the Scottish Government use a human rights approach on this basis. Poverty is also one of the leading factors for bad health. As Lorraine Tulloch, the programme lead of Obesity Action Scotland said, those facing the choice of heating or eating amid the ongoing cost of living crisis are likely to be more focused on ensuring that there is enough food to go around than noting the nutritional value of food. In Scotland, we are having to deal with the consequences of poor diet and higher weight—we also need to look at poverty, which is the leading cause of those two things.

In Glasgow, the Scottish Government are investing £500 million through the city region deal, and regional partners have secured £300,000 of Health Foundation funding as part of their work to align economic development and improved health conditions. This will include the development of a capital investment health inequalities impact assessment tool, which will ensure that the health inequality impacts on the people who live and work in the Glasgow region—which includes my own constituency of Motherwell and Wishaw—are considered throughout the life of the project. Again, the Scottish Government are doing all they can to minimise the impact of poverty, but it is really difficult.

It is also important that the plan looks at the psychological issues referred to by the hon. Member for Bromley and Chislehurst—and it does. Often, someone who has a stroke needs not only physical recovery, but the right recovery from depression and the psychological impact. I have had some personal experience of that with people I know who have had strokes. Often, they may be accepting of the fact that they will not recover all their mobility, but they find it quite difficult to lose the life they had. That is something we must all take into account. The range of disabilities stroke can give is greater than for any other condition: limb weakness; visual problems; language and communication problems; extreme fatigue; and depression, as I have already mentioned. They are all common. The really difficult thing is that two thirds of working-age survivors are unable to return to work. That leads again to further depression and anxiety.

In order for those who experience stroke to be best placed to navigate their journey, stroke care should be provided in line with the principles of realistic medicine, which include listening to and understanding the patient’s problems and care preferences; ensuring that patients are allowed to take part in the decision making; and ensuring that patients have access to the clear and understandable information required to make an informed choice about their care.

I am not quite finished. I would like to talk about something that I find really interesting and that is a wee bit more uplifting than what we have been hearing. The hon. Member for Bromley and Chislehurst referred to self-led post-stroke care groups. He and I have to declare an interest: my son’s father-in-law leads one of those in Wishaw. I know from him and some of the people in his group how beneficial they find that kind of thing. But it would be much better for everyone if they did not have the problem of finding premises and all the other things. Across the UK, that should be something that Governments can take on and fund, because it helps with the psychological distress, anxiety and depression.

I recently heard about a tech-enriched rehab programme that recently opened at University Hospital Wishaw—or “Wishy General”, as most of my constituents would refer to it. It is to help meet the overwhelming demand for rehabilitation. I talked to a patient who was treated there, and she says how wonderful it is and how good it is to get something like that locally. This incredibly exciting pilot between the University of Strathclyde and NHS Lanarkshire is aimed at reducing disability and bettering outcomes after strokes. Recent research conducted at the University of Strathclyde has shown this type of model to be safe and feasible when used by people in the chronic phase of stroke recovery and has led to improved outcomes. It is really exciting to hear of these kinds of trials; it is something the Minister might consider looking into in order to benefit folk across the United Kingdom.

I make no apologies for being a Scottish nationalist and for praising my Government for what they do, but I do not think anyone could ever accuse me of not caring about people across the UK. It is important that we share knowledge and understanding to benefit all the people in what the hon. Member for Strangford (Jim Shannon) refers to as this United Kingdom of Great Britain and Northern Ireland. I know that the Minister will have listened carefully. I hope he will take on board what has been said and look to Scotland for answers in some of the things that we do that might help to improve lives here in England and in Northern Ireland and Wales.

It is a pleasure to serve under your chairmanship, Mr Hollobone. Like others, I begin by thanking my hon. Friend—I will call him that, because we are friends—the Member for Bromley and Chislehurst (Sir Robert Neill) for securing this important debate to mark World Stroke Day. I thank him for not just his continued advocacy and the work he does here in Parliament, but sharing his personal experiences. On behalf of the whole House, we send our love to his wife and to him for the work he does to look after her.

We have had a small but perfectly formed debate. I want to thank my hon. Friend the Member for York Central (Rachael Maskell) in particular for her powerful contribution. She speaks with experience that I could only ever dream of; it is so important that her expertise, knowledge and past experiences should shape and inform the debate. I thank her for that. Likewise, I thank the hon. Member for Strangford (Jim Shannon) and the hon. Member for Motherwell and Wishaw (Marion Fellows), who leads on health issues for the SNP, for their contributions. We have had a good, thorough debate, covering a lot of issues. Hopefully we have marked World Stroke Day well in this place today.

It is stating the obvious to say that stroke can have a life-changing impact. As we have already heard, the statistics show that in the time we are here this afternoon, 14 people across the United Kingdom will have had a stroke—that is one stroke every five minutes. Although often a sudden event, the lasting impact of stroke for patients can be devastating. It is one of the leading causes of adult disability across the United Kingdom. Two thirds of stroke patients—let that sink in—will leave hospital with a permanent disability, often needing lifelong care. Sadly, stroke is often fatal, causing around 35,000 fatalities across the UK every year, making it the fourth leading cause of adult death.

What those statistics demonstrate to me is that however far we have come on the journey with stroke, we need more concerted action going forwards—not just from a patient care perspective, but given the significant impact that not acting on stroke has on the economy. There is an economic argument, not just a patient care argument.

I pay tribute to the work of the Stroke Association, which does incredible advocacy, campaigning and research in this area, as well as other organisations across the UK. Stroke Association research shows that by 2035, stroke is expected to cost the British economy £75 billion a year. That is up from £26 billion as recently as 2015—a rise of 190% in just two decades. Given the strain already on stroke pathways across our health and care system, that is simply unsustainable. The need is clear, and the need is now.

One of the issues holding us back in our fight against stroke is the workforce, as is so often the case and as we have heard today in other contributions. A well-skilled, well-resourced workforce is vital to saving lives and improving the outcomes for patients. However, for too many across the United Kingdom, the workforce is simply not there for them or not there for them in adequate numbers. Half of all stroke units across the country have at least one vacant consultancy post, with the average vacancy being left open for 18 months.

When it comes to thrombectomy—a life-changing treatment that can have a fundamental impact on patient outcomes, as the hon. Member for Bromley and Chislehurst set out—the postcode lottery for care only gets worse. A third of clinicians in this country who can perform thrombectomy are based in London. That is good for Londoners but not for other parts of the country. Given that speed of treatment is critical when it comes to long-term outcomes for strokes, this lottery facing so many people cannot be allowed to continue.

Further along the stroke treatment pathway, other issues persist. Only a quarter of community rehab teams and early supported discharge services are offering support seven days a week. That is not good enough. With patients waiting too long for treatment when they need it and too long for support in the community following treatment, it is clear that the system is broken. That is why I am proud of Labour’s firm commitments on giving our NHS the workforce it needs to get patients seen on time, by delivering an extra 7,500 medical school places, training an extra 700 district nurses each year and ensuring that at every stage of the treatment pathway stroke patients will have access to the care they need when they need it.

But there is so much more work we can do to break down the barriers that too many stroke patients face on their care journey. Breaking down those barriers will take innovation and all parts of the system to be pulling in the same direction. For stroke patients, that is exactly what is needed. Given the crucial role played by primary, acute and social care services in delivering positive, long-term outcomes for stroke patients, co-ordination is the key. However, in too many cases, that co-ordination is simply not happening, and patients are suffering as a result.

We have a primary care system with vast variety in detection of key stroke indicators, such as heart conditions, atrial fibrillation and so on. We have people not getting to the right place in hospital, with only 40% of stroke patients admitted to a stroke unit within four hours of arrival. We have a community care system without the resources it needs to deliver for patients, with the Stroke Association’s report about life after stroke highlighting that only 37% of stroke patients receive a six-month post-stroke review of their needs. It smacks of a system that is not working for anyone.

My hon. Friend is making an excellent speech. When it comes to social care, people are often untrained and as a result could cause more harm than good if they do not know how to care for a patient who has had a stroke. Will he ensure that Labour discusses how it will train our care workforce to have the right skills to deliver ongoing care?

My hon. Friend makes an important point. Some of the discussions that I have had, including this week, with professionals in the care sector have been about how we upskill care professionals working in our social care system so that they are able to genuinely—in an integrated fashion, with the NHS—work in accordance with the interests of the person they are caring for and take that person’s needs as a whole. It is also important for these workers to have the professional development, and parity of esteem, terms and conditions and so on with the NHS, to be able to take on those extra responsibilities. My hon. Friend is absolutely right, and that issue is certainly on the radar of the shadow health and social care team as we develop our plans—not just Labour’s workforce plan for coming into government, but our plans on the road map to a national care service.

Whether it is by training more GPs to ease the immense pressure on our primary care system, by putting an end to dangerous hospital waits or through a 10-year plan for fundamental social care reform delivered in partnership with users and their families, Labour is determined to get the system working again. We are determined to build a national health service that is fit for the future, with a long-term vision for a national care service firmly integrated within it. Only by doing all that, getting it right and taking people with us on that journey can we deliver on our long-term mission of cutting stroke deaths by a quarter within the next decade. That is a mission. It is something we are determined to do, because at the heart of this are people’s lives and we want to ensure that we have in place the stroke services that patients deserve.

It is a great pleasure to see you in the Chair, Mr Hollobone. I congratulate my hon. Friend the Member for Bromley and Chislehurst (Sir Robert Neill) on opening today’s debate, which is on such an important issue. He is a tireless campaigner for stroke survivors, and his experience is invaluable in bringing their voice into this place. I am sure that his wife is very proud of the work that he does.

I pay tribute to the hon. Member for York Central (Rachael Maskell) for her thoughtful contribution, drawing on her own professional experience, and for the helpful and constructive suggestions that she put forward during the debate. I also pay tribute to the hon. Member for Strangford (Jim Shannon) for his contribution and his kind words. As he knows, I have family in Northern Ireland, and I think it is vital that on issues as important as this, England, Scotland, Wales and Northern Ireland work together where we can to deliver the best outcomes for patients—something that I was also very grateful to hear the SNP spokesperson, the hon. Member for Motherwell and Wishaw (Marion Fellows), making clear in her response to the debate. I also thank the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), for his contribution.

[Sir George Howarth in the Chair]

Finally, I thank my hard-working Parliamentary Private Secretary, my hon. Friend the Member for North Norfolk (Duncan Baker). He is not allowed to speak in the debate, but he was a founder member of the all-party parliamentary group on stroke. He lost his stepfather to a stroke in July 2019, just five months before he was elected to this place, and the stroke issue is a huge priority for him; he has done an awful lot of work on it since he was elected to the House.

I would like to start as my hon. Friend the Member for Bromley and Chislehurst and so many of the contributors today did, by paying tribute to the outstanding charities that support people up and down the country to thrive after stroke. I know that my hon. Friend works closely with the Stroke Association. I was pleased to meet its CEO, Juliet Bouverie, this morning while on a visit to the Royal Berkshire Hospital to see the innovative ways that the hospital is harnessing technology to improve stroke care. I look forward to continuing to engage with her, including on the major conditions strategy, which I will cover later in my speech. I also commend the many other charities involved in this field of work, such as The Brain Charity, Think Ahead Stroke and the other—many much smaller—charities referred to by many hon. Members today. They all do fantastic work to support patients and drive forward improvements in care.

Sir George, it is excellent to see you now in the Chair. In recent years we have made great progress in understanding the condition, but as has been said, more than 100,000 people have a stroke in the UK every year. As the hon. Member for York Central reminded us, that means that during this one debate alone, 18 people will have experienced a stroke. One third of them will be left with some form of long-term disability. I am grateful to hon. Members for giving me the opportunity, less than a month after World Stroke Day, to update the House on the work that the Government are doing in this space.

I will now address as many of the points that have been raised in the debate as I can. The Government’s priority is to prevent stroke in the first place. That is why I am pleased that we are rolling out an innovative, new digital NHS health check in the spring. The original programme saw the highest number of NHS checks between April and June since its creation in 2013. We are backing the programme with £17 million to deliver a million extra checks in the first four years. We have also appointed Professor John Deanfield to develop an ambitious vision for a modern, personalised cardio- vascular disease prevention service. We are investing up to £645 million over two years to expand services offered by community pharmacies, including expanding blood pressure services. That extra capacity in the first year could prevent over 1,350 cardiovascular events, including strokes.

One ambition of the NHS long-term plan is the inclusion of a national stroke programme, seeking to improve stroke services through increased access to specialist stroke units, with a flexible and skilled workforce and better rehabilitation services. We are making progress on expanding the range of scanning across the country. Between April and June, over 95% of stroke patients were scanned within 12 hours of arrival into hospital, and 87% of patients eligible for thrombolysis received clot-busting drugs to treat their stroke. While there is of course more to be done, stroke patients now have better access to scans than ever before, but as many have said, integration is key. That is why, since April 2021, we have established 20 integrated stroke delivery networks, which bring together key partners in our fight against stroke to deliver joined-up whole pathway transformation across integrated care systems. They are now responsible for delivering optimum stroke pathways and ensuring that patients receive high-quality specialist care from before they are admitted to hospital through to rehabilitation and life after stroke.

Over the past 10 years there have been clear improvements in access to community stroke care, and the percentage of patients discharged from hospital to community stroke services has risen to 61% from just 41% 10 years ago. Every patient with acute stroke should gain swift access to a stroke unit within four hours and receive early multidisciplinary assessment. The latest data shows that 60% of patients are currently admitted to a stroke unit within that time. We have to ensure that we do better across the whole United Kingdom. That has improved over the past five years, but I recognise, as many have said, that more needs to be done. I am pleased that NHS England is trialling a new virtual consultation project between paramedics and stroke teams. We are confident that these innovative pilots will ensure timely access for patients accessing stroke units. That is being promoted across the country, and I am pleased that phase 1 was successfully completed this month and phase 2 began last month.

The hon. Member for York Central made an interesting point about whether stroke cases could be classified as cat 1 by the ambulance service. That is something I am quite passionate about. For the past nine years, I have been a community first responder with North West Ambulance Service. She will probably be aware that at the moment only cardiac and respiratory arrests are classified as cat 1, so I am not sure that that is a change I instinctively would support. However, I completely and utterly agree that it is critical that ambulances arrive as soon as possible, and that we triage patients to the correct services as soon as possible. I am happy to look at that and some of the other suggestions she made because she suggested an awful lot of good things that if we are not already looking at, we should be.

There is strong evidence that, when used appropriately, thrombectomy significantly reduces the severity of disability caused by stroke. Thrombectomy is a suitable treatment for around 10% of stroke patients and is available now in 24 centres in England, with a further two non-neuroscience centres on the way. NHS England has assured me that it remains committed and on track to reach its 10% target for all eligible patients to receive a thrombectomy by the end of 2025-26. The latest data shows that the thrombectomy rate has more than doubled in the past three years. To reach the target, the General Medical Council has approved the thrombectomy credential to support neuroradiologists to perform the procedure and increase the number that can be conducted. We have made great progress in getting cutting-edge AI technology into now over 90% of acute stroke-care providers in England. AI brain-scanning is now installed in all these thrombectomy units, reducing the time between patients’ first experiencing stroke-like symptoms and receiving treatment by more than 60 minutes. I saw that for myself this morning at the Royal Berkshire Hospital and I was incredibly impressed.

We know that stroke survivors commonly experience serious psychological, emotional and cognitive effects. Those greatly impact a person’s rehabilitation, quality of life and ability to return to work. We understand that there is a high level of demand for space in hospitals for rehabilitation services, which play an important role in a patient’s recovery and discharge from hospital. NHS England has taken important steps to increase capacity as part of its winter planning by ensuring that functions such as physiotherapy have the space they need in hospitals to operate effectively.

Of course, stroke treatment is dependent on our amazing NHS staff providing the care. There has been good progress in addressing staff shortages in several rehabilitation areas, although again I appreciate that more needs to be done. Between 2019 and 2023, we grew the number of full-time equivalent physiotherapists working in the NHS by almost a fifth, to over 23,000. NHSE has been working to increase the number of available student placements, and we have developed the speech therapy apprenticeship. Clinical neuropsychologists are a flexible workforce specifically trained to intervene across multiple care pathways, including stroke, acquired brain injury and other conditions. By 2024, NHSE will have doubled the number of training places available compared with the start of 2022.

The major conditions strategy will tackle conditions that contribute most to morbidity and mortality across the population in England. The strategy will cover prevention and treatment for cardiovascular disease across a person’s whole lifetime. As I have already touched upon, some of the key planks of the strategy include prevention, unlocking the transformative power of AI, and tackling the comorbidities that cause ill health in the first place. We published the strategy in August, and I hope to keep my hon. Friend the Member for Bromley and Chislehurst and other Members across the House updated on progress.

My hon. Friend—and most Members who spoke—raised concerns about the variation of stroke services across England. The NHS England national thrombectomy implementation group is gathering data on regional variations in access to mechanical thrombectomy. It will report on the outcomes of that by the end of this year, and if I can, I look forward to sharing that information with the APPG and others. The major conditions strategy will set out that integrated care systems tackle clusters of disadvantages in their local areas. That will include addressing variations in outcomes and the care that people receive in the context of the recovery from the pandemic.

This Government have a profound ambition to improve the lives and health outcomes of people in this country who have survived a stroke. The contributions today have played a vital role in pushing this agenda forward. I am happy to reassure my hon. Friend, and the other Members who have spoken, that I will continue to do everything I can for this matter to remain a top priority for our health service, and that the thrombectomy target will stay on track. I am especially grateful to my hon. Friend for everything that he has done to encourage his constituents to sign up for the Our Future Health programme. Our work here will have huge benefits both to patients and to our NHS overall, so that all survivors may survive and thrive after stroke.

It is good to see you in the Chair, Sir George. I warmly thank all hon. Members who have spoken. I am grateful to them for their support from both the Front and Back Benches. I particularly thank my vice-chairman of the APPG on stroke, the hon. Member for York Central (Rachael Maskell), whose expertise in this area is phenomenal.

I also thank the hon. Member for Strangford (Jim Shannon) for his characteristically compassionate remarks, as well as the hon. Member for Motherwell and Wishaw (Marion Fellows) and the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne). We all agree that we want better outcomes for people who suffer from this condition and that there are ways in which that can be done.

I look forward to working with the Minister, as do all the members of the APPG, and I am glad that he paid tribute to his Parliamentary Private Secretary, my hon. Friend the Member for North Norfolk (Duncan Baker), who was a driving force in setting up the all-party parliamentary group. I know that he will kindly and discreetly, but firmly, hold the feet at the Department to the fire on this matter. That will make our task easier.

I appreciated the references to some interesting developments. The pilot in Strathclyde, which the hon. Member for Motherwell and Wishaw mentioned, is particularly useful and interesting. In the short time I have left, I would like to mention one more—an online speech therapy app called Beautiful Voice. It has finished a useability pilot, and is run by a mixture of entrepreneurs, therapists and academics with virtually no Government funding, apart from sometimes a bit of research funding. From our experience as a family, it has been useful. Given the shortage of speech and language therapists, anything that can enable people to undertake therapy in their own home is something that I hope the Minister will look at. The Beautiful Voice app, which is available online, is delivered in conjunction with Hobbs Rehabilitation and the MiNT Academy, so there is an academic background. I hope the Government will try to find out more about that and get behind it.

With thanks to everyone, I hope that we continue to keep up the pressure. I know that it is not for want of intention, but the fact is that there is still a way to go to get us to where we want to be. If it can be done elsewhere, this is a classic case in which some investment up front—in thrombectomy, for example—and support for some of these therapies can save the country money in the long run. Above all, it can save human life and it can save and improve human experience, which is more important than anything. I am very grateful for the opportunity to debate this issue.

Question put and agreed to.


That this House has considered World Stroke Day.

Sitting suspended.