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Stroke Rehabilitation and Community Services

Volume 828: debated on Wednesday 22 March 2023


Asked by

To ask His Majesty’s Government what steps they are taking to address staffing and facilities shortages in stroke rehabilitation and community services, and to ensure the national integrated community stroke service is fully resourced to deliver personalised, needs-based, goal-orientated rehabilitation to every stroke patient.

We are increasing the number of qualified staff and ensuring a widened pool of trained staff who can work across pathways. This will help ensure that the national integrated community stroke service is fully resourced and address the workforce challenges in rehabilitation and community services. I have raised the issue of access to appropriate facilities with the CEO of NHS England, who will engage with NHS trusts to ensure access to appropriate facilities as the pressure on NHS space abates so that physiotherapists can continue their vital rehabilitation work.

My Lords, following my previous Question on this issue, I thank the Minister for writing to ICB CEOs on the urgent need for pre-Covid hospital and community rehab facilities to be returned to their former use. Can he tell me what timescales have been set and how this will be monitored to ensure that it actually happens? Strokes cost the NHS £3.4 billion a year and social care £2.3 billion in year 1, with another £2 billion on top of that for every subsequent year. What specific plans are there to expand the national integrated community stroke service, to ensure specialist rehab within five days of a stroke and to tackle the 68% of stroke sufferers who currently do not get an assessment, let alone rehab treatment, after hospital discharge?

I thank the noble Baroness for her question and for her tireless work in this space. I have fortnightly meetings with the NHS chief executive. One of the matters that I regularly raise with her is the timing of the return of physio space for this. As for ensuring that we are properly rolling out the services, the national integrated stroke service guarantees people individualised programmes of work and stroke rehabilitation services, in their homes if need be.

My Lords, the Minister told the House yesterday that the long-awaited NHS workforce plan is due “shortly”, which we are reliably informed is sooner than “soon”. We now wait with bated breath. I know that the Minister cannot speak to the specifics of the plan until it is released but I hope he can comment on its structure. Will it have the kind of detail that we need to see how staff shortages in specialist areas such as stroke rehabilitation will be remedied, or will it be so high level that further subplans will need to be developed so that specialist functional needs are not lost in the mix?

I can confirm that it is a detailed plan. Services such as physio are an important part of that and will be planned accordingly.

My Lords, as somebody who benefitted from life-saving neurosurgery almost 30 years ago, I can attest to the body’s amazing capacity to repair itself, provided that there is timely intervention. Can my noble friend confirm that timely intervention is crucial, that the resources will be made available, and that not doing so would be a false economy?

I thank my noble friend and agree. When I was looking at the waiting lists of those in need of physiotherapy, I was delighted to see that 80% of people were waiting less than 18 weeks. A plan is being put in place for musculoskeletal priority patients, so that they do not have to wait any more than two weeks. The urgency of putting these things in place quickly is recognised.

My Lords, the Minister talked about the national integrated service. He will be aware that rehabilitation services are very patchy and that, over the last four or five years, the amount of time that professionals have spent with individuals has got less. Will this new integrated care service bring us up to higher standards and see consistent standards throughout the country?

During the pandemic this was one of the areas that probably did not get enough time, for all the good reasons that we understand. Therefore, I am pleased to see that these pathways are being set out so that we can get back to the standards that we need. I believe this is something that we will see happening now.

My Lords, the Minister will know that stroke survivors, once in the community, face challenges with long-term rehabilitation and higher levels of depression, anxiety and loneliness than the rest of the community. What assessment have the Government made of arts-based therapies—I declare an interest as I am an adviser currently with King’s College Hospital—to address the whole patient as they recover from a stroke?

We are very much believers in the importance of social prescribing. I was at a reception just yesterday given by the Alliance of Sport, talking about the importance of active lifestyles for people’s mental health and recovery, and in the criminal justice system. It is something that we agree on the importance of. I will come back in more detail on the arts.

My Lords, can the Minister expand upon the encouragement that the Government are giving to people in secondary services, to encourage people to fulfil the exercise programmes that are given to them by the experts? Without that encouragement from GPs and practice nurses, such programmes may seem very difficult and may not happen.

My Lords, that is a very important point. Two things have really struck me. When people are in hospital, they lose 10% of their muscle mass per week, which is clearly key in their ability to have an active lifestyle and look after themselves outside. At the same time, they need constant support and reminders to keep up that active lifestyle. It is very much at the front of our mind.

My Lords, we know that rehabilitation at the appropriate level is key to the best outcome for stroke patients: some 10% will not have any residual disability, 25% will have a minor disability and 40% will have a moderate disability, but without rehabilitation, 80% will have a major disability. Would it be a good idea to carry out a country-wide audit of what services for the rehabilitation of stroke patients are currently like?

I thank the noble Lord. I believe that this is what the national integrated community stroke service is all about. It is the responsibility of each ICS to make sure that there is sufficient capacity in their area. At the same time, it is always good to make sure that that is happening, so I will follow up with the NHS to see what plans are in place to make sure that we really are getting that uniformity of service.

My Lords, the noble Baroness, Lady Bull, mentioned the importance of arts therapy for rehabilitation and for other issues. I add to her question by asking about the importance of musical therapy, not only for rehabilitation but to help people address mental health concerns. Could my noble friend the Minister add to his answer specifically with respect to musical therapy?

As I say, I see social prescribing as taking in a whole range of arts, music and sport. Given that that is a particular interest of my noble friend, I am happy to follow up on both arts and music.

My Lords, I draw attention to my declared interests. One of the most effective ways to reduce the burden of disease associated with stroke is to intervene earlier in trying to prevent stroke. What approach do His Majesty’s Government take to screening in the community and in populations for risk factors such as heart rhythm disorders, which, once identified, might be managed appropriately and reduce the ultimate burden of stroke?

The noble Lord makes a very good point. The House has heard me mention before that Sir Chris Whitty’s major concern right now around excess deaths is the cohort aged 50 to 65, as they missed out on three years of blood pressure and cardiovascular tests during the pandemic. With that in mind, we are looking at how we can roll out those sorts of services to the community so that they are accessible. You might not necessarily need a GP appointment, but could be tested in shopping malls and places like that, so that those things are picked up.