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NHS: Stroke Care

Volume 796: debated on Tuesday 5 March 2019


Asked by

To ask Her Majesty’s Government what steps they are taking to ensure that there are sufficient specialist medicine, nursing, rehabilitation and community staff to achieve the priority ambition for stroke care set out in the NHS Long Term Plan, to meet both current and future needs.

My Lords, the recently published NHS Long Term Plan outlined commitments to improve stroke services, including better stroke rehabilitation services and increased access to specialist stroke units. The Secretary of State has commissioned my noble friend Lady Harding, the chair of NHS Improvement, to work with Health Education England to oversee the delivery of a workforce implementation plan. This will include proposals to grow the workforce, consideration of additional staff and of the skills required, and building a supportive leadership culture in the NHS.

My Lords, as a carer keen to see improved stroke services, I welcome the recognition in the NHS Long Term Plan of stroke as a clinical priority. Excellent stroke care saves lives and needs a range of professionals across the whole stroke care pathway, including GPs, paramedics, nurses, psychologists, physiotherapists, occupational and speech language therapists, and social care workers. Not only are there chronic staff shortages among all those key groups but high turnover is a major challenge, particularly among nursing and care staff. It is small wonder that nearly half of all stroke survivors say that they do not have enough nursing and therapy support in hospitals, and that when they get home they feel abandoned because of a lack of rehabilitation and care that would help them improve or cope with living with stroke disability. Does the Minister agree that the high-intensity care models for rehabilitation for stroke promised in the NHS plan are urgently needed, and what immediate actions will be taken by the Government to ensure that there are enough trained staff and specialist staff to deliver the promises for future care and treatment?

My Lords, I agree with the noble Baroness, Lady Wheeler, that it is very important that we have the relevant NHS workforce to deliver the care needed in this very important area. Stroke is a devastating disease for patients and their families. The Stroke Association estimates that it costs the NHS around £3 billion per year, with lost productivity, disability and formal care costing the economy an additional £4 billion. To that end, we are putting in place funding of £20.5 billion each year over the next five years, with cardiovascular also being a clinical priority. This will support the national plan for stroke.

My Lords, there is a complete postcode lottery for good stroke care, with inequities in accessing treatments such as thrombolysis and thrombectomy, as well as the subsequent appropriate rehabilitation and care. By when does the Minister expect anyone who has a stroke anywhere in England to receive the same level of treatment as in London or Manchester?

My Lords, the noble Baroness is absolutely right: there is variation in care. We are working very hard to tackle the variations in the system. Within its financial constraints, the NHS is committed to providing access to stroke care and prevention services and, as the noble Baroness knows, the clinical commissioning groups are responsible for commissioning these services to meet the requirements of their populations. In doing so, CCGs need to ensure that the services they provide are fit for purpose, reflect the needs of the local population, are based on available evidence and take account of national guidelines.

My Lords, I keep hearing the word “reconfiguration” in connection with stroke services. Could my noble friend explain what this means for stroke services going forward?

I thank my noble friend for that question. Reconfiguration of stroke services is very important because there is strong evidence that consultant-led specialist treatments in large, centralised hyperacute stroke services, where geographically appropriate, save lives, improve recovery and can reduce the length of hospital stays, while saving money. Three pilots have taken place in London, Manchester and Northumbria. They have seen a 9% reduction in the length of hospital stays in Greater Manchester and a cost saving of £800 per patient in London.

My Lords, I remind the House of my membership of the GMC. Coming back to the question about hyperacute stroke services, which have been such a huge boost to patient outcomes, the Minister says this is up to CCGs, but all over the country CCGs have been obstructive to this move. They have defended their own district general hospitals, attempting to keep all their stroke services at the expense of the quality and safety of patient care. The Government have to intervene, surely?

The noble Lord makes a very valid point. As I said, evidence-based medicine is speaking about a hub-and-spoke way forward. There is the national plan. We have set up a primary board that will look at reconfiguration of services and the workforce planning within it. We hope that some of those challenges can be met head on.

My Lords, I declare my interest as chairman of University College London Partners. Is the Minister content that opportunities for rapid adoption of innovation, which could help identify those at greatest risk of stroke as a preventive strategy, and interventions that might improve stroke outcomes, are available across the entire NHS in England?

One can never be totally confident, but that is certainly the way we are working. As I said, we have set up the national board for stroke services, which will look at different pathways. It will look at assessment for prevention and rehabilitation, so that we can roll these out across the whole of the NHS. That is the plan and the £20.5 billion will unlock some of these services.