(3 weeks, 2 days ago)
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Sarah Dyke (Glastonbury and Somerton) (LD)
I am grateful to have this opportunity to address the House on World Stroke Day. Stroke is the UK’s fourth biggest killer and the single largest cause of complex disability in the UK. On our current trajectory, the number of stroke survivors will increase by 60% over the next decade, which will swallow up nearly half the current NHS budget. By that time, one in three people in Glastonbury and Somerton will be 65 or older, so we will disproportionately feel the impact of the increase in strokes over the next decade.
Jim Shannon (Strangford) (DUP)
I congratulate the hon. Lady on securing this debate. She mentioned the age of 65, which is really important; in Northern Ireland, there are some 2,800 new strokes every year. While the majority of strokes affect people who are over the age of 65, they can strike at any age. Some 25% of people who have strokes are under the age of 65, so does the hon. Lady agree that we must get away from the notion that stroke awareness is only for older people, and that we must be very aware of the FAST signs—face, arms, speech and time—that can make the difference between death and recovery? It can happen to young people as well.
Sarah Dyke
The hon. Member makes a really important point. Although we often assume that it is older people who suffer with strokes, so many young people suffer in the same way.
Unless there are major improvements, Somerset’s poor ambulance response times and poor life-after-stroke care will mean that a disproportionate number of the 42,000 people who will die from stroke in 2035 will be from my constituency.
Christine Jardine (Edinburgh West) (LD)
Further to the point that the hon. Member for Strangford (Jim Shannon) made, although I fully accept that we have to do more in terms of stroke care, does my hon. Friend agree that the population of this country is generally unaware of the early warning signs of stroke to look for? When it actually happens, we recognise the symptoms, but we have no awareness of the long-term warning signs. We need to invest in teaching people what to look for and how to care for themselves to avoid a stroke.
Sarah Dyke
I thank my hon. Friend for making such an important point. I think we have progressed in our understanding of stroke awareness, but there is so much more yet to do.
Neither strokes nor the grim predictions I have made are inevitable. Stroke is preventable, it is treatable, and it is recoverable.
Alan Gemmell (Central Ayrshire) (Lab)
Will the hon. Lady allow me to place on record my thanks to the innovative team at the stroke unit in Crosshouse hospital, whose new treatment, thrombolysis, means that—as the hon. Lady said—there is a way for many people to recover following strokes? I would like to thank charge nurse Elizabeth, consultants Martin and Sundeep, and Julie and Debbie in the hospital management team for saving my former teacher, Christine Stewart, when she self-diagnosed with FAST.
Sarah Dyke
The hon. Member makes a very good point, and I also celebrate those people, who do such hard work within their communities.
The UK knows how to deliver world-class stroke care, and some parts of England are doing that as I speak. Stroke is one of the few conditions that takes patients through the entirety of the health and social care system, from emergency services and acute care to social care, specialist rehabilitation support and end-of-life care.
Rachael Maskell (York Central) (Lab/Co-op)
I am really grateful to the hon. Member for securing this debate. Time is everything with regards to a stroke, particularly around diagnosis, but also if treatment such as thrombectomy is needed. Does she agree that we should be looking at ambulance response times in particular, and perhaps at recategorising stroke as a category 1 call-out?
Sarah Dyke
I thank the hon. Member for her intervention and for all the work she has done in this area. I will come to the issue of ambulance response times a little later in my speech.
Delays in urgent care are currently leading to high mortality rates, and post-stroke services that provide crucial emotional, practical and social support are often treated as optional, rather than essential.
Andrew Cooper (Mid Cheshire) (Lab)
I thank the hon. Lady for securing this important debate. She rightly talks about the need for stroke patients to receive urgent medical treatment. Last month, I attended a thrombectomy awareness event at which my constituent, Mark Paterson, was speaking as a stroke survivor. Mark’s remarkable recovery was thanks to the emergency thrombectomy procedure he received. Sadly, many others are not so lucky, with too many people dying or suffering disability due to the previous Government’s postcode lottery in care. About this time last year, the Stroke Association said that about 9.8% of patients receive that treatment in London, compared with 0.4% in the east of England. Does the hon. Lady agree that we need to see an increase in the proportion of patients receiving thrombectomies across the country?
Sarah Dyke
I thank the hon. Member for the intervention. He makes a strong point.
Our health and social care services are likely failing the 14,159 registered stroke survivors in Somerset at some stage in the system, but there is reason to be optimistic. If the Government put stroke at the heart of our health and social care system, each and every part of the system will be stronger and deliver better outcomes for everyone—not just stroke survivors.
Leaving aside the human cost, there is also an economic cost, as strokes lead to an avoidable £1.6 billion annual loss of productivity. I recently spoke to Garry, who works in Somerset and had a stroke in his 30s. He told me that he could have been back to work after nine months if he had had access to life-after-stroke care. Instead, he spent five years recovering, during which time he had to rely on the benefits system. At the start of the debate, I said that stroke is preventable, treatable and recoverable. If that is true—I know that it is—why are people like Garry forced to waste years in the prime of their life learning how to recover from strokes themselves?
Chris Bloore (Redditch) (Lab)
The hon. Lady is making an important point. Our clinical profession does an incredible job of saving many people who suffer from a stroke, but the rehabilitation work that follows surviving a stroke—the ability to get back into work, build emotional confidence and rebuild relationships—is so important. As she was detailing, too many people who survive strokes have to wait for years to get on with their lives, including their work, friendships and relationships.
Sarah Dyke
I wholeheartedly agree, and that is exactly the point that I was making.
Research from the Stroke Association shows that the NHS faces £1,300 of additional pressure for each person like Garry who does not receive life-after-stroke care, due to avoidable secondary strokes and other health complications. It is an injustice for stroke survivors who are suffering longer than they need to, for the taxpayer who could be paying less, and for the friends and families who often have no choice but to become unpaid carers to support stroke survivors, as my mum did for my dad after he suffered a stroke.
Unpaid carers currently bear 62% of the cost of prevalent strokes, with the NHS and social care bearing only a distant 9% and 22% respectively. Unpaid carers do a remarkable, important and often invisible job, and the Government must ensure they have access to the support that they need, including paid carer’s leave and a statutory guarantee of regular respite breaks.
There are not many easy answers when it comes to stroke. Constituents across Glastonbury and Somerton have written to me almost every month since my re-election because they are concerned about the closure of Yeovil district hospital hyper-acute services. It is right that steps are being taken to address the fact that 60% of people who arrive at hospitals do not get into a stroke unit quickly enough, so services are being reconfigured to provide patients with cutting-edge care in Dorchester or Taunton.
By concentrating hyper-acute services, wards can process patients more quickly, which is so important when caring for patients suffering from a stroke. After critical care has been provided, patients will be moved back to services closer to their home, such as Yeovil, so that family and friends will be able to visit their loved ones there rather than in critical care further away. I can understand why people are scared of potentially having to travel further in an emergency when response times are so poor. In fact, with an average response time of 42 minutes and 50 seconds, people in Somerset wait longer for an ambulance than anywhere else in England. For every minute a stroke is left untreated, nearly 2 million brain cells die, so fast ambulance response times are necessary for getting stroke patients lifesaving, disability-reducing treatments in time.
This is especially important for those living in rural locations, such as Glastonbury and Somerton, who may need to travel further for treatment. Liberal Democrat analysis has revealed that waits for life-threatening calls are 45% longer in rural areas than in urban ones. The average handover time for a category 2 ambulance call in Somerset has risen to over an hour, despite the ongoing 18-minute target, which results in ambulance crew being able to see only two or three patients per shift. The Government could lower these ambulance response times by increasing the number of staffed hospital beds, and ensuring our social care system is resourced well enough to allow people to recover outside hospital. We know that a matter of minutes can make all the difference in emergencies, so it is heartbreaking that ambulance delays are worsening and stroke victims are being left for hours for help to arrive.
I am inspired by the stroke quality improvement for rehabilitation project, which has helped over half the stroke survivors who were previously being failed by services in Somerset. The pilot has ensured that survivors have access to personalised and face-to-face support to help them with behavioural changes and re-entering work. Despite its success in preventing secondary strokes, and thus saving the health and social care system a great deal of money, the pilot is unlikely to receive funding from April next year, and 250 patients in Somerset face the prospect of losing access to good-quality life-after-stroke support.
I am particularly worried about stroke survivors in Glastonbury and Somerton, and elsewhere in Somerset, who will instead have to rely on Yeovil district hospital if this happens, as Yeovil district hospital provides only the minimum level of occupational therapy, physiotherapy, and speech and language therapy a week to less than half as many patients as the national average. There is a future where we no longer need to have a World Stroke Day, and that is what I am looking for—a future without a World Stroke Day.
Innovations such as the use of artificial intelligence in diagnosis could revolutionise recovery prospects for stroke patients, and preventive programmes could limit the impact stroke has on working-age people. We saw stroke mortality halved in just 10 years when stroke was prioritised in 2000, so progress can be made. If we are to reach that future, though, we must start by ringfencing budgets to enable the NHS to adopt innovative digital tools, invest in new technologies and develop a digital strategy.
This Government have already begun to make some progress with the Darzi report, which showed that the NHS is on its knees after years of mismanagement by the Conservatives, but we must ensure that stroke remains a top priority in their health mission.
Uma Kumaran (Stratford and Bow) (Lab)
I would just like to share my experience. On my first day here in the Commons, my husband suffered a stroke. This is a timely debate, so I thank the hon. Member for securing it. I am pleased to say that my husband is doing much better now, and he is here in the Gallery of the Chamber, as are those from the Stroke Association, who have been absolutely invaluable to our family and many stroke survivors across the country.
I would like to pick up a point that the hon. Member made about stroke. One in four strokes happens to people of working age, and one in three in this group will have to give up their jobs. It is very clear that, although the NHS has given excellent care to my husband and to families such as mine, there is much more to be done. The Darzi report revealed the scale of the challenges that our health service faces, especially with stroke services, and the severe impact of the underfunding of the last Conservative Government.
Sarah Dyke
I thank the hon. Lady, and it is so good to hear that her husband is making such a full and quick recovery.
World Stroke Day is a pertinent reminder that stroke must be well represented in the new 10-year health plan and that the Government must engage with patients, carers, and health and social care professionals, so that their lived experiences can help inform policy decisions.
The Minister for Care (Stephen Kinnock)
I congratulate the hon. Member for Glastonbury and Somerton (Sarah Dyke) on securing a debate on this vitally important issue. It is important not only for her constituents but for her personally, I think, given her family circumstances; I know she really spoke from the heart and we appreciate that.
Good health should be fundamental to all of our lives, but sadly that is not the case for too many people. Over 100,000 people have a stroke in the UK every year—one person every five minutes. One third of them will be left with some form of long-term disability. As the fourth largest cause of death for adults, stroke has a devastating impact on individuals, their families and wider communities across our country.
For decades the NHS has served us well, and it is one of the proudest achievements of the Labour party that we were at the foundation of our NHS. Our staff have tremendous expertise and dedication; they are working hard every day to make a difference. But we have to face up to the reality that we have had 14 years of neglect and incompetence on the part of the Conservative party. We are now facing a very significant set of challenges in looking to get our health and care system back on its feet and fit for the future. That is the important context for this debate.
I am very grateful to the hon. Member for Glastonbury and Somerton for giving me the opportunity to inform her and the House of the work that the Government have been doing since we came into office on 4 July, and particularly as today is World Stroke Day. The House will have seen that we have set out the three transformative shifts that we want to deliver in health and care, moving from care in hospitals to care at home, prioritising prevention over treatment, and advancing from analogue to digital solutions. These three strategic shifts will be the building blocks of our health mission, reducing time spent in poor health, tackling health inequalities and reducing lives lost from the biggest killers, which include cardiovascular disease.
We have to change the NHS so that it is no longer just a sickness service but a prevention service too. Prevention is always better and cheaper than cure. So we have to take preventive public health measures to tackle the biggest killers and support people to live longer, healthier lives. That is why in our health mission to build an NHS that is fit for the future, we have committed to reducing deaths from heart disease and strokes by one quarter within 10 years. The NHS health check, England’s flagship cardiovascular disease prevention programme, aims to prevent heart disease, stroke, diabetes, kidney disease and some forms of dementia. Each year the programme engages over 1.3 million people and, through behavioural and clinical interventions, prevents around 500 heart attacks or strokes.
To improve access to and engagement with this life-saving programme, we are developing a new digital NHS health check, which will be ready for testing in early 2025. It will enable people to undertake a check at home. We are also trialling more than 130,000 life-saving heart health checks in the workplace. These checks can be completed quickly and easily by people at work so that they can understand and act on their cardiovascular risk and reduce their future risk of a stroke.
Around 50% of heart attacks and strokes are associated with high blood pressure. Community pharmacies are providing a free blood pressure check service for anyone over the age of 40. In cases where this results in a high reading, pharmacists can make sure people receive the right NHS support to reduce their blood pressure. We know that there is more to do to prevent the causes of stroke, and the Department and NHS England are working together to tackle this issue.
I am also pleased to announce that on Monday 4 November NHS England is launching a new Act FAST campaign to increase knowledge of the main signs of a stroke and to encourage people to dial 999 immediately in response to any sign. The new campaign builds on the success of the previous Act FAST campaign and uses a revised call to action:
“Face or arm or speech, at the first sign, it’s time to call 999”.
Tessa Munt (Wells and Mendip Hills) (LD)
I pay tribute to a young man who lived in Shepton Mallet named Will. He spotted what was happening to his father. He is a young man with some difficulties himself, but he recognised FAST. He had seen it on television, and it is testament to the power of television and radio campaigns in making sure that those messages get through, because that young man has difficulties in communicating and moving, but he managed to get the rest of his family to realise what was happening to his father sitting there across the breakfast table. I just wanted to mark that.
Stephen Kinnock
I thank the hon. Lady for that telling intervention. She is absolutely right: so much of the challenge and the opportunity before us is about how we use traditional media, social media, all forms of communication and awareness-raising campaigns and techniques. By definition, we are dealing with a situation in which speed is of the essence. It is truly a public health challenge, because it is only the public who can do what Will did in that circumstance. I certainly pay tribute to Will for acting so quickly and to the Act FAST campaign. I am sure Members will welcome that we are looking to build on the success of Act FAST and to replicate and renew it.
That campaign will run in England across TV, radio, social media, national press and ethnic minority TV and radio stations. The campaign includes specific communications for multicultural and disabled audiences. A higher reduction in mortality rates over the next 10 years will require a focus on NHS England stroke priorities, including rapid diagnosis and increasing access to time-dependent specialist acute stroke care. We know that so many deadly diseases can be avoided if we seek help in enough time. That is why we are working to improve access to treatments. Current targets include increasing thrombectomy rates to 10% and thrombolysis rates to 20% through facilitating ambulance service use of pre-hospital video triage and use of AI decision support tools for brain imaging in comprehensive stroke centres. I know that my hon. Friend the Member for Mid Cheshire (Andrew Cooper) has a keen interest in that issue.
Andrew Cooper (Mid Cheshire) (Lab)
Building on the point made by my hon. Friend the Member for York Central (Rachael Maskell), does the Minister agree that stroke patients should have the highest priority for ambulance call-outs—as high as cardiac arrest, for example?
Stephen Kinnock
I am a little wary of generalising too much, because I know that so many decisions have to be made in real time by our skilled ambulance drivers and paramedics and the many others involved, but my hon. Friend makes a valid point. In a general sense, he is absolutely right that stroke needs to take priority. The red thread going through this entire debate is the need for speed. It is all about prioritising and acting quickly; he is absolutely right about that.
In the past year, we have seen a 30% increase in the number of thrombectomies delivered in England. Alongside that, our 20 integrated stroke delivery networks are looking to optimise care pathways. The General Medical Council is addressing critical workforce gaps through its thrombectomy credentialling programme, and our national optimal stroke imaging pathway is improving information sharing.
I am aware of the reconfiguration in the constituency of the hon. Member for Glastonbury and Somerton. NHS Somerset integrated care board has decided to close the hyper-acute stroke unit at Yeovil hospital and to establish a single hyper-acute stroke unit at Musgrove Park hospital in Taunton to provide 24/7 emergency treatment. All service changes should be based on clear evidence that they will deliver better outcomes for patients. A high bar is set out in guidance for intervening in contested reconfiguration cases, and the reconfiguration of services should be a matter for the local NHS. I would expect all avenues of local resolution to have been exhausted before a call-in request is made. The Department has received a formal request to call in NHS Somerset ICB’s decision, and Ministers will make a decision on whether to use their call-in powers in due course.
Unfortunately, there is still significant variation across the country in access and outcomes in relation to stroke. For example, the percentage of suspected stroke patients who received the necessary brain scan within an hour of arrival at hospital varies from 80% in Kent to only around 40% in Shropshire. That variation needs to change, and we need to bring the best of the NHS to the rest of the NHS. That will be one of the central challenges for the Government going forward.
The Government have a profound ambition to improve the lives and health outcomes of people who survive a stroke. At this point, I would like to pay tribute to my hon. Friend the Member for Stratford and Bow (Uma Kumaran) and to the man in the Public Gallery for what they have been through and for their fortitude. It was certainly not easy for my hon. Friend to come to this place and to have to go through the extremely difficult situation that she did. I also pay tribute to all the key partners and stakeholders who worked with her and her family to get through it. That really is a tribute to the immensely important work they do.
Rachael Maskell
As well as looking at acute triage to rapidly diagnose people who have had a stroke, it is important to invest in rehabilitation—something I did for 20 years in the NHS. I would be grateful if the Minister could set out how he proposes to have integrated rehabilitation teams that not only see people through the immediate aftercare, but continue to provide a top-up for them so that they do not backslide in their rehabilitation.
Stephen Kinnock
I can say a word about our national service model for an integrated community stroke service, which involves a number of specific projects aimed at improving delivery of psychological rehabilitation. The ICSS model is vital to support psychological recovery, return to work and improved quality of life, and I would be more than happy to discuss it further with my hon. Friend.
Before I close, I want to recognise the remarkable work of the charities that help people across the country to rebuild their lives after a stroke. Once again, I thank the hon. Member for Glastonbury and Somerton for this important debate, and I encourage every Member of the House to go to change.nhs.uk and to get involved in the biggest conversation about our health and care service since its foundation in 1948.
Question put and agreed to.