Diesel Emissions

Baroness Wheeler Excerpts

Wednesday 5th December 2018 Lords Chamber

[Lord O’Shaughnessy]

I absolutely agree with the noble Baroness that this is an issue of concern. It is a concern to all of us and it is certainly a concern to those of us with school-age children in urban areas, who experience the pollution every day. First, the UK has made progress on reducing pollutants, although clearly there is a long way to go, and in specific urban areas the problem is much worse than in others. Secondly, I point the noble Baroness to the clean air strategy, which will be published at the end of this year. It will contain a range of measures aimed at reducing pollution and, as a consequence, the public health damage that comes from it. I shall certainly feed in her comments about the importance of targeting these benefits on schools.

[Baroness Wheeler (Lab)]

My Lords, earlier this year the World Health Organization Science Panel reclassified diesel exhaust as a carcinogen, underlining that many cases of lung cancer could be connected to the contaminant and that exhaust could become as important a public health hazard as passive smoking. The European Public Health Alliance has pointed to the urgent need to develop research into the possible impact on other health conditions such as diabetes and dementia. Can the Minister tell the House what action is being taken in response to the WHO declaration and what research funding and programmes are in place to address the growing concerns on this issue?

[Lord O’Shaughnessy]

The noble Baroness is quite right: it is one of the biggest public health problems that we face. It is associated with around 30,000 deaths a year, and that gives us a sense of the scale of the problem. I mentioned the clean air strategy but two specific important pieces of research are also taking place. One is called the Exploration of Health and Lungs in the Environment, which is a London-based study looking at the links between pollution and children’s lung health. The Department of Health and Social Care has also commissioned a review of adverse birth outcomes and early-life effects associated with exposure to air pollution. Therefore, we take this problem seriously and are commissioning research to know not only the consequences but what to do about it.

Mental Capacity (Amendment) Bill [HL]

Baroness Wheeler Excerpts

Report: 2nd sitting (Hansard): House of Lords
Tuesday 27th November 2018 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, Amendments 49, 85 and 87, which are in my name, complement Amendment 29—which, like others, I strongly support. Information to the family and those who care deeply about the welfare of the person is the cared-for person’s safeguard against exploitation or bad care or simply having their needs ignored. It is paramount that families have a role to play in the care planning of their relatives, not least by giving them the option to stay fully informed and to object to the proposed plans if they are unsatisfied.

When an assessment happens at one point it is easy to collate all the information, get it signed off and then forget that every day until the scheduled review is a day to be lived by the cared-for person. If the conditions laid out in the authorisation are not adhered to, if the person is not empowered as much as possible to be both mentally and physically active, gradual inactivity and a slipping decline set in.

The care itself is important. Certainly, quality of care will vary between care homes and within them, but monitoring the care plan is central to ensuring that the cared-for person’s dignity is maintained. Their quality of life depends on how they are treated day in, day out, as well as whether they receive care in a way that enhances their personal dignity or, shamefully, they are treated as though they are of less worth. It is therefore imperative to ensure that the cared-for person is placed at the heart of the LPS authorisation process, which is why I want all those consulted in the initial process, as laid out in paragraph 17(2), to be able to access easily the care and support plan. Being able to apply for it is not enough; many people may not even know that they are able to apply to look at it. Relatives will notice if the care plan states that something is not happening and question why.

The care plan and authorisation record must be available to the cared-for person, enabling them to keep track of what is supposed to be happening. For those with fluctuating capacity or less severe impairments, the sense of control and empowerment that this would give is completely in line with the ethos of the Mental Capacity Act. Where the cared-for person cannot monitor their care plan, they can still know, even in their short-term memory, whether they are getting what they should get. Those with specific responsibilities for the cared-for person’s welfare—such as the nominated representative, the donee of the lasting power of attorney for health and welfare or the court-appointed deputy—must have both the authorisation statement and the accompanying care plan.

The care plan must also be provided to the care team in the cared-for person’s place of residence, because where such a place is supported living, I am concerned that those who provide support and are not on a professional register may find that they are not given all the details. I strongly support Amendment 29, introduced so clearly by my noble friend Lady Watkins. People must know what their rights are and what will happen. This will not be costly; it will be far less costly than the court cases that are likely to come if the requirement to provide information about all aspects of the process and plan is not in the Bill.

Amendment 87 deals with what to do in the event of a dispute. It requires an AMCP to be appointed to explore the reasons for the dispute and assess the situation independently. If agreement cannot be reached, independent mediation must be sought before resorting to the adversarial processes of going to court. A group of family law solicitors has been working for over a year to develop a system of mediation to be used before a court proceeding in the Court of Protection. This type of dispute, where everyone agrees that a solution must be found in the interests of the cared-for person, lends itself well to mediation; it would be swifter, cost less than any court action and be far less traumatic for all concerned. If the principle of dealing with dispute is not in the Bill, can the Minister reassure the House that it will be dealt with in the code of practice?

Before I finish, I urge the Minister to recognise the strength of feeling about people needing to be given information about their rights. If he will not accept these amendments, will he agree to bring the lead amendment in this group back as a government amendment at Third Reading? Requiring adequate information-giving must be in the Bill; it cannot be left to the code of practice, nor deferred to the Commons stages. This is one of the most essential planks in ensuring that the care that should be given is given.

[Baroness Wheeler (Lab)]

My Lords, we on these Benches strongly support the key amendments in this group. Amendment 29, to which my noble friend Lady Thornton added her name, would ensure that the responsible body has a duty to make sure that the cared-for person or the person representing them in an advocacy, professional or other capacity fully understands the rights of the cared-for person for whom deprivation of liberty is proposed, and the rights to challenge. Those rights also include specifically the rights to an independent and professional assessment, to a review of the LPS arrangements, to advocacy and support and to be able to challenge the LPS authorisation in court.

The noble Baroness, Lady Watkins, made a strong case for rights to information to be on the face of the Bill, ably following on from the interventions of the noble Baroness, Lady Hollins, during its previous stages. She spoke on the importance of this issue, particularly in respect to people with learning difficulties, and the need, wherever possible, to take steps to increase the cared-for person’s capacity to understand what is happening to them and to have as much involvement as possible to help them determine their wishes and feelings.

Gosport Independent Panel

Baroness Wheeler Excerpts

Thursday 22nd November 2018 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for reading out the Statement updating the House on government actions since this appalling tragedy was reported to the House in June. As the Statement says, the Gosport report was “truly shocking”, and once again our thoughts, sympathies and condolences go out to the families of the 456 patients whose lives were shortened. Those families campaigned for so many years to find out what happened. We also again pay tribute to these relatives for their courage, tenacity and persistence in seeking the truth, and to the panel, with particular thanks for the calm and compassionate leadership of the chair, Bishop James Jones, for its unstinting work in uncovering the injustice and for listening to and hearing the families’ concerns.

It is important to remind ourselves of the panel’s conclusions. First, there was a disregard for human life and a culture of shortening the lives of a large number of elderly patients. Secondly, there was an institutional regime of prescribing and administering “dangerous doses” of a hazardous combination of medication not clinically indicated or justified. Thirdly, relatives were constantly let down by those in authority in the hospital when they complained. Fourthly, senior management, the local constabulary and politicians, the coroner system, the CPS, the GMC and the NMC all failed to act in ways that would have better protected patients and relatives.

We welcome the commitment to strengthen protections for whistleblowers and for new legislation to compel NHS trusts to report annually on how concerns raised by staff have been addressed. Has a detailed programme of work for this been drawn up? When does the Minister envisage that legislation on these new powers will be introduced? However, much of the Statement today is about work in progress on the actions and measures that were announced when the report was published, and it is important that we receive regular updates in the future. In his June Statement, the Minister referred to the introduction next April of medical examiners to ensure that every death is scrutinised by either a coroner or a medical examiner, and yesterday’s Statement repeats this commitment. Can the Minister advise the House on progress on this? If they are to be employed by acute trusts, how will their independence be maintained and how will they link into the mortality reviews and the Learning from Deaths guidance? Has consideration been given to basing them in local authorities so that their remit can be extended to primary care, nursing homes and mental health and community trusts? What additional resources are being provided to fund these new posts?

When the report was published, the House welcomed the urgent establishment of a hotline and of counselling being made available to all those who had lost loved ones and were affected. Are these important provisions still available and will they continue to be provided? What further support is being provided? Also, in addition to the 456 patients given opiates without appropriate prescribing or as a result of the prescribing practices at the hospital, sadly, 200 more patients were referred to in the report whose clinical notes or medical records had gone missing. The panel considered that these patients had been similarly affected. What progress has been made by the workstream set up to further investigate this appalling situation? How many more cases have been substantiated as a result of this?

On the question of oversight of the use of opiates in the NHS, is the Minister satisfied that it is now tight enough to prevent incidents such as this happening again? We welcome the promise of a further review on how patient safety can be improved when prescribing and dispensing medicine, aimed at detecting inappropriate prescribing. Can the Minister give us further details of how this review is to be conducted, including the full remit and timescales?

In June, the Minister also promised a “fresh impetus” to moving forward on the need to streamline professional regulation following the report’s condemnation of the inadequacies of the GMC and NMC regulators who failed to act in ways that would have better protected patients and relatives. What progress has been made on this work?

Finally, we come back to the key issue of patient safety and the need to build a patient safety culture in the NHS. Does the Minister consider that additional legislation is needed to keep patients safe? Is a new independent body now required to pick up and take forward the remit of the former Patient Safety Agency, so unwisely abolished by the Government?

The Statement ends by underlining the cultural change that needs to be driven across the NHS to achieve openness, transparency and learning rather than blame and the cover-up of mistakes and incidents, and of course we agree with that. For all the awfulness of its findings, the Gosport panel report has managed to ensure that the carers and relatives of loved ones and staff have been listened to and heard. We on these Benches pledge our full support for the measures which will ensure that what happened at Gosport never happens again.

[Baroness Jolly (LD)]

My Lords, I join the noble Baroness, Lady Wheeler, in thanking the Minister for an update of this situation and I too pay tribute to the relatives and the whistleblowers in this awful scandal. I am sure that many noble Lords will remember how the Shipman scandal absolutely rocked the NHS back in the late 1990s. The learning which came out of that was meant to incorporate right across the NHS robust clinical governance structures. It is really quite ironic that the things which were put in place to deal with the Shipman case seem to have fallen apart completely as regards the particular issue of Gosport.

Whistleblowers need to be confident that there will be no danger of their being bullied. I am sure that other noble Lords will have had NHS employees ask to talk to them about whistleblowing issues. One of the saddest days I can remember was when I was sitting in the Royal Gallery talking to a very senior manager in an NHS trust who was trying to raise his concerns. In the end he resigned because he felt that he had been bullied into doing so. He was going to take his expertise elsewhere. There is learning that should come from that.

I welcome the Freedom to Speak Up initiative and the work from the National Guardian’s Office. What progress has been made in embedding the operation of that scheme? If it is still in train, when might it be embedded? What consideration has been given to a similar scheme for whistleblowers who work in the care sector? This has got the NHS sorted but, at the moment, there is no way that care workers who work in care homes or other care establishments can effectively blow the whistle.

Health: Stroke

Baroness Wheeler Excerpts

Wednesday 14th November 2018 Lords Chamber

Asked by

[Baroness Wheeler]

To ask Her Majesty’s Government what progress they have made in developing a national plan for stroke.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, a stroke programme board was established in March 2018, co-chaired by NHS England’s national medical director, Professor Stephen Powis, and the CEO of the Stroke Association, Juliet Bouverie. Following this, the NHS long-term plan will include a focus on cardiovascular disease and stroke, and is set to be published before the end of this year.

[Baroness Wheeler (Lab)]

I thank the Minister for his response. While the promise of including the national stroke plan in the full NHS long-term plan is welcome, nevertheless publishing it in its own entity after the national strategy ran out last year would surely have helped to sustain the progress and momentum since 2010, particularly in the reconfiguration of stroke services. Instead, thousands of stroke survivors say that they feel abandoned after they come out of hospital: 70% of patients are not offered a personalised care plan for their ongoing treatment, care and support; only 30% of CCGs are commissioning the vital six-month reviews of their progress and problems; one in four hospitals does not have access to stroke specialist early supported discharge at home; and, on average, stroke survivors wait 10 weeks for urgent psychological support. What action are the Government taking to ensure that CCGs tackle these problems now?

[Lord O'Shaughnessy]

I understand the noble Baroness’s frustration about the gap between the strategy and the plan but it was right to include the work undertaken on the stroke plan within a long-term plan, because clearly that covers every aspect of how the NHS is working. In the meantime, I point out to her that the NHS RightCare programme for cardiovascular disease has been set up. It is aimed specifically at dealing with some of the variation in service that she talked about. But there is good news in stroke care: not only is there less incidence than 10 years ago but 30-day mortality rates have more than halved, so there is progress which we need to build on.

If the noble Baroness and the House will allow me, I would like to use this opportunity to pay tribute to my noble friend Lord Skelmersdale, who died very recently. He was a predecessor in this role and a great champion of stroke care, both as a Minister and as chair of the Stroke Association for 10 years. I am sure that everyone in the House would offer their sincere condolences to his family and friends.

Child and Adolescent Mental Health Services

Baroness Wheeler Excerpts

Wednesday 24th October 2018 Lords Chamber

[Lord O’Shaughnessy]

I do not know the specifics on psychology graduates; I will write to the noble Baroness. If the number of nurses in mental health nurse training at the moment comes through into the profession, there will be 8,000 more mental health nurses by 2020. I am sure we will be keen to recruit them from wherever we can.

[Baroness Wheeler (Lab)]

My Lords, on the issue of 24/7 services, CQC evidence suggests that the number of children visiting A&E departments for mental health treatment has more than doubled since 2010. Earlier this year, a CQC review highlighted growing demand as children, young people, their families and carers find that they have to reach crisis point before they can get help. On top of this, the recent FOI response to the BBC’s “Panorama” programme showed that at least 1.5 million under-18s were estimated to be living in areas where there are no 24/7 child mental health services. What steps are the Government taking to join up services across health, education, local councils and the voluntary sector to ensure that these vital crisis and support services are available and funded?

[Lord O’Shaughnessy]

I recognise that there is variability across the country. Indeed, waiting times vary, which is not acceptable. That is why a new four-week waiting time standard is being trialled as part of the Green Paper I mentioned. I should also point out that new, community-based eating disorder clinics are being set up so that people do not have to go to an A&E environment and can access something that is better for them, frankly, both more easily and locally.

Personal Social Care: Funding

Baroness Wheeler Excerpts

Tuesday 16th October 2018 Lords Chamber

Asked by

[Baroness Wheeler]

To ask Her Majesty’s Government what assessment they have made of the report by Independent Age, A Taxing Question: How to fund free personal social care, published in September.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, the Government welcome and recognise the contribution of Independent Age and other stakeholders to the important debate around social care reform. The Green Paper that is to be published later in the year will set out proposals for a sustainable social care system that strikes a fair balance between what the state and individuals pay. Reforms must be affordable and fair across the generations, including to working-age taxpayers.

[Baroness Wheeler (Lab)]

I thank the Minister for his response. The report sums it up when it says that,

“today … accessing such support has become a game of chance: based on where you live, your social class, and your ability to pay”,

all of which was echoed in last week’s CQC state of care report, which also made it clear that any future extra funding for the NHS will just be wasted and swallowed up treating people in hospital unless there is a similar major cash injection for social care. Will the Minister confirm that all the options set out for future social care funding in the Independent Age report, particularly the strong case made for free personal social care and support for older people, are under active consideration in the social care Green Paper? How are the proposed 10-year NHS plan and the Green Paper joined together to deal with the integration lottery and fragmented care that the CQC’s local systems reviews have highlighted?

[Lord O'Shaughnessy]

I thank the noble Baroness for raising this important issue. She is quite right that extra funding is needed, which is why we have pledged £20 billion extra for the NHS and want to get this long-term funding settlement for social care. There are many proposals in the Independent Age document—nine, I think—and we are looking at a range of different options. As I said, there needs to be a fair balance between those who are working today and those who need care today, an issue that has evaded a number of Governments and which we sincerely hope to solve. On how the two plans will work together, the intention is that the long-term plan and the Green Paper will be published together around the same time and will therefore be complementary in trying to achieve the goal of integrated health and care.

Adult Social Care

Baroness Wheeler Excerpts

Wednesday 11th July 2018 Lords Chamber

[Lord O’Shaughnessy]

I absolutely agree with my noble friend. I know that she speaks from great experience. We have some good working practices now, through the better care fund, between health commissioners and local government, which is an essential part in making sure we have a sustainable system.

[Baroness Wheeler (Lab)]

Will the Minister reassure the House that the Green Paper will address the parity of esteem between mental and physical health in terms of eligibility for social care support at home? Although there is serious concern that many people suffering debilitating mental illness, particularly depression, are not receiving the basic social care support they need, it is very difficult to assess the national scale of the problem because of the very poor data on how the current eligibility criteria are applied in mental health support. How is this key issue being addressed?

[Lord O’Shaughnessy]

I reassure the noble Baroness that it will be addressed. When we have the consultation, there will be more opportunity to explore that.

Hepatitis C

Baroness Wheeler Excerpts

Monday 9th July 2018 Lords Chamber

[Lord O'Shaughnessy]

First, I applaud the noble Baroness for her work on this. We know that hepatitis C is a truly horrible disease that affects some of the most vulnerable people in our society, which is why we want to eliminate it. In terms of the NHS being geared up, we are on track to treat 70,000 people by 2020. We need to keep finding people, and, of course, they become harder and harder to find. She is quite right about the need to raise awareness. We are doing other things as well, such as reaching into hard-to-reach communities. To give one example, there is now a 100% opt-out testing offer for people entering the prison estate, which is one of the areas where hepatitis C tends to be transmitted. There is clearly a need to do more, but we are looking at how to reach those hard-to-reach communities.

[Baroness Wheeler (Lab)]

Can the Minister say a bit more about the steps the Government are taking to support the delivery of hepatitis C treatment in community settings, such as GP clinics, pharmacies, homeless shelters, substance misuse clinics and sexual health clinics? The King’s Fund estimates that spending on tackling drug misuse in adults has been cut by more than £22 million compared with last year, and funding for sexual health clinics by £30 million over the same period. How will the 2025 target for elimination of hepatitis C be met if vital education and work in these services, and the work they do in reducing reinfection rates, are not available?

NHS and Social Care Services: Parity of Esteem

Baroness Wheeler Excerpts

Thursday 5th July 2018 Lords Chamber

Asked by

[Baroness Wheeler]

To ask Her Majesty’s Government what action they will take to ensure that their strategy for National Health Service and social care services recognises the importance of parity of esteem, including pay and professional standing, for staff across hospital, community and social care settings.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy)]

My Lords, having the right number and quality of clinical and non-clinical staff is essential to realising our ambitions for the NHS, community and social care. Last week we agreed an Agenda for Change multi-year pay and contract deal, while the introduction of the national living wage has boosted pay for the social care workforce. Later this year, we will publish a 10-year integrated health and care workforce strategy informed by our recent consultations.

[Baroness Wheeler (Lab)]

I thank the Minister for his response. It is right today to pay tribute fully to the work and dedication of staff across the whole of health and social care. But for the future, both the NAO and our own Long-term Sustainability of the NHS Committee strongly criticised the absence of any long-term joint strategy to secure the well-trained and committed workforce that we need for a fully integrated service. The Minister told the House on 18 June that he is considering the implications of the very recent and welcome NHS staff three-year pay increase for the independent care sector. He recognised the need for the latter to be able to compete on a “level playing field”. Does he acknowledge that for the social care sector in particular that means aiming to level-up pay and professional standing between social care and the NHS, and accepting that parity of esteem is one of the key drivers to building integrated services for both patients and service users?

Health: Stroke Survivors

Baroness Wheeler Excerpts

Thursday 28th June 2018 Grand Committee

[Baroness Wheeler (Lab)]

My Lords, I too congratulate the noble Lord on securing this debate and on his informative speech. This is a key opportunity to focus on rehabilitation—that is, life after stroke. Like me, he is a strong admirer and supporter of the Stroke Association on stroke research, prevention, treatment, care and support. As usual, I am grateful for its briefing in support of this debate and for the key background documentation from the Lords Library.

I have spoken on a number of occasions about the importance of renewing and updating the 10-year national stroke strategy, which ran out last year. It has taken time but the strong and determined national campaign for this has resulted in the association and others from across the healthcare system now working closely with NHS England on a national plan for stroke.

There is no doubt that, despite the huge progress in the reorganisation of acute stroke care services as a result of the 2007 strategy, post-hospital support, rehabilitation and ongoing long-term community support for stroke survivors is an area that has seen least progress. It is vital that this be a declared ambition of the new plan and given urgent priority. Can the Minister update the House of progress on the national plan and a timeframe for its development and publication?

As we have heard, stroke is the fourth-largest single cause of death in the UK and is the largest cause of long-term disability. It results in over half of all stroke survivors having some form of disability. With major strokes disability is often profound and severe and, in this context, perhaps I may digress slightly and mention haemorrhagic stroke. Some 85% of strokes are ischemic strokes. Only 15% are brain haemorrhages and there is currently no acute treatment for them, despite their being associated with the most serious strokes and the worst patient outcomes. It is a significantly underfunded area of research into prevention, treatment and rehabilitation and I make a special plea for the Minister to look at this issue.

It is relevant to consideration of whole care pathways and long-term support for stroke survivors, especially those with the severe disabilities that result from a brain haemorrhage. It is also relevant to me as my partner is hemiplegic as a result of a major haemorrhage 10 years ago. He benefited from the early days of the FAST campaign and the successful reorganisation of London stroke services, which was referred to by the noble Baroness, Lady Barker. This meant that he received the emergency and stabilising care and treatment in hospital he needed within the four-hour period. Ten years on, I am pleased to say that he has a very good quality of life, lives well and is a part of the community. I single out four key basics that have led to that outcome for him.

The first is a good, reliable package of personal care, including washing and dressing, and a domiciliary agency that, overall, provides a good service with a regular team of care workers who we both know and trust. The second is a strong and active connectivity through the local community centre, with its excellent stroke support group, and other voluntary sector support. The importance of staying in touch in keeping well cannot be overemphasised as the key to rehabilitation. The third is weekly assisted disability exercise support through a local charity, which helps maintain his limited walking ability. It is not physio but movement exercises by trained assistants. Fourthly, he has the home adaptations and the disability aids he needs, such as a profile bed and splints, plus a power wheelchair, which means that he can get out and about locally on his own. I also add to the list his amazing assistance dog, who has made such a huge contribution to his mobility, independence and confidence, and pay tribute to the charity Canine Partners for its work in training such dogs and supporting disabled people in this way.

Of course, many other elements are involved in supported care at home, such as GP and primary care support, but the current support available is under huge pressure, as noble Lords have pointed out. We know that it is medical and reactive rather than proactive and focused on rehabilitation and staying well—on wellness rather than illness, as the Committee on the Long-term Sustainability of the NHS put it.

The noble Lord, Lord Lingfield, cited the Royal College of Physicians national guidance 2016 as the gold standard. It calls for stroke survivors to have,

“at least 45 minutes of each appropriate therapy … for as long as they are willing and capable of participating and showing measurable benefit”.

Hospital patients typically receive only one-third of that: the equivalent of 16 minutes a day of physio, 16 minutes a day of occupational therapy and 12 minutes a day of speech therapy. We know that, in the community, those therapies mostly have to be self-funded or obtained in the private sector.

The NHS RightCare Pathway included in the Library pack cites earlier RCP guidelines on what should be expected of NHS commissioners, which are clear and unequivocal. The guidelines stress:

“Commissioning organisations should ensure that their commissioning portfolio includes the whole stroke pathway from prevention (including neurovascular services) through acute care, early rehabilitation, secondary prevention, early supported discharge, community rehabilitation, systematic follow-up, palliative care and long-term support”.


It is vital that more CCGs and the STPs commission services that meet what is set out in the guidance. I should like the Minister to respond to that.

As all speakers have stressed, stroke is a recoverable condition. Many stroke survivors see improvements physically, communicatively and cognitively for months and years afterwards. The often-repeated adage that I heard when my partner first had a stroke—sadly, from both the public and some professionals—was that stroke improvements will not take place after two years. That is wrong. Improvements can and do happen with the right motivation, support and help along the care pathway.

I ask the Minister some questions on this issue. First, will he comment on the large regional variations in the availability and quality of community services for strokes shown in the latest national stroke audit? Secondly, will he comment on the unacceptably high waiting times for starting speech and language therapy post hospital—two months in some of the worst performing areas? Thirdly, will he comment on the 12-week waiting time for psychological support for stroke survivors across the country—up to five months in some areas, when the target is two weeks? Fourthly, will he comment on the action being taken to deal with CCGs which, despite the strong national guidance, are not commissioning ESD to provide intensive, multidisciplinary stroke-specialised rehabilitation and support for patients, carers and families? Forty per cent of patients should be eligible for this, but do not receive it. These are key questions, and I look forward to the Minister’s response.

It is small wonder that 45% of stroke survivors say that they feel abandoned when they get home from hospital, lacking in confidence, information and support. I can certainly relate to that. Fifty-one year-old Philippa Haslehurst, who had a stroke four years ago, received just two NHS sessions of physiotherapy and occupational therapy before having to pay for private treatment. She said:

“I felt like after a couple of rehabilitation sessions, the NHS had wiped its hands of me. I had made hardly any progress and I was still dealing with the debilitating after-effects of my stroke. If it wasn’t for private physio, I wouldn’t be walking now, let alone be back at work. I believe physio saved me”.


I also ask the Minister about the personalised care plans that stroke survivors are supposed to receive for their ongoing post-hospital treatment, care and support, and the findings of the recent Neurological Alliance survey that over 70% of patients are not offered one. Surely this should go hand in hand with the ESD plans for personal and domiciliary care support and generally to ensure that patients are discharged into a safe environment. Can the Minister also explain what action is being taken to ensure that all CCGs commission the six-month post-hospital review of stroke survivors’ progress and problems? Less than a third of stroke survivors receive this review and only half of all CCGs actually commission it. NHS RightCare guidance includes follow-up annual reviews, which are obviously needed if a patient’s progress is to be monitored effectively.

As the noble Baroness, Lady Barker, said, one of the key issues arising from this debate is the lack of post acute-stroke data in comparison with that for acute care. We need strong and consistent data on the provision of the different types of therapy, treatment and rehabilitation as well as on measurable patient outcomes; its lack is seriously hampering progress in this area. Can the Minister outline what work is being done and will the recommendations in the national stroke plan include ensuring that this key aspect is addressed?

This has been an excellent, thoughtful and wide-ranging debate, despite having few contributors, while we wait for the national stroke plan to be finalised and for the publication of the social care Green Paper, now promised for the autumn. I hope that the Government will recognise that prioritising effective rehabilitation for stroke survivors will achieve significant long-term savings across the health and social care system as well as being of huge benefit to stroke survivors themselves.