World Stroke Day

Debate between Rachael Maskell and Philip Hollobone

Thursday 23rd November 2023 Westminster Hall

[Rachael Maskell]

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.

[Mr Philip Hollobone (in the Chair)]

No Westminster Hall debate would be complete without a contribution from Jim Shannon.

The Future of Work

Debate between Rachael Maskell and Philip Hollobone

Thursday 19th November 2020 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for East Renfrewshire (Kirsten Oswald) for introducing the debate.

It is always a pleasure to follow my hon. Friend the Member for Easington (Grahame Morris). He is absolutely right to speak up for the Rolls-Royce workers. We are seeing that the opportunities for employers come on the back of working people when they offshore jobs. That is one of the biggest threats to our economy, and I support Unite in its battles against employers who have done such things.

The reason why the people of Barnoldswick have come to our attention is very much at the heart of my speech. Work defines us; it gives us dignity. It is where we spend most of our waking hours, build our security and friendships, display our skills, and contribute to society. Without work, we lose our identity, purpose and self-worth.

Tragically, for many, work has been hardly an edifying experience in recent times. Slavery conditions, poverty wages, insecurity and uncertainty have framed the working experience for too many. Recently, we have seen a sharp increase in zero-hours contracts, on which many people languish at the behest of their employers. Many jobs, good and bad, hang in the balance as we face a catastrophic tsunami of job losses. We have to build back better.

We have to decide what kind of economy we want to build. There have obviously been advances in technology and automation, but the word “growth” was mentioned again in this debate, and we have to understand what it means. Does it mean depth, or does it mean forever chasing profits for those at the top of organisations at the expense of workers?

I want the Minister to comment on how her Government view economic thinking such as that of Kate Raworth, who is looking at things such as doughnut economics and the value being put in, and Julian Richer, whose work on the good business charter looks at how work can have a more ethical base, including a real living wage, environmental responsibility, fairer hours, paying fair tax, employee wellbeing, a commitment to customers, employee representation through a trade union, diversity, inclusion, timely payments to suppliers and ethical sourcing. That would reshape the economy for the future in a far better, qualitative way.

Before I talk about my constituency, which is due to be the worst-hit area in the country from the current economic crisis—we could see unemployment rise from 2.8% last year to 27% next year, because the recovery from the last economic crisis was built on insecure jobs—I want to highlight three areas where we could see real movement in reshaping the economy. First, we should build sectoral councils. The fragmentation of the economy is not helping our response, so we need the economy to come together. Establishing sectoral councils will provide a framework for employers, workers, trade unions, academics and industrial leaders to come together, build back better, institute a skills analysis and look at the economic opportunities of those sectors. The fragmentation is preventing that from happening, but linking with local and devolved authorities and local enterprise partnerships would be a real opportunity to focus on the future and ensure that the big issues such as climate mitigation are at the heart of the discussions. It is also about building a base for sectoral negotiations to determine things such as pay, pensions terms and workers’ conditions in those sectors.

Secondly, I want to look at the university and further education sector. I have to say that I was disappointed by the debate earlier this week on the union learning fund and the opportunity it brings. Education is at the heart of growth: if we enable people to reach their potential and the extent of their skills, we can do so much more in local economies.

We see real under-employment in the city of York in my constituency. The two universities have now come together with the two further education colleges to form Higher York in order to shape the economy, but we need the education sector to have a more central role in establishing the future of the economy, looking at things such as the skills gap and inequality, and at the wider community interest—not just from the perspective of education alone, and not just looking at higher-end skills. In my city, 30,000 people work in areas such as retail, tourism and hospitality. Those jobs will not be there next week, next month and possibly next year, and we therefore need the university and further education sector to intervene and to address the many challenges that we face.

Perhaps the most difficult conversation that any of us have had over the past eight months has been with small employers and the self-employed, who have poured everything into their businesses—their money, their time, their resources and their lives—only to see them melt away without Government support. In building back for the future, we need to build more resilience into business by building collective support and looking at more social models of business support, to ensure that businesses are more sustainable in the future as they move forward—looking at the co-operative models and social enterprises that have good reach into their communities and real roots, which can address some of the real challenges around employment, too.

I turn briefly to my constituency of York Central. Already the high street is the worst impacted in the country—we have lost around 60 businesses to date, and I daresay there will be many more to come. As those businesses have been struggling, Government grants have been slipping through their fingers into the hands of leaseholders who live offshore and do not pay their taxes in our country. The taxpayer is subsidising that lifestyle, and hard-working people in our local businesses and shops do not see any of the benefits. There has to be responsibility when the Government hand out resources. Although they are saying they are supporting these times, we have to look where that money is ending up—it is certainly not ending up supporting business. I call on the Minister to look at how we can have proper investment and a responsibility put on property tycoons to ensure that the money is not just invested in their tax havens.

On a green new deal, the BioYorkshire project is incredible. It will create 4,000 jobs and retrain 25,000 people to have the skills to bring about a real revolution in the bio-economy, putting York at the heart of that—not just in the UK, but globally. The Government are tying this to a devolution deal that could be two and a half years away, but we need investment in those jobs and skills in York now. Before next Wednesday, can the Minister have words in order to bring that forward, so that we can start the work in creating the jobs that we are losing hand over fist at the moment?

Finally, and most importantly, if we are to have a strong future of work, we need to protect workers’ rights and to think about the real challenges that workers face in the workplace today. After 50 years of looking at health and safety, it is timely that we now have a health, safety and wellbeing commission to look at the wellbeing of workers. We know that issues such as mental health, bullying in the workplace and even the fallout of occupational health services were not discussed 50 years ago. We do not have a legislative framework to protect workers, particularly those who experience issues such as stress, poor mental health and bullying. We need to ensure that such a framework is introduced. Finally, we need to introduce a right to learn and to ensure that the union learning fund is invested in, because this is the opportunity to rebuild our economy.

[Mr Philip Hollobone (in the Chair)]

A Westminster Hall debate would not be complete without Jim Shannon.