Stroke Services

David Amess Excerpts

Tuesday 5th December 2017 Commons Chamber

[Sir David Amess (Southend West) (Con)]

I am grateful to you, Mr Speaker, for allowing me the opportunity to raise the crucial subject of the provision of stroke services throughout the United Kingdom. Every Member of Parliament will have a relative or friend who at some stage has suffered from stroke, so we all appreciate at first hand what the outcome of stroke can be. It can sometimes be halted and a recovery can be made, but that is not always the outcome for people who are not so fortunate. We can all recall the former Member for the Isle of Wight, Andrew Turner, who suffered a stroke recently, and there have been many others.

On Thursday 26 October, I chaired a roundtable on stroke solutions and the revolutionary potential of mechanical thrombectomy for stroke patients. The facts about stroke are as follows: more than 100,000 strokes occur in the UK each year; there are more than 1.2 million stroke survivors in the UK; and almost two thirds of stroke survivors leave hospital with some sort of disability.

[James Duddridge (Rochford and Southend East) (Con)]

I understand that this debate is very much about the UK and stroke units, but is my hon. Friend and parliamentary neighbour aware that today I met the Stroke Association, which is prepared to come to Southend to discuss changes in the stroke unit with the public? It will also have discussions with the wellbeing board, specifically to talk about the experience of reorganising acute and hyper-acute stroke units to give better outcomes, fewer deaths and fewer disabilities. This is good news for Southend, and the Stroke Association is happy to come to speak to us in Southend.

[Sir David Amess]

I very much welcome that news. I think that the two of us will look forward to meeting the Stroke Association and working with it to enhance the already excellent facilities at Southend Hospital.

The costs of stroke to the NHS and social care are about £1.7 billion a year, which is a huge amount. If I may be biased for a moment, let me say to the Minister that since 2013, the Government whom I support have contributed to significant advances in the treatment of stroke victims all over the country. The percentage of patients scanned within one hour of arrival in hospital has risen from 42% in 2013 to 51% last year, and the figure for those scanned within 12 hours has increased from 85% to 94%. I think the whole House will welcome that improvement, and I am grateful to Members on both sides of the House who are in the Chamber to listen to this Adjournment debate. I hope that their constituents will recognise the fact that they have stayed here.

[Jim Shannon (Strangford) (DUP)]

I sought the hon. Gentleman’s permission to intervene before this debate, Madam Deputy Speaker.

Right across the UK there are many problems in relation to stroke services. Some 4,000 people in Northern Ireland have had a stroke in the past year, and 36,000 people in Northern Ireland are living with the effects of a stroke. What consideration has the hon. Gentleman given to people having a normal life after stroke through the provision of rehabilitation, and of occupational and cognitive therapies, and through the way in which the NHS handles aftercare, especially for the growing number of younger people who have strokes? This is not just about people in their 70s; it is sometimes about those in their 30s, 40s and 50s.

[Sir David Amess]

If I did not know better, I would have assumed that the hon. Gentleman had read my speech, because I was just about to say that in the past three years there has been a rise in compliance with standards for physiotherapy from 53% to 79%, and from 24% to 47% for speech and language therapy. I know that similar progress has been made in Scotland. With all that in mind, it is essential that the NHS continues to lead from the front. We must utilise some of the newest technologies to improve the effectiveness of stroke treatment, to allow patients to live fuller lives, and to decrease the burden of ill health after someone has suffered a stroke.

Two out of three stroke survivors currently leave hospital with a long-term disability at a cost of £1.7 billion, as I said. The provision of healthcare to people who have had a stroke accounts for approximately 3% to 5% of all healthcare expenditure, which is a vast amount. The cost of stroke treatment will rise to £43 billion in 2025 and £75 billion in 2035. If I remember rightly, I think the husband of the hon. Member for North Down (Lady Hermon) suffered strokes during his illness.

[Lady Hermon (North Down) (Ind)]

It is very kind of the hon. Gentleman to mention my late husband. He did not actually suffer from a stroke; he suffered from Alzheimer’s, which was unfortunately the cause of his death. While I am on my feet, however, may I encourage the hon. Gentleman to put on record his appreciation for all the wonderful charities that work with stroke victims, and that support them and their families after what is a devastating health incident?

[Sir David Amess]

I absolutely join the hon. Lady in celebrating the work of all those charities.

The European Stroke Journal found that improving access to thrombolysis and early supported discharge services alone can contribute to reducing the financial burden of stroke on health and social care services. When the benefits of treatments such as mechanical thrombectomy are included, the costs can be lowered significantly. What measures are the Government taking to address the rising costs associated with strokes in England? I very much hope the Government are considering the widespread use of mechanical thrombectomy, which is a new and effective way of treating some of the most serious strokes caused by a blood clot.

[Maggie Throup (Erewash) (Con)]

I have heard first-hand stories about the impact of mechanical thrombectomy and just how fantastic a treatment it is. It can enable people who might have had lifelong disabilities to lead normal lives. I gather it is being rolled out throughout the NHS through specialised commissioning, but does my hon. Friend agree that the roll-out needs to be speeded up, and that we need more people in place to carry out the treatment so that more individuals can benefit from it?

--- Later in debate ---

[Sir David Amess]

Even though money is tight, I absolutely agree with my hon. Friend. I have seen a video of the operation, and it is just extraordinary that a catheter can be inserted into a patient’s artery to access the clot, which is then mechanically removed. The technology is extraordinary.

Mechanical thrombectomy significantly reduces disability rates after strokes. It removes clots that are too big to be broken down by drugs alone. For each six-minute delay in the delivery of mechanical thrombectomy, there is a 1% increase in the proportion of people who become disabled. Royal College of Physicians guidelines for stroke care label it as the best recommended practice. It is an effective procedure with very low complication rates. It is highly cost-effective, too. The Stroke Association has calculated that over a 10-year period, the net monetary benefit of 9,000 eligible patients receiving the treatment would be between £530 million and £975 million.

Mechanical thrombectomy enables more stroke survivors to live independently in their own homes, which is crucial, and then to return to work and take control of their lives again, thereby saving the NHS money. It really is a game-changing treatment that could revolutionise stroke victims’ experiences, yet despite NHS England’s agreeing to fund it, it is delivered for only 0.008% of the 85,122 acute stroke admissions, versus the EU benchmark of 3%, so we are really some way behind.

Let me blow the trumpet for Southend, following on from what my hon. Friend the Member for Rochford and Southend East (James Duddridge) said earlier. Southend has been developing an interventional neuroradiology service alongside a hyper-acute stroke service providing thrombectomy. Our service is led and delivered by an interventional neuroradiologist. It has been developed with the local trust board since 2013, but due to a current recommendation that only interventional neuroradiologists can perform the procedure, she is the only person who can perform thrombectomy at the moment, so the service is provided on a “best endeavours” basis and is not, unfortunately, a regular service. The service is currently available only at Southend and nowhere else in Essex. We need to expand it to provide a 24-hour service. The only other place where it is provided is at St George’s Hospital in London.

Mr Paul Guyler, who is a lead consultant in stroke medicine at Southend University Hospital, tells me that less than 1% of ischaemic stroke patients receive endovascular treatment and that, despite around 9,000 patients being eligible for mechanical thrombectomy, only 400 patients received the treatment last year. He has argued that the barriers to this treatment revolve around skills and education, resources and attitudes.

This is not a criticism of my hon. Friend the Minister, because he cannot wave a magic wand and solve all these problems, but Mr Guyler has advised me that there are not enough trained specialists to be able to provide a 24/7 service in all areas. Unfortunately, we also have a postcode lottery, with not enough neuro- radiologists and only 80 interventional neuroradiology operators in the United Kingdom.

[Maggie Throup]

My hon. Friend is being very generous with his time. He has hit the nail on the head: the treatment is very specialist and is carried out by surgeons and neurologists who are not normally there to treat stroke victims. The change in the way in which stroke centres work has been fantastic. Stroke services have been centralised, but we need to go a step further and to make sure that we get the right training for these neurologists so that we can continue to save lives.

[Sir David Amess]

My hon. Friend is spot on in her analysis. I know that the Minister will take the points that she has made to heart and consider how we can improve the present situation.

Consensus forecasts predict that 150 trained people are required to run a fully functioning 24/7 national service. Mr Guyler says that training in stroke intervention is not readily available, that not enough hospitals can afford 24/7 availability and that there are not enough expert neuroradiologists to interpret CT scans. He says that there are turf wars between neurologists, cardiologists, neurosurgeons, radiologists, vascular surgeons and neuro- radiologists on who can and will perform interventional stroke treatment in the future. I do not think it is for politicians to get involved in those turf wars. The medical staff need to sort out between themselves who will lead in these matters. Apparently, there are also turf wars between university and district general hospitals on who should perform the procedure.

Mr Guyler also highlighted the fact that we have the expertise to develop this treatment significantly. The UK has one of only five training simulators in Europe—we should be proud of that—which is based at Anglia Ruskin University.

What are the Government doing to encourage more areas to reconfigure acute stroke services? We do need a new national stroke plan. I was at the launch of the original plan at St James’s Palace many years ago, but it is now time for a new one.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

The hon. Gentleman is making an excellent speech on stroke services, which are invaluable right across the United Kingdom. I refer the House to my entry in the Register of Members’ Financial Interests. Does the hon. Gentleman agree that it is important that people who suffer strokes also have access to psychological services? Many people experience depression when adjusting post stroke, and it is important that counselling is available to support them through that.

[Sir David Amess]

The hon. Lady, with her considerable expertise in this area, is right to bring that particular matter to the attention of the House. We certainly need more provision of the women and men who give that sort of support.

A significant part of a new national stroke plan should be the development of 24/7 access to mechanical thrombectomy for all United Kingdom citizens, no matter where they live. Southend has already shown itself to be both safe and effective. It exceeds the recommended audit standards, its improvement in patient outcome is similar to international trials and, despite a severely ill patient collective, its results exceed the British Association of Stroke Physicians’ quality benchmarks. I want all my constituents to have 24/7 access to the best possible stroke treatment, so I urge the Government to find a way of effectively introducing mechanical thrombectomy to all parts of the United Kingdom. What is the Government’s assessment of the national stroke strategy, and will the Minister update the House on progress with its replacement?

I am not criticising the Government’s provision in any sense but, as with all these things, we could and should do more. We could do better. It is frustrating that a wonderful technique is available but is not available to everyone. Perhaps we can find a few more resources now because that should result in a saving in the long run. Finally, does the Minister agree that this wonderful facility at Southend Hospital is a further good reason for Southend to be declared a city?