Oral Answers to Questions
Debate between David Amess and Maggie Throup(5 years, 5 months ago)
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Maggie Throup (Erewash) (Con)
Sir David Amess (Southend West) (Con)
Stroke Services
Debate between David Amess and Maggie Throup(7 years ago)
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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?
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.