Covid-19: Deteriorating Long-Term Health Conditions

Gillian Keegan Excerpts

Thursday 10th March 2022 Westminster Hall

[The Minister for Care and Mental Health (Gillian Keegan)]

It is a real pleasure to serve under your chairmanship, Mrs Cummins, and to follow the hon. Member for Denton and Reddish (Andrew Gwynne), who showed no symptoms of brain fog in his eloquent speech. He has my personal assurance that we will definitely focus on both research into long covid and its treatment.

I thank my hon. Friend the Member for Bromley and Chislehurst (Sir Robert Neill) for raising this very important issue, and for his proud advocacy for patients with many different long-term conditions who rely on NHS services, particularly those who have had a stroke. I extend my best wishes to my hon. Friend’s wife, Ann-Louise, who I am sure informed much of his powerful speech. Many of the experiences we have heard about will resonate with many of us. My father had a stroke a couple of years ago, and rehabilitation has been vital to his recovery, which is a long road that he is still on.

I was deeply moved to hear of the difficulties that the pandemic has caused people with deteriorating long-term conditions, many of which have been outlined. I want to reassure all hon. Members that we remain committed to making sure that everyone has access to the care and support that they need and deserve. We know we have to catch up after the impact of the pandemic.

My hon. Friend the Member for Bromley and Chislehurst mentioned spinal cord injury. I attended the all-party parliamentary group on spinal cord injury yesterday to hear about the concerns and the impact that the pandemic has had on people with the condition, and what more we need to do to respond to it.

We know that covid has had a significant impact on the health and care system, including on rehabilitation services. It has had a real and profound impact on people with rehabilitation needs and their treatment. I am very sorry for any undue suffering that that has caused. We remain committed to making sure that everyone has access to the care and support that they need and deserve. Throughout the pandemic, we have worked to maintain access to health services in what has been an extremely challenging environment, but we recognise that getting that support at the right time is vital for people’s health. That is why we protected priority services across England during the pandemic, which included rehabilitation and post-acute services, for people who had survived a stroke, and their families and carers.

Continued service delivery was in part supported by innovative methods of care—we have talked about a few of them—throughout the pandemic. NHS England and Improvement supported people with long-term conditions by providing safe and person-centred assessments and diagnosis via remote methods, or in face-to-face consultations when appropriate. Providers innovated and rolled out remote consultations using video, telephone, email and text message services, and health services implemented new models of care with effective triage processes to make sure that patients received the care appropriate to them and in outpatient settings closer to home.

Clinical teams used and will continue to use virtual rehabilitation services alongside face-to-face contact to ensure that every patient gets the treatment and support that they need. Almost half of stroke survivors have received virtual care since the pandemic began, transforming their experience of the health system. Over 80% reported positive or very positive experiences, as my hon. Friend the Member for Bromley and Chislehurst outlined, but we know that remote consultations are not suitable for everyone or for every situation, as eloquently outlined by the hon. Member for York Central (Rachael Maskell), who has experience in this matter. We will continue working to make sure services are suitably tailored to meet patients’ often complex needs.

For example, NHSE&I has worked with memory assessment clinics to capture best practice on remote consultation and virtual diagnosis of dementia, which is vital, as mentioned by my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn), to promote its use. It has published guidance to help enhance best practice in dementia assessment and diagnosis, and to support a personalised approach with choice over the delivery of remote consultation and diagnosis.

There has been further guidance for a range of conditions to help health systems adapt to the challenges of the pandemic, including the National Institute for Health and Care Excellence guidance on chronic obstructive pulmonary disease and the Association of British Neurologists guidance to help healthcare professionals prioritise neurological services.

People with different long-term conditions may also need emotional and psychological support, as has been mentioned by many hon. Members, and that is why NHS mental health services stayed open throughout the pandemic, and why local areas continued to offer talking therapies—remotely in many cases—with a face-to-face option if appropriate. We are investing in a mental health recovery action plan, which will help us to provide more appointments, which, sadly, were missed during the pandemic. That will help us catch up.

We are committed to ensuring that those who need it are given outstanding and tailored care with choice, control and the support that they need to enable them to live independent lives, and we are committed to ensuring that people find adult social care fair and accessible. A lot of reforms are coming forward in this area. We recently introduced our strategy for the social care workforce in our “People at the Heart of Care” White Paper, which is supported by at least £500 million to develop and support the workforce over the next three years.

As highlighted by the “Moving forward stronger” report, rehabilitation services were particularly affected by the pandemic. The health system has long recognised the importance of rehabilitation. Many hon. Members mentioned how important that is to lifelong conditions and how important it is to enable people to avoid more acute illness later on, requiring more services from the health service. Specific commitments are set out in the long-term plan, which include the expansion of pulmonary rehabilitation services over 10 years from 2019, new and higher-intensity care models in respect of stroke rehabilitation, and the scaling up of cardiac rehabilitation to prevent up to 23,000 premature deaths.

Following the publication of the national stroke service model in May 2021, NHS England and NHS Improvement have committed to creating integrated stroke delivery networks across England, bringing together health and care services across the whole stroke pathway, from prevention to rehabilitation. As my hon. Friend the Member for Bromley and Chislehurst mentioned, linking those services is vital. More than 20 integrated stroke delivery networks are now operational, bringing together health and care services across the whole stroke pathway. Over £3.3 million has been dedicated to the establishment and ongoing delivery of those networks, which have already brought about some improvements to the co-ordination and direction of how the stroke care pathways across England are delivered.

The NHS is committed to delivering personalised, needs- based stroke rehabilitation to every stroke survivor who needs it, and we recognise the vital role of multidisciplinary teams, comprising occupational therapists, speech and language therapists and physiotherapists, in assessing, diagnosing and treating issues concerning different daily activities, speech and cognitive communication. Community rehabilitation services continue to benefit from extra investment, with £4.5 billion of investment in primary medical care and community health services by 2023-24 and productivity reforms set out in the long-term plan. The long-term plan committed to the rolling out by 2024 of new two-hour urgent community response and two-day reablement ambitions, which will improve the responsiveness of community health services to people’s needs across the country. We anticipate that the wider package of investment in community and intermediate healthcare will eventually free more than 1 million hospital beds, allowing health systems to better support those in need.

Underlining our commitment to improving rehabilitation services, the NHS has created the new role of national director for hospital discharge and rehabilitation, which was rightly called for. Jenny Keane, who was appointed to the post in December 2021 and started recently, will lead a team of 60 people responsible for hospital discharge and rehabilitation. Her team within NHSE is already taking forward important work in this area, including a programme to identify the optimum bed-to-home model of care for non-acute rehabilitation services. That will support the implementation of the discharge-to-assess policy, and improve the delivery of timely and high-quality care in home settings. Ultimately, that will empower more people to recover and maintain their independence following an unplanned event or a period of acute care.

The programme will estimate the capacity for bedded non-acute rehabilitation care that integrated care systems will require for their populations. Systems will be supported to shift towards new rehabilitation models through a range of guidance, frameworks and tools. I anticipate that rehabilitation will also benefit from the wider reforms set out in the Health and Care Bill, reorienting systems towards co-operation and strengthening NHS action to reduce health inequalities. Rehabilitation will also benefit from the plans that we have set out in the integration White Paper, under which patients will receive better, more joined-up care.

Looking ahead, the NHS published its delivery plan for tackling the covid-19 backlog of elective care last month. The plan sets out a clear vision for how the NHS will recover and expand elective services over the next three years, including how it will support patients. We plan to spend more than £8 billion between the next financial year and 2024-25. That is in addition to the £2 billion elective recovery fund and £700 million targeted investment fund already made available to systems this year to help to drive up and protect elective activity. However, my hon. Friend the Member for Bromley and Chislehurst is right that we must ensure that the voice of rehabilitation services does not get lost in that considerable investment.

That funding could deliver the equivalent of around 9 million more checks, scans and procedures, and it will mean that the NHS in England can aim to deliver around 30% more elective activity by 2024-25 than it was delivering before the pandemic. A significant part of that funding will be invested in staff, in terms of both capacity and skills. The delivery plan also contains some targets to ensure that by March 2025 people will not wait longer than a year for elective care.

[Jim Shannon]

I am finding the Minister’s response very helpful and supportive of what we are trying to do, but I asked a specific question in relation to those who are waiting for eyesight-saving operations. We need to ensure that they do not lose their eyesight because of the delays. If the Minister is able to give me a response today, that will be great, but if she cannot, I am happy for all of us to receive a response by letter.

--- Later in debate ---

[Gillian Keegan]

I thank the hon. Gentleman for his intervention and I am very happy to respond by letter. However, I do know—I have had conversations about it—that these prioritised electives will be prioritised. Somebody whose sight can be saved through an operation would, I imagine, be a key priority for our NHS colleagues.

At the October 2021 spending review, the Government announced a further £5.9 billion of capital funding to support elective recovery, diagnostics and technology. That funding will drive investment in technology to improve patient experiences of care and help patients manage their experience.

The NHS has been working on rolling out 44 community diagnostic centres, which will massively increase diagnostic activity. As we take the road to recovery, we are also reforming and transforming how care and health services are delivered for patients, including through dedicated surgical hubs and more convenient and efficient community diagnostic centres.

Finally, I want to thank hon. Members for the points that they have made in the debate.

[Sir Robert Neill]

I am very grateful for the Minister’s detailed response and for her commitment to trying to improve these matters. She referred to a delivery plan for recovery of elective services, but is not the logical thing to ensure that the voice of those with long-term needs and of rehabilitation is not lost, and that we also have a specific delivery plan for rehabilitation and for catching up on the backlog? I did not hear mention of that. Are we going to have that?

[Gillian Keegan]

I mentioned the work that Jenny Keane will be doing following her recent appointment. She will be responsible for work on rehabilitation and discharges, as well as other areas covered by NHS continuing healthcare and the better care fund. That work is ongoing but does not include a specific commitment at this point to a strategy, as outlined.

[Sir Robert Neill]

Can the Minister tell me why not?

[Gillian Keegan]

I think it is only fair to say that, obviously, Jenny Keane has just started her work in this area—it is very new—but I know that she will be dedicated to ensuring that we make progress on the plans that I have set out. I hope that they reassure hon. Members that we will continue to support people who are living with long-term conditions and, by learning the lessons from the pandemic, ensure that they have access to the right services, at the right time, to enable them to live the fullest and happiest life they can. A lot of work is ongoing. We need to get behind that work and, obviously, support the team who are looking to deliver it. I thank everybody very much for their contributions.