Transient Ischaemic Attacks

Helen Jones Excerpts

Wednesday 5th November 2014 Westminster Hall

[Helen Jones (Warrington North) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Riordan. I am glad to have the opportunity to debate transient ischaemic attacks, or TIAs. They are also known as mini-strokes, but we should be careful with our terminology, because a TIA is a serious matter; it is a warning of a possible future stroke. Because it is a serious matter, I am a bit perturbed that no one is sat on the Government Front Bench. I hope that the Minister will join us shortly. A possible future stroke could kill or incapacitate someone temporarily or permanently, and the risk is greatest in the first few days after a TIA. In fact, one in 12 people will go on to have a stroke within a week of a TIA, yet TIAs are often not taken seriously by members of the public and are sometimes not recognised by health staff.

We have known for some time, however, that dealing with TIAs urgently can prevent future strokes. In fact, research published in The Lancet in 2007 indicated that 10,000 strokes a year could be prevented if all TIAs were treated urgently, but that still does not happen. Those strokes could be prevented, people could avoid serious disability and the NHS could save a huge amount of money.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I intervene only to apologise most profusely for not being here at the start of the debate. We checked with the Doorkeeper following the Division and were advised that a quarter of an hour would be added and that this debate would start at quarter to 5. I would never be so discourteous to the hon. Member for Warrington North (Helen Jones). I really am extremely sorry, but that was the advice that we received. We were only next door.

[Mrs Linda Riordan (in the Chair)]

Order. The sitting was suspended at 4.15 pm, but Members were back shortly after the vote. The rules are that we start again as soon as the Minister, the Member who proposed the debate and the Chair are back. As long as three Members are here, we can resume, which we did, and the debate finished at 4.38 pm. Helen Jones began her debate then.

[Helen Jones]

I of course accept the Minister’s apology. I am sure that she would not be deliberately discourteous to any Member of the House.

Part of the reason why action is not being taken is that public awareness of TIAs is low. A 2012 poll for the Stroke Association found that few people understood the symptoms. In a recent survey of people who had experienced TIAs, the association found that 44% had no knowledge of TIAs prior to having had one and, astoundingly, 61% did not know that it was a warning sign of a possible future stroke. Those were people who had already had TIAs, so it is unsurprising that a third of people take no action following a TIA. Others do not realise that it is a medical emergency and wait for appointments. Astonishingly, the Stroke Association found that a quarter of the people surveyed did not take any action even though they had had TIA symptoms more than once. People may not know where to go for help, and some think that nothing can be done.

When people do seek help, however, it is fair to say that the service that they receive is variable. The all-party group on stroke heard from two former patients, one of whom had been treated quickly and efficiently, but the other had had the opposite experience. The Stroke Association found that while many people have a great deal of praise for how they were treated and for the care provided by health care staff—it is important to put that on the record—16% felt that they were not taken seriously and 25% said that their symptoms had been misdiagnosed. One person at the all-party group meeting had actually heard a paramedic say those classic words, “It’s just a funny turn.” Another person told the Stroke Association:

“Our GP has told us not to bother to attend GP surgery or A and E as it is not worth it for TIAs.”

Another said:

“I had numerous TIAs that were misdiagnosed as migraine.”

Such comments are worrying, particularly given that parts of the NHS deal with the matter well and show great examples of good practice. The south-western ambulance service, for example, has pioneered direct referral of suspected TIA patients to a TIA clinic. It has invested in training its staff and all ambulances carry details of TIAs, of the referral pathway and, importantly, information for patients. I have also heard a great deal about what has been done at Southend university hospital, which went from having a Monday to Friday TIA clinic to having an online rapid referral system, using new technology, that helps GPs and health care staff to assess patients and to transmit information directly to the clinic or even to the consultant’s mobile. It trained more clinical staff to do ultrasounds and changed the protocol for MRI scans, so that patients can be accommodated in between the normal list. As a result, its service operates seven days a week and sees all high-risk patients within 24 hours and others within a week, as recommended. That service saves lives and enables tests to be done and treatment to be begun on the same day. If that can be done in Southend, it can be done elsewhere. The first problem is actually getting patients to realise that they need treatment.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for giving way, and I appreciate her bringing this matter before the House. The Government run the FAST campaign, which covers symptoms similar to those of TIAs. Could the issues be addressed through that campaign? The Government, officials, GPs and families could use it in the same way. That might be a way forward.

[Helen Jones]

The hon. Gentleman takes the words right out of my mouth. I was going to put it to the Minister that the FAST campaign has been excellent and has raised awareness of stroke symptoms and of the need to call an ambulance. We need to extend the campaign to TIAs, because people still wait for treatment or do not access it at all. There are also people who go to the wrong person for treatment, such as an optician, because they mistake their symptoms for something else.

Investment in staff training is vital, in particular for front-line staff, because TIAs are difficult to diagnose. Often when a patient is seen, their symptoms have gone and health care workers rely on reports of what happened. It is also true that TIAs can mimic other illnesses, such as epilepsy, migraine or visual disturbances, which is all the more reason why front-line staff—the first point of contact for patients—should be trained to recognise the symptoms. We must also ensure that referral systems are in place, so that people can access treatment rapidly. I hope that the examples I have given show that it is possible to meet the guidelines contained within the national clinical guidelines for stroke, so that people can be treated quickly and easily. However, the Stroke Association found that 22% of people wait more than a week for their first appointment, which is quite outside what the guidelines recommend.

The provision of information is absolutely vital. The Stroke Association’s report, “Not just a funny turn”, contains many examples of people who have changed their lifestyles and diet after being given proper information following a TIA, so that they hugely reduce the risk of a future stroke, but that does not always happen. Some 40% of people say that they are given little or no information following an attack, and some 50% do not know about the risk of a possible future stroke. The report contains some worrying comments. One person says:

“After TIA I had no support or advice or information… I didn’t know about risk of stroke—was not told this by anyone.”

I find that profoundly shocking. It is not even a case of spending a lot of money; it is simply about having information to give to patients. What will the Minister do to ensure that that actually happens?

My next point, which the Minister and I have debated with regard to stroke, is about the provision of emotional support after a TIA. Like a stroke, a TIA is an event that someone does not expect or plan for. Many people lack support afterwards, but with support they can make changes that reduce their future risk. Some people feel that they need counselling, others simply want to talk to someone who has experienced a TIA and others want to be in contact with patients’ groups or organisations such as the Stroke Association. If people are given the right information, they can do all that, but the information is often not given to them at all. That, too, could be done with little expense.

We have some good care in the national health service—some excellent care—but it is patchy. I want to hear from the Minister how she plans to raise public awareness of TIAs and to extend the FAST campaign to cover them, as the hon. Member for Strangford (Jim Shannon) said.

What will be done about training front-line staff so that we bring everyone up to the level of the best? That is a difficult matter. We cannot blame staff for misdiagnosis if they are not trained properly. We need to train them. What will be done to ensure rapid access to treatment everywhere in the country, not simply for those who happen to be lucky and live near an excellent hospital? The NHS works best when its organisations co-operate and learn from one another. We need to ensure that that co-operation takes place.

Finally, what will the Minister do to ensure that people get the right information following a TIA, as well as support afterwards to deal with the emotional issues and to help change their lifestyles to lessen the risk of stroke in future? That would be a sensible investment for the NHS. It would ensure not only that we saved a great deal of money, but that we prevented a great deal of disability and heartbreak and even deaths.

I look forward to hearing the Minister tell us what is to be done about the important issue of TIAs. We could save lives if we invested in it properly.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

Once again, my apologies to the hon. Member for Warrington North (Helen Jones) for missing the first two minutes of her contribution, because of a misunderstanding on our part.

The hon. Lady is a great expert on the subject and, as she said, we have debated it in the past—in fact, it was the subject of the first debate that I responded to as a Minister, about a year ago. It is good to see her commitment. As the chair of the all-party group on stroke—she is one of Parliament’s great champions of the issue—she also takes great interest in transient ischaemic attacks. The debate is timely, because it was world stroke day last Wednesday, which this year focused on the impact of stroke on women.

As ever, I will try to respond to as many of the points that have been made as I can, but the matter is obviously the responsibility of the NHS. In a debate of this nature, I always undertake to draw to it the attention of the key people in NHS England, in particular the national clinical director—

[Helen Jones]

I am sorry to interrupt, but Ministers are in the end responsible for what happens. If they are not, there is no point in them being Ministers. A huge bureaucracy has now been set up, but it is still open to a Minister to pull the strings to ensure that the things that need to be done are done. I hope to see the Minister doing that.

[Jane Ellison]

I note the hon. Lady’s comments. NHS England is the lead on the subject, because it is ultimately a clinical matter. I always draw the attention of our clinical leaders to the views of Parliament and, where I need to underline them, I of course do so, but it is also important to recognise that in a large organisation the views and leadership of senior clinicians are vital. I will refer to that.

[Helen Jones]

The Minister is gracious to give way, but I am sorry, I had to intervene at that point. The clinical details are not in doubt. We know what works and what best practice is; the problem is that best practice is not always followed.

[Jane Ellison]

I note the hon. Lady’s comments.

Turning to the Act FAST campaign, when people have a TIA, getting medical attention quickly is key, as the hon. Lady said. Ensuring that the general public are familiar with the signs and symptoms is important. Public Health England continues to run the highly impactful Act FAST stroke awareness campaign, which covers similar signs to those of a TIA—I note that she is right to draw the distinctions—and the simple message to call 999 if such signs are witnessed. The campaign was run again in March this year, and new adverts feature an Afro-Caribbean man to underline the fact that people from some ethnic groups, whether south Asian, African or Caribbean, are at higher risk of TIA and stroke than others. PHE plans to run the adverts again later in the financial year. Over the summer, the Stroke Association also ran a campaign to raise awareness of TIA, “Not just a funny turn”. It was welcome and many of us saw it.

The hon. Lady also referred to front-line staff and to raising awareness of signs and symptoms. Act FAST and the Stroke Association’s campaign were aimed at public and professionals alike to ensure that everyone acts swiftly. PHE plans to run its adverts, which do not only face the public, again before April 2015.

In addition, NHS England has produced a resource for clinical commissioning groups, to support them in setting and delivering on the level of our ambition to reduce premature mortality. TIAs form an important part of that. The resource includes information on the most high-impact interventions that CCGs can consider commissioning to reduce premature mortality, and TIAs fit into that description. One such intervention is to increase the proportion of patients suffering a TIA treated within 24 hours from 71% to 100%. Let us recognise that TIAs sit right at the core of all the resources being distributed to our front-line staff and produced by NHS England.

NHS England has also been working with the 111 service to ensure that the protocols and triaging systems on the phone lines are used to identify as many people with stroke and TIAs as possible. We recognise that there is more to do and that such work is ongoing.

On getting patients the treatment that they need, quite a lot of work is under way in many parts of the country to reorganise services. That involves reconfiguring care for patients with TIAs as well as acute strokes. For example, in Birmingham and the black country, Warwickshire, Surrey and Sussex standards for TIA care have been set and services are being redesigned to ensure that patients with high-risk TIA can be seen and managed within 24 hours.

The reorganisation of vascular surgery services into a smaller number of higher-volume units is also improving the efficiency of the provision of surgery for TIA. There have been huge improvements in TIA patients’ access to neurovascular clinics in recent years. That is important because, as the hon. Lady said, we know that the risk of stroke in the first four weeks after a TIA can be as high as 20%. It is vital that people are seen urgently and their symptoms investigated, and that a management plan is put in place.

The hon. Lady said that services can be inconsistent. We want to ensure that we work towards making all services as good as the best, but part of that work is to define what the best standards are and to disseminate best practice. I will talk about some of the ways in which that is done.

The 2012 national clinical guidelines for stroke recommend that patients who have had a TIA are seen, investigated and treated in a neurovascular clinic within one week. A few years ago, such clinics were relatively unusual and waiting times could run to weeks or months. Information from the latest Sentinel stroke national audit programme organisational audit published in 2012 shows a picture of real improvement. According to the audit, 100% of trusts in England, Wales and Northern Ireland now have a TIA or neurovascular clinic, with a median of 20 clinics held in each four-week period. There has been a really big improvement in access to those clinics.

The same audit also said that there are very few areas of the country where a high-risk TIA patient would need to wait more than a week, and that over half of high-risk in-patients could be seen the same day, seven days a week. We are waiting for an update of that audit, which is due to be published quite soon. I hope to see further improvement.

In the mini-exchange I had with the hon. Lady at the beginning of my contribution, we touched on best practice. The strategic clinical networks are important for that. They bring together clinicians from across health care settings and the wider health and care system in 12 geographic areas. The SCNs share best practice and promote initiatives on their core service areas, which include cardiovascular disease. The networks hold regular meetings to enable communication and information sharing. As an MP for a London constituency, I saw the benefit of bringing that clinical excellence to bear in the reorganisation of stroke services in London. Such work is ongoing, to make sure that best practice is disseminated around the country.

Care Workers

Helen Jones Excerpts

Wednesday 5th November 2014 Westminster Hall

[Paul Burstow (Sutton and Cheam) (LD)]

I congratulate the right hon. Member for Oxford East (Mr Smith) on securing the debate, and on the fact that he has pursued the matters in question for some time now, making progress in his own patch by raising them here and, I am sure, back in Oxfordshire. I agree with a lot of his remarks and want to underscore some of the points that he made, but I also want to draw out some opportunities to make progress with this terrible, thorny and long stuck-in-the-mud issue.

The Government published a White Paper in 2012, which acknowledged in stark terms the contracting practice that turns care workers into clock-watchers and that sees their function as purely a transaction in which they turn up, perform a set of tasks and leave—with far too little time given to them even for that. The White Paper made it clear that such commissioning practice had to end. We now have the vehicle by which that can happen. Parliament passed the Care Act 2014, which broadly speaking was supported by all parties. Recently—I am sure that the Minister will expand on this later—guidance covering the matter was issued for local authorities. I want to dwell briefly on that first. It is important to remind the House of it today, and to show how assurance checks will be applied to it, to ensure that it bites on what local authorities do.

The guidance states:

“When commissioning services, local authorities should assure themselves and have evidence that contract terms, conditions and fee levels for care and support services are appropriate to provide the delivery of the agreed care packages with agreed quality of care, that will not undermine the wellbeing of people who receive care and support, or compromise the service provider’s ability to meet the statutory obligations to pay at least minimum wages and provide effective training and development of staff.”

Everything that the right hon. Member for Oxford East has called for is encapsulated in that guidance statement, but how will local authorities assure themselves that it happens? Clearly, part of the answer is what they put in the contract, and part must be their contract monitoring. Another part is the local authority’s proactive role to assure itself and its citizens that the national minimum wage, at least, is being paid.

[Helen Jones (Warrington North) (Lab)]

Does the right hon. Gentleman remember supporting a Local Government Finance Bill that imposed the most draconian cuts on authorities whose populations were most in need of care? If he wants all this to happen, the finance must follow through.

[Paul Burstow]

I will come to finance, but I hope that when we have contributions from Front Benchers there will be some indication of commitments for the future and of what has been done so far. For many years under the previous and current Administrations, local government settlements have left local authorities in a difficult position when funding social care. No one disputes that, but we should be honest about the fact that that problem did not start in 2010, although the incoming Administration had quite a bit of difficulty in dealing with the deficit.

I want to draw attention to 15-minute contracts, which are another aspect of this debate that relates to the guidance. During the passage of the Care Bill, hon. Members on both sides of the House, particularly in the Public Bill Committee, were very clear with Ministers that we expected the guidance to be clear on that point, as it is. It says:

“For example, short home-care visits of 15 minutes or less would not routinely be appropriate for people with intimate care needs”,

and goes on to list what that would mean in practice. I hope that the Minister will explain how he intends to ensure that local authorities are both supported and encouraged to ensure that the guidance is put in place.

I wanted to speak in this debate because at a constituency surgery about a month ago, a home care worker came to see me wanting to talk through what was happening to them and the people they worked with concerning their time sheets and pay. They have to pay for work-related calls on their own mobile phone, and for fuel in the car that the organisation provides. That might be thought to be a good thing, but I was told that the care workers have to take the car to be MOT-ed, and if it fails they are encouraged to drive it without. There is some pretty shoddy practice going on, and care workers are at the front.

The right hon. Member for Oxford East was right to highlight the issue of flu jabs, and I hope the Minister will say what is intended. The guidance is clear: health and social care workers should have access to the jab, but if it is not provided free to social care workers, it is likely that it will not be widely taken up.

--- Later in debate ---

[Helen Jones (Warrington North) (Lab)]

I rise to make a brief contribution to the debate. The issues have been set out admirably by my right hon. Friend the Member for Oxford East (Mr Smith) and others. I apologise in advance for the fact that I cannot stay for the wind-ups.

We are facing a scandalous situation. The people who do some of the most difficult jobs in our society are not even reaching the minimum wage because of the scams that are being perpetrated in the care sector. They are not paid for travel, they are on zero-hours contracts, and other scams are perpetrated against them. When I talk to care workers in my constituency, I see that they are decent people who just want to do a decent week’s work, and I can see what that means. They have to rush between appointments, and they feel guilty about not being able to spend time with their clients. They believe that the care they are giving is not of the quality that people should receive.

Care is not just about getting somebody washed and dressed, or giving them their breakfast; it is what it says it is. Care is about spending time with people, listening to them and talking about the problems they face. It says much about our care workers that, as well as worrying about their own wages, as they are entitled to do, they worry about the impact on their clients of what is, frankly, a rotten system.

Let us consider what really happens. If care workers are on zero-hours contracts, they are paid only for their actual appointments, and not for their travelling time. It is estimated that 220,000 people are not being paid the minimum wage. That has been allowed to happen for far too long—those 220,000 people cannot meet their bills at the end of the week, despite working full time. Does the Minister honestly understand what that means? I do, because I remember it from my earlier life. It means running out of money by the end of the week and relying on friends or family to help out. Friends and family bring things saying, “Well, I got it as a two-for-one offer,” or, “This was on sale,” but people know they were not and that their friends and family are trying to spare their feelings. Zero-hours contracts mean that it is a crisis when a child needs a new pair of shoes or grows out of their coat. That is the position that we inflict on people who do some of the most difficult jobs in our society by caring for the elderly and the disabled—the most vulnerable. I suspect that most of us in this room could never do those jobs, except for my hon. Friend the Member for Blaydon (Mr Anderson), who has actually done it.

Her Majesty’s Revenue and Customs found that nearly half of the firms it inspected in the care sector were not paying the minimum wage. Very few of those firms have even been named and shamed. How many of them have actually been prosecuted? As the Minister said, they are criminals. In what other sector of life would we say to a criminal, “We know you are doing it, and we would like you to stop. We are not actually taking you to court, and we are not prosecuting you. We know you are a burglar, but will you just give it up?” We do that with the minimum wage, which is an absolute disgrace. The Government must take responsibility. Yes, some local councils must take responsibility, too. It is true that local councils do not always monitor the contracts that they give out, do not ensure that people are paid properly and do not check workers’ wages, but that is not surprising given the situation in which they find themselves.

It is all very well for the right hon. Member for Sutton and Cheam (Paul Burstow) to tell us about the duties he imposed on local councils, but if we will the end, we have to will the means. It is a fact that the councils that face the most draconian cuts under the Government’s Local Government Finance Act 2012 are also the councils that have the highest levels of long-term disability and the biggest need for social care.

If the Government want to impose duties on local councils, they have an obligation to ensure that those councils have money available to meet those duties, otherwise councils will simply put the responsibility elsewhere and fail to meet their own. We know what happens when such systems are in place, and we know what happens when care workers cannot spend enough time with their clients: health problems go undetected, and people’s feelings of loneliness and isolation increase, driving up mental health problems. There are more falls and more admissions to hospital. There is a cost to the people concerned, and to the NHS, because a good care system cannot be run on the cheap. It requires properly trained, properly paid and properly supervised staff. The most vulnerable people in our society deserve no less. The Government have been trying to run care on the cheap, on the backs of dedicated workers who are being treated shamefully, and it is time that that stopped.

[John Robertson (in the Chair)]

I thank hon. Members for their use of time.

NHS Services (Access)

Helen Jones Excerpts

Wednesday 15th October 2014 Commons Chamber

[Helen Jones (Warrington North) (Lab)]

My right hon. Friend is rightly outlining this Government’s failures on health. Is he aware that towns such as Warrington face a triple whammy, whereby the number of full-time equivalent GPs is down, ambulance response times are up and yet while this Government last year gave £10 million to Cheshire West and Chester to deal with winter pressures, they gave absolutely nothing to the hospital in my constituency? Does he think that decision was politically rather than health based?

[Andy Burnham]

Many questions are raised by that decision. Areas of the country where services were being run well would say that they did not get money and instead the money was given to areas where things were not working properly. The situation my hon. Friend describes is what is happening across the NHS in England. The Government have cut the GP budget, the mental health budget and the social care budget, and all that has led to increased pressure on hospitals. There are too many people in hospitals right now in England. The wards are full and people cannot be sent back home because the social care is not there. So the wards do not become free, and A and E cannot admit people to the wards because no beds are available. A and E therefore becomes blocked. Ambulances cannot hand patients over to A and E so they end up queuing outside, meaning that ambulance response times get worse. That is the knock-on effect of the Government’s policies across the NHS, and the deteriorations she is seeing for her constituents are mirrored right across the country.

Special Measures Regime

Helen Jones Excerpts

Wednesday 16th July 2014 Commons Chamber

[Mr Hunt]

We do. I think it is time that those on the Opposition Front Bench, in particular, recognised that they were wrong to oppose so bitterly the move to get rid of 19,000 administrators in the NHS, so that we can afford 7,000 more doctors and 4,000 more nurses across the whole NHS. That has made a huge difference to the statement we are making today.

[Helen Jones (Warrington North) (Lab)]

The Secretary of State is right to say that abuse should never be tolerated, but does he not also accept that many of the problems in residential care for the elderly stem from a system that is trying to make profits out of the running of homes that are grossly underfunded because of the cuts his Government have imposed, and which, despite having some excellent staff who do their best, rely largely on untrained and underpaid staff? When is he going to tackle the real problems at the heart of the system, as well as announcing inspection regimes?

[Mr Hunt]

I do not accept that all profit-making organisations are going to deliver poor care. There are some excellent ones and some bad ones. Poor care is poor care wherever it exists. The hon. Lady is right to say that we need to value more the staff who work in residential care homes and domiciliary care services. They do a fantastic job that is often not well paid. The best thing we can do for them is to make sure that, where they are in an organisation that delivers poor care, we shout about it and talk about it, so that people find out about it and something gets done.

Oral Answers to Questions

Helen Jones Excerpts

Tuesday 15th July 2014 Commons Chamber

[Norman Lamb]

My hon. Friend raises an incredibly important point. I have the same experience in my county of Norfolk. Clinical commissioning groups are responsible for commissioning stroke care. The Herefordshire CCG is working with Wye Valley NHS Trust to improve the quality of stroke services and is seeking to establish a sustainable, hyper-acute service in the county, and it is clearly necessary that that is achieved.

[Helen Jones (Warrington North) (Lab)]

Emotional and psychological support after stroke can be just as important as physical care, yet many patients do not get the care they need even though research shows that investment in this area can not only benefit patients but save the NHS money in the long run. What steps will the Minister take to ensure that all stroke survivors get the right emotional and psychological support after stroke?

[Norman Lamb]

The hon. Lady is absolutely right. The cardiovascular disease outcomes strategy, which was published last year, acknowledges the importance of access to psychological therapies. Indeed, there is some really innovative work going on. A psychiatrist called Andre Tylee in London is doing work with heart patients, bringing in psychological therapies and improving their physical as well as their mental health outcomes, and the hon. Lady is absolutely right to make the case for that.

Oral Answers to Questions

Helen Jones Excerpts

Tuesday 1st April 2014 Commons Chamber

[Mr Hunt]

I much enjoyed a recent dinner where I had the chance to meet a consultant from South Warwickshire NHS Foundation Trust. One of the discussions I remember having with him was how inside the NHS the definition of success for a hospital was in the past too narrowly focused on targets and financial balance, and not enough on patient safety, compassionate care and clinical outcomes. He, and many other people in the NHS, welcome the change that this Government have made in the past year to change that balance.

[Helen Jones (Warrington North) (Lab)]

Does the Secretary of State agree that compassionate care begins with being able to see a GP? In areas such as mine, GP appointments are increasingly hard to get. In fact, one practice has had its contract rescinded because of its failures. Does he now regret scrapping the target allowing patients to see a GP within 48 hours?

[Mr Hunt]

I am interested and rather astonished that the hon. Lady dares to mention the words “GP” and “contract” in the same sentence. It was Labour’s GP contract changes in 2004 that made it disastrously more difficult for people to see their GP and destroyed the link between patients and doctors by getting rid of named GPs. She will be pleased to know that from today we are reintroducing named GPs for the over-75s, which is big step forward in making it easier for people to see their GP.

NHS

Helen Jones Excerpts

Wednesday 5th February 2014 Commons Chamber

[Andy Burnham]

My hon. Friend is absolutely right. I will come on to say that the single most important underlying cause of the A and E crisis is the severe cuts that we have seen to adult social care. That has created a situation in which older people are trapped on the ward and cannot go home because there is not adequate support at home. That means that A and E cannot admit to the ward because the beds are full. Hospitals are operating way beyond safe occupancy levels. Because of that, the whole hospital begins to jam up and the pressure backs up through A and E. When A and E cannot admit to the ward it becomes full, so ambulances queue up outside because they cannot hand people over to A and E.

That is exactly what is happening in our NHS at the moment. A and E is the barometer of the whole health and care system. If there is a problem anywhere in the system, it will be seen eventually as pressure in A and E. That is what is happening. The simplistic spin from the Conservative party, which says that it is all to do with a GP contract from 10 years ago, is discounted by expert after expert.

[Helen Jones (Warrington North) (Lab)]

My right hon. Friend rightly said that back-ups in A and E cause problems elsewhere. May I draw his attention to the fact that over the past 18 months, more than 1,600 people have waited more than 20 minutes in ambulances outside Warrington hospital before they could even get to A and E and the clock starts ticking? North West Ambulance service says that it cannot be accurate about the waiting time for hundreds of incidents. Does that show that waiting times may be even worse than first thought?

[Andy Burnham]

I fear my hon. Friend is absolutely right. I know Warrington hospital well and the pressures that have been on it, and I agree that ambulance response times have increased across the country because so many ambulances have been held in queues outside A and E, unable to hand over patients to A and E staff because it is full. That has left large swathes of the country—particularly in rural areas—without adequate ambulance cover, and very serious incidents have taken place across the country, not least in the Minister’s area of Norfolk where people have not received ambulances on time. That is the consequence of the pressure on A and E not being addressed, and it is threatening to drag down the rest of the NHS.

Oral Answers to Questions

Helen Jones Excerpts

Tuesday 26th November 2013 Commons Chamber

[Jane Ellison]

My hon. Friend is right to champion early diagnosis and he has raised these issues in the House on many occasions and with me. Improving cancer survival is a key priority for this Government. We aim to save an additional 5,000 lives each year by 2014-15. Clinical commissioning groups have a duty on early diagnosis. It is part of their crucial outcomes indicators set, and they will be held to account for that because we cannot deliver those improvements in cancer outcomes without early diagnosis.

[Helen Jones (Warrington North) (Lab)]

When the Government decided to slash council budgets and, therefore, adult social services, did they know what effect that would have on hospitals, particularly A and E, and decide to carry on anyway, in which case they are too callous to be running the NHS, or did they not know, in which case they are too stupid to be running the NHS?

[The Minister of State, Department of Health (Norman Lamb)]

Throughout this Parliament we have ensured that extra funding has gone into social care to recognise the fact that council budgets have been under strain. The point that I made earlier—that there has been a 50,000 reduction in delayed discharges to social care—demonstrates just how well they are doing under significant pressure.

Urgent and Emergency Care Review

Helen Jones Excerpts

Tuesday 12th November 2013 Commons Chamber

[Mr Hunt]

Just as there is more pressure on A and E departments, there is also more pressure on ambulance services. We are treating that as very much part of how we support accident and emergency services over the coming period. There are particular pressures in the London area, the east of England and the east midlands, and we are doing everything we can to put those problems right.

[Helen Jones (Warrington North) (Lab)]

The Secretary of State referred to the Chancellor’s recent announcement about money for social care, yet this is only a tiny fraction of what the Government have already taken out of the social care budget through their 30% cuts to councils. Did he not realise the impact that that would have on A and E, or did he just not care about it?

[Mr Hunt]

I am very conscious of the pressure that having to sort out Labour’s deficit is creating on all Government Departments, but the Opposition cannot have it both ways. They cannot say that they are in favour of fiscal responsibility and then complain about every single cut. The difficult decision that this Government took was to protect the NHS budget. That is something that the Opposition did not agree with. They wanted to cut the budget from its current levels.

Stroke (Emotional and Psychological Consequences)

Helen Jones Excerpts

Monday 21st October 2013 Commons Chamber

[Helen Jones (Warrington North) (Lab)]

As the chair of the all-party group on stroke, I am pleased to have secured the debate.

When I was in my early twenties, my father had a stroke. He was sent home from hospital, an extra rail was put on the stairs, he was given a walking stick and consigned to the care of my mother. He received very little help and support, and we did not know what to expect or how best to help him. I watched him struggle desperately hard to get better, but we did not know how best to support him.

My father had a second stroke and died. Nowadays, his chances of a physical recovery would be very much better. The previous Labour Government’s investment in stroke networks and specialist stroke units have improved the outcome for stroke patients hugely. More people are now admitted to a specialist stroke unit, more people who can benefit from clot-busting drugs get them, and two thirds of people get a brain scan within 24 hours. There is a lot more to do, but there is no doubt that great progress has been made. However, our investment and progress in the psychological and emotional support of stroke survivors has not kept pace with physical care, despite the fact that stroke is the biggest single cause of severe disability in adults.

One cannot prepare for a stroke, because it is a sudden and catastrophic event. If the part of the brain that deals with emotions is affected, many people find themselves thinking, feeling and behaving in an entirely different way. Many suffer feelings of anger and frustration because they can no longer work, care for their families or do even simple tasks. It is not surprising, therefore, that anxiety and depression often result. Families, too, can find themselves in a difficult position, sometimes in the worst cases grieving for the person they have lost while still taking care of that person.

The emotional and psychological effect of stroke was set out by the Stroke Association last year in its report, “Feeling Overwhelmed”. I am grateful to it for its research, and to the people who came to the parliamentary reception we held and were kind enough to share their experiences with me. The effects can be seen in all age groups, but are particularly severe in the 30 to 59 age group, where 76% of people who responded to the Stroke Association’s survey reported feeling severe anxiety and 69% suffered from depression. People find that they lose control of their emotions after a stroke, and it is estimated that two thirds suffer from post-traumatic stress. Despite that, we do not have the services in place to support them. In response to the survey, 42% felt abandoned when they left hospital, and two thirds said that their psychological care did not match the physical care that they received.

If we are going to change that, we have to see psychological and emotional support following a stroke as just as important as physical rehabilitation, and we have to accept that it can be needed for a long time. One person, for example, told the Stroke Association:

“Many of the emotional issues arise, not at the time of the stroke when all you are doing is trying to get well again physically, but it’s months later when the reality hits you that you will never be the person you once were.”

It is not surprising that many people experience feelings of anger and lose confidence. Their greatest fear is often, understandably, of having another stroke. Some people suffer from aphasia, which is a common side-effect of stroke, yet they seldom get the care that they need. For example, one person said to the Stroke Association:

“Because I looked and still look physically well, I had hardly any help in dealing with inability to read, write and understand speech, lack of confidence or emotional problems.”

That person was given just three sessions of speech therapy—totally inadequate.

Another man told how, despite his inability to speak, write or comprehend letters, he was discharged to the care of his children, aged 16 and 14 at the time. This lack of care cannot be justified.

--- Later in debate ---

Motion made, and Question proposed, That this House do now adjourn.—(Mr Gyimah.)

[Helen Jones]

These stories are not uncommon, and we have to begin to take them seriously. We would not accept such lack of care for us or any of our families, which means it is not suitable for anyone else either.

Carers, too, can suffer an awful lot of emotional distress. When the Stroke Association surveyed carers, it found that distress increased the longer someone had been caring: 48% of those who had been caring for three years or less suffered from stress; that figure rocketed to 69% among people who had been caring for seven years or more; 79% suffered from heightened anxiety and 56% from depression. Not tackling that is simply not good enough. These people take on a burden willingly that most of us could not cope with and save this country millions of pounds. We cannot, and should not, leave them unsupported.

I hope we all recognise the moral argument for doing these things, but there is also an economic argument. Research by the stroke improvement programme in England—sadly, no longer in existence—showed that an investment of £69,000 in psychological support using a properly led, multidisciplinary team could save £108,000 in NHS social care costs in two years. When the King’s Fund researched the link between long-term conditions and depression, it found that care costs for those who suffered from depression and a long-term condition were about 45% higher, typically, than for those who did not suffer from depression. Moreover, depression can increase the risk of another cardiovascular incident—in other words, of a stroke. A person is one and a half times more likely to have another stroke if they suffer from depression.

We should be taking seriously the need for psychological and emotional support after a stroke. We ought to be doing three things in particular. First, we need to see psychological support as an essential part of the care pathway for stroke survivors. At the moment, only half of stroke units have access to psychological support. That needs to change, and I should like to hear from the Minister what she plans to do about recruiting more clinical psychologists and putting in place those multidisciplinary teams to support stroke survivors. We ought to recognise, too, that the need for support is not a one-off; it might occur throughout life. That is particularly true, for instance, for children or young people who have suffered a stroke. We do not think of stroke as a disease of the young, but it can be, and young people often need support at particular moments in their lives—when they start school or dating or when they move away from home, for example.

Secondly, we must ensure that people get timely and accurate information about the services available to them, whether in the voluntary sector or in health and social care. At the moment, trusts differ enormously in the information they provide to people. We must also ensure that those who suffer from aphasia are talked through the information and helped to understand what is available to them. The voluntary sector has an important role to play in this. Many people find stroke clubs extremely helpful, for example. People who have suffered a stroke often feel alone, and mixing with others who have been through the same thing, learning from their experience and going out and socialising with them can be of enormous benefit.

Thirdly, I should like the Minister to pay attention to the need for all stroke survivors to get a proper assessment of their health and social care needs, and a written care plan. Although that should happen at the moment, people are telling the Stroke Association that they do not always get that assessment. In fact, one survey discovered that only 39% of respondents had had such an assessment, and that of those, only 60% got a written care plan. Good practice means that people should get an assessment six weeks after leaving hospital, then at six months, and annually thereafter. In fact, 47% of the people who said that they had had an assessment only ever had one. That needs to change. It is also vital that we support carers, and that they know the services that are available to them. At the moment, two thirds of carers say that they have received no support, help or advice on dealing with their emotional problems, and only a quarter say that they feel supported after the person they are caring for has left hospital.

As chair of the all-party parliamentary group on stroke, it has been my privilege to meet some remarkable people. I have met young people who are setting out on life with enthusiasm despite what has happened to them, determined to make a life for themselves, to work and to be part of the community. I have met people who have struggled with severe disabilities but still gone on to help others. I have met people who are determined to put something back into the community by setting up stroke clubs or using art to help others, and who see that as their way of paying back for the care that they have received. It has been an enormous privilege to meet people like that, but at the moment, we as a society are failing them by not giving them the help and support that they need to make a life for themselves after stroke.

I hope that the Minister will see the importance of bringing about change in this area by improving psychological services for stroke survivors in the same way that we have improved their physical care in the past. I look forward to hearing from her how the Government propose to take that forward.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate the hon. Member for Warrington North (Helen Jones) on securing this debate on an important issue that affects so many of our constituents. She spoke with great knowledge and passion about the subject. I am also aware of the great work that she does as chair of the all-party parliamentary group on stroke.

Stroke is one of England’s biggest killers. It is the single largest cause of adult disability. Its effects can be devastating, both for those who have a stroke and for their families and loved ones. It is worth reiterating the great progress that has been made in tackling stroke, particularly the physical aspects, in recent years. Many thousands of people have benefited from that. Fewer people now die from stroke; mortality rates dropped by 37% between 2001 and 2010.

Treatment for stroke has improved in a number of areas, as the hon. Lady mentioned. Stroke patients do better when they are treated on a stroke unit, and over 83% of stroke patients now spend the majority of their hospital stay on a stroke unit. Access to immediate brain scanning is vital, and has improved considerably, as has access to clot-busting drugs, which give people a better chance of regaining their independence following a stroke. We all want that progress to continue, and that is why stroke remains a priority for the Government and the NHS. We also know, however, that we need to do more to improve support for people after stroke, which is the subject of tonight’s debate.

When it comes to national incentives to improve outcomes, stroke is covered in two parts of the NHS outcomes framework and the mandate to NHS England. Through the mandate we are monitoring how the NHS performs both in reducing mortality from cardiovascular disease, including stroke, and in improving recovery from stroke. Some stroke survivors are unfortunately left with long-term disabilities, as was said, so how we support people with long-term conditions will be important to them. Through the mandate, we are monitoring how the NHS is performing in supporting people to look after themselves; whether a person is able to live as normal a life as possible; and how successfully the NHS manages long-term conditions by looking at unnecessary hospital admissions and excessive length of stay in hospital.

[Helen Jones]

The Minister refers to the outcomes framework, but will she ensure that it focuses not just on physical rehabilitation, but on psychological support, because both are essential if people are to go on and build a life for themselves after stroke?

[Jane Ellison]

Quite. As the focus of the framework is about recovery from the stroke, it includes exactly what the hon. Lady says—not just physical recovery, but psychological and emotional recovery, too. Much of what we are trying to do is to set about getting people on that full pathway towards recovery, not focusing only on acute symptoms and the immediate aftermath of the stroke.

The clinical commissioning group outcome indicator set mirrors the areas we are monitoring for stroke and for long-term conditions. This is the indicator set that will be used to hold CCGs to account and to provide information for the public on the quality of services and the health outcomes achieved through that local commissioning. The CCG indicator set also contains measures to ensure stroke survivors are discharged from hospital with a joint health and care plan, and receive follow-up assessments within about six months. I have heard what the hon. Lady said—that this is not happening. I have taken note of it, and it will be discussed with NHS England and all those responsible. It is our clear objective to do that. I appreciate the information the hon. Lady has given us about the Stroke Association’s work in monitoring whether it is really happening. It is obviously a priority. The new Sentinel stroke national audit programme will also monitor the outcomes of stroke care in all patients six months after stroke.

When patients leave hospital, it is important that the NHS and social services work together to get the right services in place to ensure they have the support they need to make the best possible recovery. The measures and indicators I have talked about, alongside a shared measure in the adult social care outcomes framework on the success of re-ablement and rehabilitation services, provide an incentive for the NHS and social services to work together to ensure that happens.

The adult social care outcomes framework is helping us to gauge the progress made by local services and to promote improvement in standards across the country. A key area of the framework is to reduce the need for care and support—exactly as the hon. Lady said—and delay any dependency. Those measures will support the sector to maximise people’s level of independence and minimise their need for ongoing support. Under the framework, local authorities will be able to compare their performance with that of other authorities around the country—we obviously want everyone to match up to the standards of the best—and to make improvements based on what has been proven to work elsewhere. Through that common focus for improvement, the NHS, public health and adult social care outcomes promote joined-up, integrated care, driven by the needs of the individual. For stroke survivors, this means providing access to the support they need to get that better quality of life.

I shall now deal more specifically with the issue of emotional and psychological support for people who have had a stroke. The cardiovascular disease outcomes strategy, published earlier this year, recognises that stroke services that incorporate psychological care deliver the best outcomes for people who have had a stroke. There are also national stroke strategy recommendations and evidence-based national guidance that patients should be routinely screened for mood and cognition after their stroke. These recommendations are included in the National Institute for Health and Care Excellence quality standard on stroke. That answers the question the hon. Lady posed about whether these were at the heart of what we saw as best care—very much so.

It is, of course, the responsibility of NHS England and CCGs to ensure that stroke patients receive the psychological and emotional support they need. NHS England recognises that this area of stroke care is of great importance for many patients. Improvement in community services with greater access to early supported discharge teams and longer-term rehabilitation is also high on NHS England’s agenda.

NHS England is also exploring ways of improving the use of existing resources. The hon. Lady will be aware of Improving Access to Psychological Therapies, an NHS programme that is rolling out services across England that offer interventions for people with depression and anxiety disorders. Many areas now have IAPT, which benefits people including those who are suffering from symptoms following a stroke. I understand that there have been discussions about how the IAPT teams might increase the proportion of the time that they spend with people whose psychological problems are secondary to physical disease, but are none the less important and—as the hon. Lady said—sometimes become more important as time goes on.

Some IAPT services have developed psychological support skills through enhancing the training of nurses and therapists, and some have employed the services of counsellors to support people who have had strokes in the community. I know that some of the good local examples of support for stroke survivors and their families are in the hon. Lady’s constituency. She will be well acquainted with initiatives such as the family support service, which helps stroke survivors and their families to adjust to life after a stroke, and the communication support service, which helps people with aphasia and other communication problems to cope. Stroke sufferers and their families can also receive emotional and psychological support via the local IAPT service.

It is for NHS England to consider how to spread best practice from services such as those in Warrington, using some of the frameworks that I have described. However, I am glad that the hon. Lady has taken this opportunity to bring the issue to Parliament, because I feel strongly that Parliament has an important role to play in highlighting great practice and spreading the word about good local initiatives such as those to which I have referred.

We recognise that, while supporting those who have had strokes, we must also support those who care for them. We set out our priority areas for action on carers in our paper “Recognised, Valued and Supported: next steps for the carers strategy”, which was published in November 2010. We have also made available to the NHS additional funding of £400 million between 2011 and 2015 so that carers can be given much-needed breaks to sustain them in their caring role. Carers are central to the Government’s proposals for care and support, and, as the hon. Lady will know, the Care Bill offers significant improvements in that regard. I am sure that we shall hear far more on the subject as the Bill progresses through Parliament.

Once again, I congratulate the hon. Lady on securing the debate and raising the profile of this very important issue. I shall consider the specific issues that she raised with which I have not been able to deal tonight. I shall also be happy to engage in a continuing dialogue with her and with the Stroke Association. I have read the association’s 10 key indicators and familiarised myself with them. However, the issue is so important to so many people that there must clearly be an ongoing debate about how we can ensure that the very best care is provided throughout the country, because we need the consistency to which the hon. Lady referred.

Let me end by paying tribute not just to all those who work in the NHS, but to those in the voluntary sector who care for stroke patients and their families.

Question put and agreed to.