Covid-19: Deteriorating Long-Term Health Conditions

Jim Shannon Excerpts

Thursday 10th March 2022 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairmanship, Mrs Cummins, and I seem to be doing so regularly. I am pleased to participate in this debate. I want to thank the hon. Member for Bromley and Chislehurst (Sir Robert Neill) for bringing it forward and for setting the scene with the detail and information to help us participate. I am pleased to see the shadow spokesperson, the hon. Member for Denton and Reddish (Andrew Gwynne), and the Minister in their place.

We often parley in this Chamber. Indeed, the Minister, the two shadow spokespersons, myself and others here, including the hon. Member for York Central (Rachael Maskell), are always willing to come to these debates. I am my party’s spokesperson for health, so I am always pleased to speak in health debates. People may say that I speak in every other debate, but that is by the way. If I am spared another hour, I will speak in the next debate as well. Members of Parliament in a small party find that they have more portfolios than most. I have got a lot of issues, and that is why my participation in debates is so frequent.

During the pandemic I repeatedly spoke about the impact on schoolchildren and those who were ill. My fears have unfortunately been realised. We have children with issues catching up on basic education. We have a raft of people who are undiagnosed or misdiagnosed, and treatable conditions have escalated. As the hon. Member for Carshalton and Wallington (Elliot Colburn) has done, I want to thank all health workers—doctors, GPs, pharmacists, nurses, care workers. I also want to thank family members, who gave up a lot of time to look after family members who were unwell. Pharmacists have also been mentioned, and it is important to place on the record our thanks to them. It is because of their industrious efforts that we have all been able to get to the other side of this pandemic.

I would also like to thank the Minister and the Government for what they have done. Covid and the vaccine roll-out enabled us to move toward what I always hoped we would see, and which the Prime Minister has been keen on—a normal life, where we do not react to covid but learn to live with it. That is where I want to be, and I believe it is where the people want to be as well.

There are those who suffer from long-term deteriorating health conditions who have not received the necessary treatment and care. In some areas, people will have had a poorer quality of life because of covid.

I am always reminded of one gentleman in particular, who is a minister of the church in Newtownards—we call him Pastor Mark. He took covid early on and is very fortunate to be in this world. He was ill for a long period of time. He is a young man with a wife and a young family. He suffers from long covid, the deteriorating effects of which are very clear to him. Today he does not have the stamina and energy that he once had. He tires easily. He refers to brain fog. I am not sure what that means, but I understand when he tells me. These are some of the repercussions of the pandemic. The sad fact is that covid has robbed us of so many, and we must rebuild where we can.

Some of those with severe health problems were in a queue to receive treatment. For some, delays were part of the reason for the numbers of those who passed away. I recall with sadness people I knew who were on a list to get an operation or a treatment. They were put to the back of the queue because of covid, and they are no longer here today. That operation is lost and the opportunity for treatment was not given. I cannot say that it would have prolonged those lives, but it would have given a better quality of life and would maybe have added a few years. We must think of all those people who were not able to get the help they needed.

The hon. Member for Carshalton and Wallington spoke about dementia. We had a debate on dementia in Westminster Hall some time ago. He is right. Probably because of my length of time as an elected representative, I know lots and lots of folk who, over the last period of time, have developed dementia and Alzheimer’s. I see the detrimental effect on their wellbeing and on their families—how dementia and Alzheimer’s robs people of their quality of life and their knowledge of their family members.

A wee lady passed away just this week. Her daughter phoned me on Sunday and let me know. I have known her all my life—she was 94 or 95 when she passed away. She took dementia and she came home. Some things people do remember. One thing her daughter told me on Sunday was, “Jim, she bought the Chronicle every week”—that is our local paper—“and when she saw your picture, she knew it was you, though she might not have known that I was her daughter.” Some things rob people of the very core of their life, and that concerns me.

More than 150,000 had their lives cut short by the virus. As the Alzheimer’s Society, Macmillan, Stroke Association, Age UK and many others have highlighted, across the UK, many people with pre-existing long-term health conditions have deteriorated faster than usual since the pandemic began. The increased rate of deterioration is due to the effects of having covid-19, as well as the measures taken to contain the virus, such as lockdown to reduce social contact and the suspension of rehabilitative services.

During the first wave of the pandemic, maybe professionals who provide rehabilitation were deployed to acute services for covid-19 patients. We understand the logic behind that, but there is an impact and there are side effects, which we are pointing to. Community rehabilitative services moved to primarily offer virtual support. As a result, rehabilitation services were unable to provide the same level of support that they did pre-covid. Community services are vital in helping to support people with long-term conditions. The mental wellbeing of those undergoing treatment for cancer, MS and heart conditions, and of disabled people, was greatly impacted, which gives us some cause for anxiety and concern.

The question for the Minister today, and for my Government, is where to go next. I support the aims of the organisations that produced “Moving forward stronger” and its specific recommendations, three of which I will cover in the timescale that you have indicated, Mrs Cummins. First,

“fully fund a national two-year rehabilitation strategy that ensures people with significantly deteriorated long-term conditions get the therapeutic support they need”.

That is really important. The second is to

“appoint a national clinical lead to implement this rehabilitation strategy”

and thirdly, to

“ensure local partners—such as local authorities and Integrated Care Systems…develop and deliver their own localised rehabilitation strategy, and that each ICS has a regional rehabilitation lead.”

When the Minister responds, I have every confidence that she will be able to reassure us that the things we are asking for today—collectively, but from different parts of this great United Kingdom of Great Britain and Northern Ireland—will be addressed.

I know that the Minister has regular contact with the Minister back home—Robin Swann of the Northern Ireland Assembly. I think that is important. I am a great believer in the Union, not because I come from Northern Ireland and am a Unionist, but because I believe in the Union for England, for Wales, and—with great respect—for Scotland, with equal passion and concern. I would therefore ask the Minister what talks she has had with the Minister back at the Assembly.

I will give a quick plug for those who are waiting for cataract operations, and those who had glaucoma. Do you know what really annoys me, Mrs Cummins? It annoys me that some people have lost their eyesight because they have not had the care within the time when they should have had it. Maybe the Minister can give some reassurance on that.

I finish with this: these are things that I absolutely stand behind. I ask the Minister, to address the possible reasons why Government will not stand behind and implement the “Moving forward stronger” recommendations —although I hope that she will reassure me otherwise. We have people with a quality of life that can be improved with the right strategy, and the document lays a foundation to build on as we seek to repair that which has been decimated—through no fault of Government; it was covid-19 that did it. We are taking the approach that we must live with covid; those people have lived with the side effects it has had on their illnesses, and that cannot be allowed to continue. With that in mind, I very much look forward to the Minister’s response.

--- Later in debate ---

[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.