Transient Ischaemic Attacks

Debate between Jim Shannon and Helen Jones

Wednesday 5th November 2014 Westminster Hall

[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.

Anti-social Behaviour, Crime and Policing Bill

Debate between Jim Shannon and Helen Jones

Tuesday 4th February 2014 Commons Chamber

[Jim Shannon]

I sympathise greatly and understand the issue that the hon. Lady raises. In the case of someone against whom a domestic complaint has been made to the police which is unsubstantiated, how would that be taken care of, in the Opposition’s view, under impending legislation? Incidents are not always taken as proof; there may be only complaints that are not substantiated.

[Helen Jones]

The hon. Gentleman makes a fair point. He is right that incidents of domestic violence do not always make it to court for a number of reasons, usually involving the vulnerability of the victims, but in such cases the police would have to find credible evidence of domestic violence or drug or alcohol abuse, and that refusal could be challenged in court. As a first premise, we should be clear that we should not put guns in the hands of people with such a record. We know that there are people who need to hold guns for a number of reasons. For example, farmers—some of my relatives are farmers—and vets do, but we should not be putting guns into the hands of people with a record of domestic violence. I hope that in time the Government will see that.

I shall comment briefly on the amendments to deal with child sexual exploitation, particularly amendment 76, which allows closure of premises suspected of harbouring those who have committed child abuse. We know from the cases that have happened in Rochdale, Oxford and other towns in this country how horrific some of this abuse has been. The reviews from Oxford and Rochdale were very clear that certain premises were repeatedly used for grooming and sexual exploitation. It was, in my view, impossible for the proprietors of those premises not to know what was taking place there. In Oxford it was guest houses in particular, and it was horrific beyond belief.

When the Minister responds to the debate, will he clarify one point in particular? For a closure order there has to be reasonable suspicion that a criminal offence has occurred. This could be a sexual offence against a child, but the obvious thing that we are likely to be dealing with in such situations is grooming, and the offence of grooming is quite a hard one to establish. That is why there are few convictions for it. The adult has to have met and communicated with the child twice, and the adult must then meet the child and, at that time, the offender must have the intention of committing a relevant sexual offence.

Perhaps the Minister could clarify for us how the police will have a reasonable suspicion of all aspects of the offence of grooming, and whether the difficulties in establishing this will prevent the power from being used. If that is found to be the case as time goes on, will he undertake to come back to the House with further proposals if necessary? This issue is causing deep disquiet in some of our communities, and rightly so. When we are talking about protecting children, we should err on the side of caution—on the side of children, as it were, rather than anyone else.

Anti-social Behaviour, Crime and Policing Bill

Debate between Jim Shannon and Helen Jones

Tuesday 15th October 2013 Commons Chamber

[Helen Jones (Warrington North) (Lab)]

I was not in the Chamber yesterday, so may I welcome the Minister to his new post and let him know that any conspiracy theories he comes up with about me will probably be true?

The Opposition accept the need to deal decisively with forced marriage in Scotland, as in England, and we are pleased that the Government are extending to Scotland provisions that make forcing someone into a marriage a criminal offence. We therefore support the new clause and its consequential amendments. It was clear from evidence taken in Committee that there are differing views on the issue, and some who are active in the sector oppose the use of criminal law in that area because they believe it would deter victims from reporting what is happening to them. That is an understandable view, but not one I share. Victims of forced marriage are British. They are of many ages, although many are young people. British boys and girls, of whatever colour, deserve the same protection as every other British boy and girl.

It is important to make the point that forced marriages are not about religious beliefs—they are not condoned by any of the major faiths, whether Christianity, Islam or Hinduism. Forced marriages are about abuse, often of children. What we condemn as abuse in any other sector of society cannot be condoned because of the colour of a person’s skin, their ethnic background or their parents’ culture. I am therefore glad that new clause 9 will make coercing someone into a marriage a criminal offence in all parts of the UK. I hope we will give young people, their communities and others the confidence to challenge forced marriage and to stand up and say no, knowing that they are supported by the law throughout the country, and, I would hope, by others in the community.

It is fair to say that, in some respects, Scotland has moved ahead of the rest of the UK on the matter because, as the Minister has said, breach of a forced marriage protection order is a criminal offence in Scotland, as it will be in the rest of the UK when the Bill becomes law. It is therefore clearly right that new clause 9 extends the criminal offence of coercing someone into a marriage into Scottish law. However, the UK Government and the Scottish Government need to do much more. No forced marriage protection orders have been issued in Scotland since its current legislation came into force, and yet no one would seriously argue that there were no forced marriages last year. In fact, the UK forced marriage unit gave support in 1,483 cases related to possible forced marriage. That is a high number, but the National Centre for Social research report published in 2009 estimated that there were between 5,000 and 8,000 reported cases throughout the UK each year. Of course, many cases go unreported.

The Opposition therefore support the Government’s legislation for Scotland and the rest of the UK, but I should tell the Minister that the legislation by itself is not enough. We need to put in place a system that allows people to report when they are at risk of forced marriage, that encourages them to report, and that offers them the support they need. Currently, that is sadly lacking. For example, much more work needs to be done in schools, so that teachers are alert to the signs that a pupil might be being forced into marriage. Young people need to be educated so that, if they or one of their friends are at risk, they know where to seek help.

I therefore ask the Minister to say what the Government are doing to raise awareness of forced marriage. Where is the money to fund such a campaign? In 2012, the forced marriage unit said that many agencies, whether those dealing with children or with vulnerable adults, still did not recognise forced marriage as a safeguarding issue. That is totally unacceptable. There is evidence that police throughout the UK recognise the need to deal with forced marriage proactively, but other agencies—not just schools, but colleges and health organisations—still have a long way to go. I hope Ministers discuss the measures needed with the Scottish Government, so that we can develop a common approach throughout these islands.

We must have training not only for teachers to allow them to recognise the signs that their students are at risk, but for others. Teachers are important because, sometimes, they are the only person outside the family with whom a victim has contact at first. I remember the tragic case of Shafilea Ahmed in my area—she lived in the constituency of the hon. Member for Warrington South (David Mowat). She was so desperate that she drank bleach when she was taken to Pakistan. Later, she was missing for a week before anyone from the school raised the fact that she was not there, despite the warning signs she had given. Teachers did not intervene, and health workers did not follow up or ask the right questions. In the end, she was tragically murdered. I tell the Minister that, although the legislation is welcome, the Opposition want to know what he will do to ensure there is not another Shafilea.

Social services provision is struggling because of the draconian cuts the Minister’s Government are making to council services. Women’s refuges have lost a third of their budget, and refuges and specialist advice services are closing. There is evidence that services that cater for women from black and ethnic minority communities are particularly hard hit. One test of the willingness of both the Scottish Government and the coalition Government to enforce the provisions will be whether they provide the services that people need.

[Jim Shannon (Strangford) (DUP)]

Is the hon. Lady’s submission to the House that more focus should be on certain cultural or ethnic groups rather than having a generic focus? I ask because the examples she gives—other hon. Members will give similar ones—come from certain cultural areas. Should the financial focus be on those areas to help them?