Stroke: Aftercare

Jo Churchill Excerpts

Wednesday 21st April 2021 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

It is a pleasure to serve under your chairmanship, Sir Edward. I thank my hon. Friend the Member for Bromley and Chislehurst (Sir Robert Neill) not only for giving us all the opportunity to discuss this issue, but for sharing his and Ann-Louise’s journey and experience. I wish her well in her future recovery, but he articulated very well what some of the challenges are, as did many other Members.

The debate has made clear how stroke touches so many lives. I can feel an APPG coming, and I would welcome it, because the Stroke Association is a fantastic charity which does great work, and I am sure that they will be listening and keen to support an APPG. I thank all those at the Princess Royal and all those—in Stockport and throughout the country—who work in stroke services in the acute sector and out in the community. As has been articulated, it is a team game to give people the proper, consistent support so that they can achieve the optimum recovery.

I am so pleased that the friend of the hon. Member for Stockport (Navendu Mishra) made a fully recovery, but as hon. Member for York Central (Rachael Maskell) explained clearly, using her vast expertise, why it is a different journey for different people. Some people need a much more needs-based approach, which is obviously where we hope to head. That will hopefully be music to the ears of my hon. Friend the Member for Beaconsfield (Joy Morrissey). I hope to assure the hon. Member for North Norfolk (Duncan Baker) that we, too, are driving services in his area.

I do not have many minutes to speak, so if there are further questions I will be happy to go over them with individual Members. We have made enormous progress but, as many hon. Members said, that progress still needs work. We need to do better and we need to go faster. One of the ambitions of the long-term plan is the inclusion of a national stroke programme that looks to improve services, including better rehab services and increased access to specialist stroke units through a flexible and skilled workforce. We heard more than once about the challenges on the workforce front.

The prevention and treatment of stroke is a key priority for the NHS. Despite the many challenges presented by covid, the stroke programme has continued to support regional delivery. In some areas, we have accelerated implementation because it is such an important area. As of 1 April, there are now 20 integrated stroke delivery networks operating to support the national stroke service model. Those networks have patient voices and public voices, which it is quite important to let everybody know, because this does need to be patient-driven, and people need to know that they are being heard. ISDNs bring together key stakeholders in stroke to deliver a joined-up, whole pathway transformation through the integrated care systems.

I am sure that my hon. Friend the Member for Bromley and Chislehurst knows that such an ISDN is now operational in his constituency. They will be responsible for delivering optimal stroke pathways based on best evidence, which he referred to. They will ensure that patients who experience a stroke and, so very often, quite debilitating outcomes from it, receive excellent care from pre-hospital, through to rehabilitation and then life after stroke.

There is good evidence that stroke units delivering hyper-acute stroke care 24/7 enable the NHS to achieve ever-improving outcomes. Receiving high-quality specialist care in well-equipped, well-staffed hospitals is the optimum, and 90% of stroke patients will receive care in a specialist stroke unit. More patients will have access to disability-reducing treatments of mechanical thrombectomy and thrombolysis; combined with increased access to rehabilitation, that will, hopefully, deliver long-term improvement and a more seamless pathway.

As we heard from my hon. Friends the Members for Bromley and Chislehurst and for Beaconsfield, navigation of all the different systems is really part of the challenge as well. My hon. Friend the Member for North Norfolk will be pleased to hear that Norfolk and Norwich is one of the new pilot areas for non-neuroscience centres that will work towards the delivery of thrombectomy.

Delivering the right treatment quickly will lead to the best outcomes. We see that with ischemic strokes: busting the clots has become increasingly effective using the right drugs and treatments. All stroke units in the UK can deliver intravenous thrombolysis. Early diagnosis by stroke specialists, followed by early thrombolysis, has been transformative in stroke care.

Thrombectomy is a procedure used to treat some stroke patients, and there is evidence that, where used appropriately, it will reduce the severity of disability. Thrombectomy is available in 22 centres, with two further non-neuroscience centres under development, of which the Norfolk and Norwich centre is one. The expansion of these services is in the long-term plan, with plans to increase the workforce who are able to perform the procedure. Owing to training requirements, that is currently restricted to neuroradiologists, which is a challenge, so we have worked with the General Medical Council to develop a credentialling programme. That will hopefully enable the acceleration of training to a wider cohort of medical professionals, such as radiologists, cardiologists and neurosurgeons.

On rehabilitation services, if the stroke patient has had a hyper-acute treatment they will need early therapy, as we have heard from so many hon. Members. That needs to be delivered by physio, speech and language therapist specialists, and should be accessible within 24 hours. We have heard of the challenges. Long-term rehabilitation is also best undertaken locally, so that people do not face the challenges of chasing around for the service—that also supports the family, who are often vital in a patient’s journey—and to enable the assessment of the appropriateness of homes by occupational therapists and others. We do not want reviews every six weeks, every six months and annually. We want reviews to be patient-led, which I think is what the hon. Member for York Central was driving at.

The integrated community stroke service model has been developed by clinicians, experts and charities, whom I thank for the help that they have given us. To ensure that evidence-based care is being delivered, we have worked with them to address the variation across the country, which is a problem. The stroke rehabilitation pilots mobilised in 2020 are implementing an integrated community stroke service that will enhance care path- ways, including psychological support and vocational rehabilitation. Recognising that everybody’s needs are different is very important, as is delivering personal, needs-based stroke rehabilitation to every stroke survivor, in their home or place of residence.

We have funded the Stroke Association during the pandemic to provide the Stroke Association Connect service. Stroke rehabilitation pilot sites are also testing improved data collection.

The hon. Member for Stockport will be pleased to hear that we have turbocharged research, calling for more research into stroke areas, because evidence-based research is really important. Building on the rehabilitation pilot initiative, we will launch the new stroke quality improvement for rehabilitation later in 2021. Working closely with integrated stroke delivery networks, that will help address variation. Combined with funding for quality improvement projects and expansion of community data, we will then expand. In addition, the national stroke service model, due for publication in late spring, will support that service. The Government have initiated the biggest recruitment drive for allied health professionals in decades, including speech and language therapists and occupational therapists.

I want to give my hon. Friend the Member for Bromley and Chislehurst a couple of minutes to respond, but in conclusion, I hope I have demonstrated that this is a serious issue. I know the stroke community will have heard our discussion. I would welcome the opportunity to discuss the subject more fully, when there is time for me to go over some of the developments and ambitions we have to ensure that we impact the lives of people with strokes. We can give them significant benefits, we can benefit the NHS and, as my hon. Friend said, we can bring people back the best way that we can.