Health: Stroke Survivors

Lord Lingfield Excerpts

Thursday 28th June 2018 Grand Committee

Asked by

[Lord Lingfield]

To ask Her Majesty’s Government what action they are taking to improve the provision of long-term rehabilitation for stroke survivors.

[Lord Lingfield (Con)]

My Lords, I thank noble Lords and the Minister for giving up time for this debate. I remind your Lordships of my registered interest as the chairman of the stroke charity ARNI, Action for Rehabilitation from Neurological Injury.

We know that in the UK over 150,000 people have a stroke annually. But happily, people do not die nearly so often from stroke as they used to. In fact, some 85% of those who suffer a stroke survive it. They do so because: first, there is a greater recognition out there of what a stroke looks like, and the importance of immediately calling the emergency services; secondly, ambulances get stroke victims to hospital more quickly; and thirdly, when they are there, hyper-acute stroke units can carry out rapid diagnoses, first-class scanning and excellent treatment.

The net result of this upsurge in the welcome ability to save lives is that we have a very large number of stroke survivors. In this country, some 1.2 million people are living with the effects of stroke at any one time. It is the biggest disabler of all. It is those people whom I want to discuss this afternoon for, if the clinical treatment of stroke patients has been a great success story, sadly, helping them to live as near normally as possible afterwards has not been so.

Rehabilitation starts typically with physiotherapy and, if required, speech therapy. It begins for most people in hospital; they then continue as out-patients or receive treatment at home, but it is very much time limited. The health watchdog, the National Institute for Health and Care Excellence, has produced guidelines based on recommendations by the Royal Society of Physicians, which suggest that patients should receive 45 minutes of each therapy that they need every weekday, for as long as their disabilities require it. This is a huge ask of course but, typically, we are told that stroke survivors average the equivalent of just 16 minutes per day of physiotherapy, 12 minutes of occupational therapy and 12 of speech therapy. Moreover, on leaving hospital, many have to wait six weeks before community therapy, such as it is, is initiated. The Stroke Association says that, at this stage, many are forced to pay for private care.

One-quarter of all strokes in the United Kingdom happen to people of working age, and one-fifth of these are under 45. Stroke therefore reduces employment prospects for the future for its sufferers, with all that means for society. It has a knock-on effect for family and friends involved in a patient’s care and who are usually, of course, unpaid in this role. The estimated aggregate costs of stroke are a substantial £25 billion. There is still a commonly held misconception, however, that people cannot significantly recover from the effects of having a stroke and that they are stuck with whatever mobility they have after hospitalisation and its consequent physiotherapy for the rest of their lives. However, well-established evidence shows that neuroplasticity of the brain can be utilised to augment recovery, leading to better function and action control even some years after the stroke has happened.

Stroke-specific physical training, applied at home, which targets upper and lower limb deficits can be the key to a better quality of life and for readmission to employment. In short, active approaches where patients are highly involved in their own rehabilitation and do many hundreds, sometimes thousands, of specific repetitive actions can lead to positive neural adaptation, whereas those where survivors are merely the recipients of predominantly traditional therapy are much less likely to do so.

It is precisely these active interventions which my own stroke charity, ARNI, does so well and with such heartening results. ARNI was created in 2001 to ensure that there is a growing body of qualified exercise instructors available for stroke survivors. They go into homes to help people to rehabilitate and we now have more than 100 therapists and professional instructors across the country, many of them running group classes as well.

This kind of rehabilitation works with people of all ages, including those whose strokes happened some years before. Here is the testimony of John Scrivener, an elderly former paratrooper who suffered a massive stroke in 2012, losing the use of his left arm and leg. Two years later he was introduced to ARNI’s exercise techniques at which he works hard and regularly with his instructor. He says:

“I can now go up and down awkward steps with no handrails. I have no difficulty in going into strange environments and I can even get up unaided from the floor. I am astonished by the changes that have made such a difference to my life”.


The broadcaster Andrew Marr has said publicly and often how ARNI’s exercise regime helped him enormously after his own stroke and gave him better gait, balance, grip and strength, the better to be able to cope with his arduous public life.

Last year I saw Harry Baker, then 16 years of age, start his rehabilitation with my charity. He had significant limitations and could hardly lift his hand. A year later, after determined and repetitive special exercises, he has improved so much that he has had the confidence to join a martial arts class, where I witnessed his agile kicking and dextrous handling of a football. The appalling and depressing effects of a stroke, probably the result of a sports injury, were felt deeply by this teenager whose social life was reduced to zero. Normal life beckons for him once again.

One simple ARNI technique reported at the World Stroke Congress has improved the lives of hundreds of patients and saved many thousands of pounds in public funds. It is called “off the floor” and enables stroke-impaired patients to get up from a fall by themselves. Typically, before learning it, many would lie immobile for hours or, often with huge embarrassment, had to rely on calling 999 for paramedics to help get them back up.

Stroke survivors rely on charities like my own for this kind of long-term rehabilitation because it is not available from any other sources. I pay tribute to the Stroke Association, which last year began its £2 million project of Life After Stroke grants, having been sponsored as the Royal Mail’s charity of the year. These grants of £300 each can enable longer-term rehabilitation such as that which I have mentioned to take place. We badly need two things: first, the recognition that disabilities caused by stroke can be much improved by techniques such as those I have described, and secondly, grants from public funds to make this happen. As always, such investment will save money even in the medium term by reducing the number of people who are expensively re-hospitalised by injury or physical decline, by reducing their reliance on the ambulance service, and by reducing the burden on carers. Above all, it will help to give survivors of all ages back the dignity of being able to live more normal lives physically and socially, and even the ability to return to the world of work.

We are extremely good at dealing with the immediate effects of stroke, but now we must deal just as effectively with its long-term effects as well.