Lord Lingfield
Main Page: Lord Lingfield (Conservative - Life peer)
Lord Lingfield (Con)
My Lords, I am indebted to my noble friend Lord Borwick for tabling this far-seeing debate. I remind your Lordships of my registered interest as the chairman of the stroke charity ARNI, Action for Rehabilitation from Neurological Injury.
Stroke is the leading cause of disability in the United Kingdom and there are some 1.25 million people living with its effects at any one time. My noble friend mentioned the period 50 years ago when stroke, often then loosely called apoplexy or seizure, was a death sentence; today things are, of course, very different. There are about 130,000 new stroke victims each year in the UK, and the vast majority leave hospital having survived. The reasons for this are the extraordinary advances in acute clinical care during the last decades. There is also far greater public awareness of stroke, of its immediate symptoms and of the absolute necessity of seeking urgent help from the emergency services. I pay tribute to the Stroke Association and other stroke charities for their very successful dissemination of this vital information.
If you have a stroke, you should be rushed off to hospital and treated with a thrombolytic—a clot-busting drug—within four hours. You then stand an excellent chance of survival. However, it is on discharge from hospital that, for many people, their future disabilities really strike home; disabilities which will require lifelong support for a great proportion. For instance, 70% of them will have upper limb problems that render a hand useless and many will suffer weakness and lack of control of a leg, which makes walking extremely difficult. If they are of working age, too often employment becomes impossible. The annual cost of stroke in the UK is estimated at £26 billion. The stark reality is that families and carers pay for three-quarters of long-term care themselves. The current evidence suggests that the average annual cost of a stroke can be as much as £22,000 per family.
Alarmingly, the incidence of first-time strokes in people aged over 45 is expected to increase by 60% over the next quarter century. Many of these people hope to return to work. They are, in fact, three times more likely to be unemployed than if they were not disabled by stroke. Following discharge from hospital, patients may receive some, largely passive, physiotherapy and, if necessary, speech therapy, but this is quite strictly time limited, measured in weeks rather than in years—and then, to quote Andrew Marr, whose own stroke brought him considerable disability, you fall “off a cliff”.
Most stroke survivors, therefore, are stuck in perpetuity with their impairments and incapacities and a much-reduced lifestyle; the consequent effects for them and their families and carers are huge and debilitating. What can be done in future years to improve their rehabilitation? We most seriously need more research on rehabilitation. At the moment, stroke research is allocated about £56 million each year, compared to, for example, £554 million for cancer. Most, quite rightly, has gone on clinical research on the acute stage, on primary care, the causes of stroke and its prevention; far too small a proportion has gone on rehabilitation.
One hopeful area is to take advantage of neuroplasticity, the ability of the brain to reorganise itself by forming new neural connections to compensate for injury. However, this reorganisation does not just happen; it seems to require constant repetitive active exercise to make neural connections stronger and to drive functional changes. To give an example, last year I met a stroke survivor aged 38 who had lost all ability to grip a glass or mug. She was trained by my charity constantly to attempt this, day after day, in a special routine. At first the movements were almost imperceptible, but she persevered. Eight months afterwards she could demonstrate to me an extraordinary improvement: she could lift the mug to her mouth and drink. Each day of determined repetitive exercise had made her neural connections stronger until her hands operated again.
Another patient, a young man aged 17, was devastated to be paralysed by a stroke, probably caused by a sports-related injury. Absolutely determined to improve his ability to walk, he devoted himself for a year to a series of specially tailored repetitive exercises, performing them day after day and gradually making tiny improvements. He was, at the end of this period, able to kick a ball and catch it. I have seen very many other examples of success: they require dedication and patience. My charity trains and qualifies specialist rehabilitation instructors. They visit patients in their homes to help them with repetitive exercise routines, to do action control work for upper limbs, to do strength training and to teach crucial physical coping strategies for those with loss of control on one side of the body, such as getting down on and getting off the floor without support. In short, this is targeted therapy aimed at finding what improves individual stroke survivors.
At the moment, stroke rehabilitation of this kind is carried out by only a few charities; it has been subject, however, to some excellent pilot studies. We badly need a national programme of such treatments, publicly funded and assisted by ongoing research into outcomes. Given our ever-ageing population, we need these in the next five years, not in the next 50. Given this serious gap in provision, I hope my noble friend the Minister will be able to give me some hope and reassurance that there will be a change in attitude and direction concerning rehabilitation after stroke.