Stroke Services

Maggie Throup Excerpts

Tuesday 5th December 2017 Commons Chamber

[Sir David Amess]

I absolutely join the hon. Lady in celebrating the work of all those charities.

The European Stroke Journal found that improving access to thrombolysis and early supported discharge services alone can contribute to reducing the financial burden of stroke on health and social care services. When the benefits of treatments such as mechanical thrombectomy are included, the costs can be lowered significantly. What measures are the Government taking to address the rising costs associated with strokes in England? I very much hope the Government are considering the widespread use of mechanical thrombectomy, which is a new and effective way of treating some of the most serious strokes caused by a blood clot.

[Maggie Throup (Erewash) (Con)]

I have heard first-hand stories about the impact of mechanical thrombectomy and just how fantastic a treatment it is. It can enable people who might have had lifelong disabilities to lead normal lives. I gather it is being rolled out throughout the NHS through specialised commissioning, but does my hon. Friend agree that the roll-out needs to be speeded up, and that we need more people in place to carry out the treatment so that more individuals can benefit from it?

[Sir David Amess]

Even though money is tight, I absolutely agree with my hon. Friend. I have seen a video of the operation, and it is just extraordinary that a catheter can be inserted into a patient’s artery to access the clot, which is then mechanically removed. The technology is extraordinary.

Mechanical thrombectomy significantly reduces disability rates after strokes. It removes clots that are too big to be broken down by drugs alone. For each six-minute delay in the delivery of mechanical thrombectomy, there is a 1% increase in the proportion of people who become disabled. Royal College of Physicians guidelines for stroke care label it as the best recommended practice. It is an effective procedure with very low complication rates. It is highly cost-effective, too. The Stroke Association has calculated that over a 10-year period, the net monetary benefit of 9,000 eligible patients receiving the treatment would be between £530 million and £975 million.

Mechanical thrombectomy enables more stroke survivors to live independently in their own homes, which is crucial, and then to return to work and take control of their lives again, thereby saving the NHS money. It really is a game-changing treatment that could revolutionise stroke victims’ experiences, yet despite NHS England’s agreeing to fund it, it is delivered for only 0.008% of the 85,122 acute stroke admissions, versus the EU benchmark of 3%, so we are really some way behind.

Let me blow the trumpet for Southend, following on from what my hon. Friend the Member for Rochford and Southend East (James Duddridge) said earlier. Southend has been developing an interventional neuroradiology service alongside a hyper-acute stroke service providing thrombectomy. Our service is led and delivered by an interventional neuroradiologist. It has been developed with the local trust board since 2013, but due to a current recommendation that only interventional neuroradiologists can perform the procedure, she is the only person who can perform thrombectomy at the moment, so the service is provided on a “best endeavours” basis and is not, unfortunately, a regular service. The service is currently available only at Southend and nowhere else in Essex. We need to expand it to provide a 24-hour service. The only other place where it is provided is at St George’s Hospital in London.

Mr Paul Guyler, who is a lead consultant in stroke medicine at Southend University Hospital, tells me that less than 1% of ischaemic stroke patients receive endovascular treatment and that, despite around 9,000 patients being eligible for mechanical thrombectomy, only 400 patients received the treatment last year. He has argued that the barriers to this treatment revolve around skills and education, resources and attitudes.

This is not a criticism of my hon. Friend the Minister, because he cannot wave a magic wand and solve all these problems, but Mr Guyler has advised me that there are not enough trained specialists to be able to provide a 24/7 service in all areas. Unfortunately, we also have a postcode lottery, with not enough neuro- radiologists and only 80 interventional neuroradiology operators in the United Kingdom.

[Maggie Throup]

My hon. Friend is being very generous with his time. He has hit the nail on the head: the treatment is very specialist and is carried out by surgeons and neurologists who are not normally there to treat stroke victims. The change in the way in which stroke centres work has been fantastic. Stroke services have been centralised, but we need to go a step further and to make sure that we get the right training for these neurologists so that we can continue to save lives.

[Sir David Amess]

My hon. Friend is spot on in her analysis. I know that the Minister will take the points that she has made to heart and consider how we can improve the present situation.

Consensus forecasts predict that 150 trained people are required to run a fully functioning 24/7 national service. Mr Guyler says that training in stroke intervention is not readily available, that not enough hospitals can afford 24/7 availability and that there are not enough expert neuroradiologists to interpret CT scans. He says that there are turf wars between neurologists, cardiologists, neurosurgeons, radiologists, vascular surgeons and neuro- radiologists on who can and will perform interventional stroke treatment in the future. I do not think it is for politicians to get involved in those turf wars. The medical staff need to sort out between themselves who will lead in these matters. Apparently, there are also turf wars between university and district general hospitals on who should perform the procedure.

Mr Guyler also highlighted the fact that we have the expertise to develop this treatment significantly. The UK has one of only five training simulators in Europe—we should be proud of that—which is based at Anglia Ruskin University.

What are the Government doing to encourage more areas to reconfigure acute stroke services? We do need a new national stroke plan. I was at the launch of the original plan at St James’s Palace many years ago, but it is now time for a new one.

--- Later in debate ---

[Steve Brine]

I echo the hon. Gentleman’s sentiment that that work is critical. I mentioned the Act FAST campaign, which was a heavily evidenced public health campaign showing that the quicker we act after the event, the better the outcome, so he is absolutely right to highlight that issue. However, I am conscious of time, so I am going to press on.

My hon. Friend rightly spoke about mechanical thrombectomy, which he called a game-changer, and he is absolutely right. To continue and build on our stroke service success and to address the costs associated with stroke in England, which was one of my hon. Friend’s first asks, it is imperative that we keep identifying and developing innovative treatments and cutting-edge procedures.

In mechanical thrombectomy, or MT as we shall know it, we have an innovation that we believe can significantly improve patient outcomes, and my hon. Friend spoke about that. In April this year, NHS England announced that it will commission mechanical thrombectomy so that it can become more widely available for patients who have certain types of acute ischaemic stroke, which is a severe form of the condition. My understanding is that work by NHS England is now under way to assess the readiness of 24 neuroscience centres across the country. It is expected that the treatment will start to be phased in later this year and early next year, with an estimated 1,000 patients set to benefit across the first year of introduction. Overall, this will benefit an estimated 8,000 stroke patients a year and save millions of pounds in long-term health and social care costs—my hon. Friend was absolutely right to point out the rising costs to NHS England around this condition.

As the clinical director for stroke at NHS England has said, we are committed to fast-tracking new and effective treatments that will deliver long-term benefits for patients. For me, this treatment is just one example of many that we believe have the potential to tangibly improve patient care and to address rising costs.

[Maggie Throup]

Will my hon. Friend give way?

[Steve Brine]

I am going to press on, because we have to finish at a certain time, but I thank my hon. Friend for her contribution earlier.

Stroke services are an important part of the range of vital services delivered in the part of Essex represented by my hon. Friend the Member for Southend West. It is important that his constituents have the right access to the right care at the right time, which in this case means specialist acute and hyper-acute stroke units. As he knows, and as we have discussed in Adjournment debates previously, there is a lively debate in his local area about the best way to configure services in order to meet these needs. As ever, he makes a powerful case for Southend, which he says has shown itself to be both safe and effective, and I have no reason to doubt his word.

My hon. Friend’s second big question was about what we are doing to transform services. Sustainability and transformation partnerships are absolutely key in this regard. STPs cannot but help in improving stroke services; they have a huge part to play. STPs should bring the local population, NHS organisations and local authority bodies together to propose how they, at a locally designed level, can improve the way that their local health and care is planned and delivered. These local areas have been encouraged to take a collective view of the local health system so that they can explore how best services within the local area, including stroke services, can be streamlined and centred around the patient, and determine what configurations are necessary within each local area to deliver the best possible care. My hon. Friend’s description of turf wars does not surprise me, although it does disappoint me. If he wishes to raise anything specific with me, I ask him to write to me about it. As the Minister responsible for STPs, I do not want to see this happening, and if I can help with it, I will certainly do so.

Much guidance has been issued to the system from us at the centre to help support STPs in making these crucial local reconfiguration decisions. My hon. Friend’s associated STP, Mid and South Essex, is making good progress and has recently been rated through our STP dashboard as being in the top half, so it is a top-half-of-the-table team among STPs. Mid and South Essex’s stroke services compare very well with the best, in many ways, but, as he says, we could be doing much better. One area that it has identified for improvement is that none of the three existing hospitals currently has the right number of specialists to provide the level of specialist stroke unit care that is being proposed. That goes to the heart of some of the examples that he gave from the consultant he has been speaking to.

I welcome the fact that organisations within my hon. Friend’s area, and other STP areas across England, are working in partnership to develop proposals that can really benefit those who matter most—the patients. There are proposals currently out for consultation in his area, which obviously my hon. Friend the Member for Rochford and Southend East (James Duddridge) takes a very close interest in as well. I look forward to seeing the results of that consultation in due course. Knowing my hon. Friends, I feel almost certain that we will be back here discussing that at some point.

I mentioned the tangible progress that has been made in improving both the quality and delivery of stroke services, with evidence-based public health campaigns and really strong, well-organised local services, but there is so much more to do. Patient mortality has indeed fallen, compliance with the standards has risen, and patient experience and satisfaction continues to improve. This is a pathway on which I expect us to continue. New services that my hon. Friend is absolutely right to raise, such as mechanical thrombectomy, can really help us in achieving this. He said what a fascinating piece of medical technology that is. Putting the mesh into the groin for it then to travel through to have such an impact is truly incredible. We are very clever, in many ways.

How this is being delivered is changing, and that is important. The STPs are providing a new way of working. They can be controversial because they involve difficult decisions around reconfiguration, but they should involve local organisations, local services, local people, and local MPs. Local MPs who are not involved in their STPs should ask themselves why not. STPs, and the whole reconfiguration process, are a huge opportunity for us. Locally led commissioning enables local need to be taken into account in decision making about the shape of all services. It can result in very strong local services that can meet these needs, and nowhere is that more important than in stroke care. It is a system that drives improvement in all patient care, and that is what we are about. I thank my hon. Friend for bringing this debate to the House, and other hon. Members who have contributed.

Question put and agreed to.