Stroke: Aftercare

Rachael Maskell Excerpts

Wednesday 21st April 2021 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op) [V]]

Thank you for calling me, Sir Edward. I extend my gratitude to the hon. Member for Bromley and Chislehurst (Sir Robert Neill) and wish his wife well on her stroke journey. I was a physio in the NHS for 20 years and worked in stroke rehabilitation, so I obviously know this issue well from a practitioner’s point of view. I echo much of what I have heard in the debate as the reality of clinical practice. During the course of the debate, about 12 more people in the UK will have had a stroke, which is why urgency in getting things right is so important.

Public health measures are absolutely crucial, because smoking and poor diet and exercise contribute extensively to the risk of having stroke. Above and beyond that, once somebody has entered that journey, we need to make sure that they get the optimum care. In acute care, thrombectomy processes are improving people’s chances of good recovery, which is fantastic, but a significant postcode lottery still loiters around that, which we have to address.

My first question to the Minister is therefore whether, as the NHS goes through significant change over the next couple of years, integrated care systems will be charged to set up their own clinical networks for strokes and to ensure that they have the specialism for that acute phase of stroke placed in each one and also spread through the network. It is really important that we bring this to the fore, and that, as the NHS changes, we make sure that the right services are in place.

All too often, as patients were discharged from my care, I would fret about where they went. If they went to a specialist rehabilitation centre, I knew that all would be well, but if they went to a more generalist step-down facility, or were discharged into the community, without that specialist input—speech and language therapists, occupational therapists, clinical psychology as well as neuro physio—I would worry. It is a specialism in and of itself; indeed, neuro physio diverts into stroke rehab. Making sure that people have the up-to-date specialist skills makes all the difference. They take a long time to train, but they change the way somebody with a stroke is approached.

One challenge I always found was the pressure to get people out the hospital door and discharged quickly. To actually re-educate somebody’s mind and body to synchronise and work together in a new way takes time, and therefore ensuring that there is that investment in time is really important. We also cannot push somebody because they become tired, so we have this really delicate balancing act of timing.

It is different for absolutely every patient, but as they go through that journey, they need that specialist support. I will give an example. They may be discharged home, but we know that so many people, once they go home, will just sit in a chair, as opposed to carrying on their rehabilitation. Or perhaps, even when getting up from the chair, they will take the short cut of pulling themselves up, increasing their muscle tone, which is detrimental, as opposed to, say, using a proper Bobath method of facilitating their muscles. That makes a real difference how this issue is approached, and therefore the paucity of stroke rehab specialists must be addressed, making sure that that skill mix is there, but also with the right level of training. That is crucial.

I ask for more training around stroke rehab for GPs and in the community in particular. A community physio may deal with respiratory patients, musculoskeletal patients, neuro patients. We want neuro physios in the community through an extension of specialist rehab centres moving into the community while keeping that clinical case load. We also want the same clinicians along a patient’s rehab journey. It is not easy for clinicians to relay information about a patient simply, so following them into the community could be a different way of doing that as opposed to the silos of our institutions that we currently see.

One other thing is really important. We know that stroke is for life, and therefore we need to ensure that the services are there for a substantial amount of time. I have raised the issue of the six-month review, which is far too long to wait—an individual may plateau or even regress in their care. Regular intervention is really needed and, if someone has plateaued or regressed when they could have been progressing, they should be brought back into more specialist care, even if that is residential care, to help them take that step forward again and get that continuity that is needed. If we do not put in those interventions, clearly the impairments experienced by someone will deepen, which will create pressures that will show themselves elsewhere in the NHS or the social care system. Therefore, that investment is so important for people as they are recovering from stroke.

There is clearly so much to be done. I really welcome the call for an APPG and would be happy to serve on such a group should it arise, but as we are currently reimagining healthcare, this is a real opportunity to put the patient’s need at the centre of a stroke service and ensure that we sustain that for the rest of their life.