World Stroke Day

Rachael Maskell Excerpts

Thursday 23rd November 2023 Westminster Hall

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

Thank you for those kind words, Mr Hollobone. I will open by saying that I used to be a physiotherapist working in acute care, specialising in stroke care, so I bring other experience to the debate as well. I serve on the all-party parliamentary group on stroke, and I am indebted to the hon. Member for Bromley and Chislehurst (Sir Robert Neill) for securing today’s debate. We work assiduously on this issue here in Parliament, and it is so important for all our constituents. We believe there is real scope for change within the Government’s approach to help our constituents not only to prevent stroke, but to survive stroke, and to benefit from that.

As the hon. Member for Bromley and Chislehurst said, every single five minutes, somebody will experience a stroke. For some people, it will be brief—a transient ischaemic attack. For other people, it will clearly be very serious indeed, and for some people it will lead to mortality. To bring that home, during the course of the debate another 18 people will have experienced strokes. The urgency is now, and we cannot lose time. Over the course of a year, around 100,000 individuals experience stroke, but that means that 100,000 families also come into contact with the NHS. As a result, it is really important that the Government renew their focus. Although we welcome the major conditions strategy, it is simply not enough. Of course, the major conditions strategy is so major that the necessary focus needs to be brought to the fore. I suggest that we make 2024 a year of stroke, so that we really bring that focus down to deliver. If we had that focus across the system, we could make such a difference.

I will not go into all the statistics that my hon. Friend the Member for Bromley and Chislehurst did, but I just want to say that stroke is very avoidable. Of the people who experience it, 80% will have risk factors that can be controlled. We must talk about prevention. As a vice-chair of the Health and Social Care Committee, I must mention our inquiry into prevention in health and social care, which I am sure the Minister will pay much attention to. We must look at how we prevent individuals having stroke. Of course, we can undertake monitoring, for instance around blood pressure, with high blood pressure being an indicator and also atrial fibrillation. This is also about lifestyle choices; it is really important that we remember that smoking is still a major cause of stroke. We must ensure that individuals have early help, not least if there is a familial issue with stroke, to see how we can avoid that.

I also want to talk about health checks. It is really important to make those early interventions. We heard today about a 41-year-old who experienced a stroke, and one in four people who experience a stroke are under retirement age, so we must remember that it is often younger people who experience the need for this process. As a result, we should monitor people. The health checks that came in for those aged 40 are not often applied within integrated care board areas. We need a real sea change there, because monitoring things such as what is happening with blood pressure as early as we can, with really quick tests, can make a sizeable difference.

The Health and Social Care Committee has just returned from Singapore, where we heard about the early healthcare interventions being made there and, of course, saw the outcomes. If the Minister is determined to make a difference in his short time in the role before my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) takes charge, introducing those interventions to monitor what is happening could be a life-changer.

I also want to highlight how we need to respond. Response is too slow, and I want to challenge the system. For ambulances, a stroke is currently a category 2 call. I would like it to be made a category 1 call and the response expedited, because every minute that passes in the golden hour can make a difference to somebody’s future and whether they will experience severe disability—or, indeed, die—or receive interventions that could prevent such disability. Changing the categorisation would save both money and lives. It is important to look at that again. It could make a difference, not least because the time lags for the ambulance service on category 1 and category 2 calls at the moment mean that categorisations are insufficient to get patients to the right place at the right time in order to get the right interventions. I hope that the Minister will take that away and carry out some work in that area to expedite the process towards diagnosis and treatment.

I turn to diagnosis. In a country like Germany, individuals are diagnosed at the kerbside, at home, or wherever they have their stroke, and the process will start immediately. At the point that the patient is experiencing deficits—perhaps they are still going through a cerebral event—or as soon as the ambulance is called, the clock starts on the diagnostic process and then treatment. Using the best diagnostic techniques to scan at the kerbside, using AI to help, we know—[Interruption.] It looks like the Minister is in some pain; perhaps he needs my physio skills.

[The Minister of State, Department of Health and Social Care (Andrew Stephenson)]

Sorry; it is my shoulder.

[Rachael Maskell]

Being able to undertake the diagnostic process really early means being able to get the information into the stroke unit of the hospital as early as possible, so that when the patient arrives at the door, they are whipped through the system and interventions can start. The problem is that we have such a time lag that intervention is often too late. Will the Minister look at what is happening on a global scale with interventions that could really make a difference?

Of course, there are two types of stroke: some people have a cerebral bleed and some have an infarct, or a blockage, where the brain is starved of oxygen. As a result, different treatments are undertaken. There is thrombolysis, which is a medical intervention to blast a clot through, and mechanical thrombectomy, which the hon. Member for Bromley and Chislehurst talked about, where a wire is fed through the femoral artery into the brain, captures the clot and withdraws it. As a result, the brain can receive the oxygen it needs so that it does not experience the damage that we have heard about.

We need to increase the specialist interventional neuroradiologist workforce. It is a highly trained specialism; we need enough of them, and a sufficient supply. We should have a workforce plan for the specialism to ensure we are training sufficiently and expanding the workforce. In other countries, there has been a real increase in the number of people able to access this treatment. As we have heard, the average across the UK is 3.3%, but in other countries it is 10%. Not all patients can benefit from this life-saving treatment, but of those who can, only about a third get access to it.

We need to think about where the centres are based. It is important that they are in major centres because doctors need to do a lot of these procedures to be expert in them. We need people to be expert in them, but we also need more centres. I ask the Minister to look at the mapping of that, and at specialist commissioning through NHS England to ensure provision right across the country. Will he also work with the ICBs in this area?

We need a specialist workforce. It is positive that we are training more people in stroke specialisms, but in physiotherapy, for example, significant further training is needed on Bobath—a technique used in stroke rehabilitation—and we need to ensure that it is easily accessible. Other professionals do not get the same access to training budgets as medics, so there is often a lag in getting people through the specialist training that is needed. I ask the Minister to look at that to ensure that the workforce is trained in the best techniques to treat stroke, and to carry that specialism.

This is all about investing to save money, because the better the intervention, the better the outcome for the patient. We need physios, occupational therapists, speech and language specialists—there is a significant shortage of them—and clinical psychologists to work as a team around the patient. They often work together. To give hon. Members an idea of how long it takes, a physio can spend an hour a day with a patient, because they have to break down and rebuild their tone and spasticity, which takes time. But as they are sitting the patient up, the speech therapist often comes along and does a swallow test, and an OT may do some function work. That team needs to come together. Unfortunately, the gaps in the workforce mean that it is hard to have the quality of treatment that will benefit the patient, from the most acute phases of the stroke right through to rehabilitation.

Of course, we want patients to go to stroke units—specialist rehabilitation places—where they can benefit from therapeutic intervention and get the best outcomes possible to optimise their baseline before they are discharged back home. Being in that environment is really important, but at the point of discharge, after all that cost—we have talked about diagnosis, intervention and therapy—what happens? Well, experiences are very varied, and 45% of survivors feel abandoned, so we know something is going wrong. Individuals can easily lose confidence and function.

If an individual is on a pathway to a care home, the care home should be properly trained in supporting people who have had a stroke. Everything matters: the person’s positioning, how they lie in bed, how they sit in a chair and how their hand rests can make a real difference to their function, and their hygiene and personal care. It is necessary to ensure that, if they are mobilising, it has an impact. How patients are transferred can make a difference to those outcomes, so it is important that a person is discharged not just to a care home, but to a care home that has undergone proper training. If someone is moving to the community, we need to ensure that the family around them are trained in how to support them, just as carers who provide domiciliary care must be.

I want to pick up on what the hon. Member for Bromley and Chislehurst said about people seeing improvements in their baseline functioning. It is possible that individuals do and will. Through the process of neuroplasticity, a person’s brain changes and can make alterations and repair, so we need to ensure that, when somebody gets home, there is ongoing therapeutic intervention. It is easy to slip into bad ways and take shortcuts, which can undo some of that good work, and those interventions to top people up can make a difference and keep people functional, mobile and independent. If people miss out on those interventions, they will rapidly require more acute care.

I draw the Minister’s attention to that and ask him to look at the whole pipeline. The lack of support is clear: only 37% of patients got their six-month check last year, which is completely insufficient. We need the figure to be 100%, so there is clearly some work for the Government to do. We are talking about 40,000 people who missed out altogether, which affects ongoing care and support. In the same way that a cancer care navigator works with patients, we need somebody who co-ordinates care and individual support on the stroke pathway, as a permanent process.

As I have already said, we have an opportunity next year to make a seismic difference to individuals by focusing on stroke. I hope that the Minister will take that opportunity, with a laser focus on a new stroke strategy across the country. If he does not, I will badger my hon. Friend the Member for Denton and Reddish to take that on, whenever he gets the first opportunity. It is important that we do that.

Finally, research in this area could be improved, and investment in research is needed. As we have seen in recent times, investment in thrombectomy has been a game changer. It gives people who experience a stroke real hope. Other interventions can and will be made: we need to understand more about our brain health, therapeutic interventions, and how to use new technologies to help people to be independent and live full and comprehensive lives. I trust that the Government will look at the research base and at investment in research as an opportunity. I trust that they will also work with the voluntary organisations that work so hard in this area—they are real experts—to ensure that we have the best stroke strategy and stroke outcomes that any country could ever have.

[Mr Philip Hollobone (in the Chair)]

No Westminster Hall debate would be complete without a contribution from Jim Shannon.

--- Later in debate ---

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. Like others, I begin by thanking my hon. Friend—I will call him that, because we are friends—the Member for Bromley and Chislehurst (Sir Robert Neill) for securing this important debate to mark World Stroke Day. I thank him for not just his continued advocacy and the work he does here in Parliament, but sharing his personal experiences. On behalf of the whole House, we send our love to his wife and to him for the work he does to look after her.

We have had a small but perfectly formed debate. I want to thank my hon. Friend the Member for York Central (Rachael Maskell) in particular for her powerful contribution. She speaks with experience that I could only ever dream of; it is so important that her expertise, knowledge and past experiences should shape and inform the debate. I thank her for that. Likewise, I thank the hon. Member for Strangford (Jim Shannon) and the hon. Member for Motherwell and Wishaw (Marion Fellows), who leads on health issues for the SNP, for their contributions. We have had a good, thorough debate, covering a lot of issues. Hopefully we have marked World Stroke Day well in this place today.

It is stating the obvious to say that stroke can have a life-changing impact. As we have already heard, the statistics show that in the time we are here this afternoon, 14 people across the United Kingdom will have had a stroke—that is one stroke every five minutes. Although often a sudden event, the lasting impact of stroke for patients can be devastating. It is one of the leading causes of adult disability across the United Kingdom. Two thirds of stroke patients—let that sink in—will leave hospital with a permanent disability, often needing lifelong care. Sadly, stroke is often fatal, causing around 35,000 fatalities across the UK every year, making it the fourth leading cause of adult death.

What those statistics demonstrate to me is that however far we have come on the journey with stroke, we need more concerted action going forwards—not just from a patient care perspective, but given the significant impact that not acting on stroke has on the economy. There is an economic argument, not just a patient care argument.

I pay tribute to the work of the Stroke Association, which does incredible advocacy, campaigning and research in this area, as well as other organisations across the UK. Stroke Association research shows that by 2035, stroke is expected to cost the British economy £75 billion a year. That is up from £26 billion as recently as 2015—a rise of 190% in just two decades. Given the strain already on stroke pathways across our health and care system, that is simply unsustainable. The need is clear, and the need is now.

One of the issues holding us back in our fight against stroke is the workforce, as is so often the case and as we have heard today in other contributions. A well-skilled, well-resourced workforce is vital to saving lives and improving the outcomes for patients. However, for too many across the United Kingdom, the workforce is simply not there for them or not there for them in adequate numbers. Half of all stroke units across the country have at least one vacant consultancy post, with the average vacancy being left open for 18 months.

When it comes to thrombectomy—a life-changing treatment that can have a fundamental impact on patient outcomes, as the hon. Member for Bromley and Chislehurst set out—the postcode lottery for care only gets worse. A third of clinicians in this country who can perform thrombectomy are based in London. That is good for Londoners but not for other parts of the country. Given that speed of treatment is critical when it comes to long-term outcomes for strokes, this lottery facing so many people cannot be allowed to continue.

Further along the stroke treatment pathway, other issues persist. Only a quarter of community rehab teams and early supported discharge services are offering support seven days a week. That is not good enough. With patients waiting too long for treatment when they need it and too long for support in the community following treatment, it is clear that the system is broken. That is why I am proud of Labour’s firm commitments on giving our NHS the workforce it needs to get patients seen on time, by delivering an extra 7,500 medical school places, training an extra 700 district nurses each year and ensuring that at every stage of the treatment pathway stroke patients will have access to the care they need when they need it.

But there is so much more work we can do to break down the barriers that too many stroke patients face on their care journey. Breaking down those barriers will take innovation and all parts of the system to be pulling in the same direction. For stroke patients, that is exactly what is needed. Given the crucial role played by primary, acute and social care services in delivering positive, long-term outcomes for stroke patients, co-ordination is the key. However, in too many cases, that co-ordination is simply not happening, and patients are suffering as a result.

We have a primary care system with vast variety in detection of key stroke indicators, such as heart conditions, atrial fibrillation and so on. We have people not getting to the right place in hospital, with only 40% of stroke patients admitted to a stroke unit within four hours of arrival. We have a community care system without the resources it needs to deliver for patients, with the Stroke Association’s report about life after stroke highlighting that only 37% of stroke patients receive a six-month post-stroke review of their needs. It smacks of a system that is not working for anyone.

[Rachael Maskell]

My hon. Friend is making an excellent speech. When it comes to social care, people are often untrained and as a result could cause more harm than good if they do not know how to care for a patient who has had a stroke. Will he ensure that Labour discusses how it will train our care workforce to have the right skills to deliver ongoing care?

[Andrew Gwynne]

My hon. Friend makes an important point. Some of the discussions that I have had, including this week, with professionals in the care sector have been about how we upskill care professionals working in our social care system so that they are able to genuinely—in an integrated fashion, with the NHS—work in accordance with the interests of the person they are caring for and take that person’s needs as a whole. It is also important for these workers to have the professional development, and parity of esteem, terms and conditions and so on with the NHS, to be able to take on those extra responsibilities. My hon. Friend is absolutely right, and that issue is certainly on the radar of the shadow health and social care team as we develop our plans—not just Labour’s workforce plan for coming into government, but our plans on the road map to a national care service.

Whether it is by training more GPs to ease the immense pressure on our primary care system, by putting an end to dangerous hospital waits or through a 10-year plan for fundamental social care reform delivered in partnership with users and their families, Labour is determined to get the system working again. We are determined to build a national health service that is fit for the future, with a long-term vision for a national care service firmly integrated within it. Only by doing all that, getting it right and taking people with us on that journey can we deliver on our long-term mission of cutting stroke deaths by a quarter within the next decade. That is a mission. It is something we are determined to do, because at the heart of this are people’s lives and we want to ensure that we have in place the stroke services that patients deserve.