World Stroke Day

Robert Neill Excerpts

Thursday 23rd November 2023 Westminster Hall

[Sir Robert Neill (Bromley and Chislehurst) (Con)]

I beg to move,

That this House has considered World Stroke Day.

As ever, it is a pleasure to serve under your chairmanship, Mr Hollobone. I am grateful for the opportunity to raise this important topic. This year, World Stroke Day fell on 29 October. We had hoped to have this debate a little nearer to then, but the date we were originally given had to be vacated because of the Prorogation of Parliament. I am grateful to the Chairman of Ways and Means for so swiftly rescheduling it.

I refer Members to my interest as co-chair of the all-party parliamentary group on stroke. I am delighted to see one of the vice-chairs, the hon. Member for York Central (Rachael Maskell), in her place. I also declare a personal interest. My wife Anne-Louise suffered a stroke four years ago, as many in this House know. She made a courageous fight to recover, and I think we have discovered a number of areas where much more work needs to be done because stroke is very often, to a degree, a hidden condition. It does not receive as much publicity as heart attack or cancer, for example. Although we have made improvements and advances in recognising early stroke symptoms so that swift treatment can be given, the thrust of the debate is to say that much more needs to be done.

[Matt Western (Warwick and Leamington) (Lab)]

The hon. Member is making a powerful speech, and I appreciate his passion. He spoke of awareness, understanding and education about strokes. We need much more work on that; many people are unaware of stroke symptoms. They should be aware of what might be happening to a family member or friend before their very eyes.

[Sir Robert Neill]

That is right and that is why I commend the Stroke Association for raising awareness and recognition of symptoms. It promotes the Act FAST campaign, which details the symptoms that should be looked out for: if someone shows facial weakness, arm weakness or speech problems, then it is time to call 999. That has been important in raising awareness. I thank the Stroke Association for the briefing it has provided, as well as others who have assisted in the preparation of my comments, including the Royal College of Radiologists and, from the private sector, Ipsen UK, a biopharmaceutical company that works in this field. I will refer to its research.

The essence of the matter is this: stroke is not often recognised, but even when it is, the quantity is not talked about enough. In the UK, stroke strikes every five minutes and more than 100,000 people have strokes every year. It is a leading cause of adult disability; two thirds of stroke survivors leave hospital with a disability. Sadly, it is also a leading cause of death in the UK. Leaving aside the human cost, there is also an economic cost. Too many survivors are unable to return to work. A conservative estimate of the cost to the economy is some £26 billion a year. Some would suggest that it is even more. Never mind the care costs and the burdens on unpaid carers, which some of us know all too well.

Stroke is preventable. In about 80% of cases, it can be treated by changing risk factors, checking for high blood pressure and atrial fibrillation, but we still lag behind other countries on stroke outcomes. The Stroke Association told me that, for every minute a stroke is left untreated, nearly 2 million brain cells die. The brain is both extraordinary and fragile, which is why fast treatment and swift responses are so important. That means getting somebody to a specialist stroke unit as soon as possible. In Anne-Louise’s case, we were lucky that that was not far away, but sadly there will always be disability thereafter. However, that can be reduced through investment in treatments, such as mechanical thrombectomy. If a patient gets mechanical thrombectomy swiftly, their level of impairment is greatly reduced.

Sadly, access to mechanical thrombectomy greatly varies across the country. In Greater London, where my constituency is, the percentage of patients given a thrombectomy in 2021—there may be updated figures, but this is the latest one the Stroke Association had—was 7.8%. In the east of England, it was 0.3%. In most other parts of the country, it hovers around 2%. Even if that has grown somewhat, it is still far less than we would wish to see. I welcome the Minister and am grateful to see him in his place, and I am sure that he is aware that investment across the piece would greatly improve people’s outcomes. That needs to be mainstreamed into investment plans, and we certainly seek to do that. I hope the Minister will commit to removing that postcode lottery in survival according to where a person is when they have the misfortune of having a stroke. If we do not do anything about this, the cost I referred to is predicted to increase to about £75 billion by 2035. We cannot afford for that to happen, either economically or in human terms.

We have talked about prevention and thrombectomies, which can be a game changer, but we do not have anything like the numbers accessing them that other countries do and the figures are not in line with the Government’s own targets. Perhaps the Minister could tell us what is being done to catch up and spread availability across the piece, because at the moment only about a third of the people who need that treatment receive it. That is simply not good enough for the two thirds that were unlucky enough to be in the wrong place at the wrong time. That is important, but there is also the issue of the workforce. I am indebted to the Royal College of Radiologists on this point. Early diagnosis, of course, can help through either thrombectomy or other interventions, but we have a shortfall in the number of clinical radiology consultants of some 30%. They are needed to do the imaging—the MRIs and all the other things—that could enable those other treatments to take place swiftly. Without further action, that shortfall of consultants in radiology is forecast to increase to 41% by 2027—2,890-odd posts. What is being done to address the shortfall in that specialism and, indeed, others?

Only 48% of hospital trusts can provide adequate 24/7 interventional radiology services, largely because of that workforce shortage. I am sure the Minister will once again agree that that is not satisfactory. The use of interventional radiology—image-guided surgical treatments, effectively—is critical in the modern treatment of strokes. When we look at the national health service’s workforce plan, what are the plans specifically to recruit the workforce—the skilled specialists we need to support those new procedures, which will save lives and improve lives for survivors?

As well as the key issues of intervention and treatment, the other issue I want to touch on is what happens thereafter, because the outcomes can vary greatly. Some people, as we all know, are fortunate enough to be out of hospital quite quickly, whereas others—my wife included—spend much longer there. What troubled me was when Anne-Louise eventually left the rehabilitation unit in Orpington, where she had excellent care, we were lucky enough to be able to continue care at a proper level, through our own resources as a family. There was a young woman in there, probably in her mid-40s, who was a single parent. She lived on her own and had no one to take care of her. She was there before Anne-Louise arrived in the unit; she was still there when Anne-Louise left. What happens to someone in that condition is a real worry to us.

I am sure the Minister will rightly observe that the percentage of patients discharged into community stroke services has risen from 53% to 61% in 2022-23, but the quality and consistency of the community service provision is very variable. There are real shortfalls in the number of specialists—again—so we have a workforce problem in the community as well when it comes to physiotherapists, speech and language therapists and neuropsychiatrists.

We sometimes forget that, as well as the very real physical impacts of stroke—which can be a lack of mobility or balance, a level of paralysis, speech impairment and post-stroke spasticity, as it is called, which I will come back to in a moment—there is very frequently a degree of mental ill health associated with such a life-changing event. Many stroke survivors suffer from varying degrees of depression, and the lack of neuropsychiatrists and psychologists to assist them is very stark.

We know that nearly half of stroke survivors experience some degree of post-stroke spasticity within six months of having a stroke, and some will be classed as severely disabled. We then find that some 80% of survivors may develop it at some point unless they get that proper and consistent treatment. At the moment, we do not deliver the recommended levels of community care in the therapies, of all kinds, that are recommended by the nationally accepted guidelines. What is being done to improve that?

At the moment, in the community setting, post-stroke patients experiencing post-stroke spasticity may have to wait four to seven months to be seen for a multi- disciplinary-team assessment. That is far too long. I have a constituent who has been waiting for nearly a year to be assessed to receive the multidisciplinary treatment that she needs. Accessing that support surely should not be done on such a fragile basis.

Ipsen has recently published a report, “Neuro- rehabilitation: State of the Nation”, which discusses this issue. It found that there is a lack of foundational awareness about spasticity and that it is not picked up often or soon enough. In fact, there are issues with the sporadic nature of treatment and a five to six months average waiting time for spasticity services. One in four NHS sites in England do not have access to specialist services for spasticity—there are only 0.26 consultants per 1,000 in prescribed specialist services in England and Wales compared with two to three in most European countries. Something like two in three stroke survivors do not receive a six-month review of their care, and that is one of the fundamental targets set out in the national guidelines. If two thirds are not receiving it, then clearly something is failing us badly.

We would like the Government to designate stroke as a major condition, and they also ought to consider post-stroke spasticity management as an integral part of the major conditions strategy. Perhaps the Minister will take that away and consider it. What can be done to level up the commissioning and provision of those rehabilitation services? What can be done to look at the high-level priority areas for stroke research that have been identified? These are important matters and we would hope that that could be done. There are other things that I hope the Minister will take a look at. Can we continue to improve availability at community level? Can we ensure that everybody receives the treatment set out in the National Institute for Health and Care Excellence guidelines? As I say, at the moment we are falling significantly short.

In conclusion, having set out those points—I could go on for much longer if we wanted—I hope that my speech highlights some of the real areas of concern. I also want to say a word about the voluntary groups; most of us in the field have become aware of the work of the very well-established Stroke Association, but we have a number of other groups, and in some cases entirely survivor-led groups give each other mutual self-support without any support from public funding.

I want to pay tribute to one group—frankly, the one that helps my wife and that she has received a great deal of assistance from being a member of. It is called Sidcup Speakability Group, and, as the name implies, it operates in our part of south-east London. It is the group’s 10th anniversary, so I just wanted to put on the record what it has done. It works entirely off its own back, and the level of conditions that people have varies greatly. But it proves that there is willingness. It is also worth remembering, as any senior consultant in the field will say, that there is sometimes a myth that a patient gets to a stage where they can never improve any more. Obviously, a patient has the best improvement earlier on. That is why early treatment and interventions are so important, and why the waiting times are so unacceptable. But even if the rate might be less, if people work continually, gains can still always be made incrementally. That is what the people at Speakability have found. To do that, we cannot expect the burden to fall simply upon friends and families. We need specialist treatment to be consistently available. That can turn people’s lives around. In our case, it may not be enough to turn it around in time, but it will be for others. That will be worth our while. The more people we can get back into work, as they wish, the more people can lead enriching lives, to a greater or lesser extent, as many stroke survivors do. There is light at the end of the tunnel, but we have to give them those fundamental services to start with.

I am very grateful to the Minister for paying great attention to the issue, and I hope he will take away those specific asks. Perhaps he could keep in touch with us, as a group, on how we could roll out services much more consistently and give people the level of treatment they deserve. I know a number of us in this room have been affected by stroke within our families, and I think we all want to work together—there is no party political issue in this—to have a proper strategy to sort it out.

[Mr Philip Hollobone (in the Chair)]

The debate can last until 10 minutes past 3. I am obliged to call the Scottish National party spokesperson no later than 2.37 pm. The guideline limits are 10 minutes for the SNP; 10 minutes for His Majesty’s Opposition; 10 minutes for the Minister; and then Sir Bob Neill will have three minutes to sum up at the end of the debate. We have half an hour of Backbench time, and I have to decide which of two stellar Members I should call first. I will go on the principle of ladies first, but also because I understand that the hon. Member for York Central (Rachael Maskell) is vice-chair of the all-party parliamentary group on stroke, so is probably far more qualified to talk about these issues than the delightful hon. Member for Strangford (Jim Shannon).

--- Later in debate ---

[Sir Robert Neill]

It is good to see you in the Chair, Sir George. I warmly thank all hon. Members who have spoken. I am grateful to them for their support from both the Front and Back Benches. I particularly thank my vice-chairman of the APPG on stroke, the hon. Member for York Central (Rachael Maskell), whose expertise in this area is phenomenal.

I also thank the hon. Member for Strangford (Jim Shannon) for his characteristically compassionate remarks, as well as the hon. Member for Motherwell and Wishaw (Marion Fellows) and the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne). We all agree that we want better outcomes for people who suffer from this condition and that there are ways in which that can be done.

I look forward to working with the Minister, as do all the members of the APPG, and I am glad that he paid tribute to his Parliamentary Private Secretary, my hon. Friend the Member for North Norfolk (Duncan Baker), who was a driving force in setting up the all-party parliamentary group. I know that he will kindly and discreetly, but firmly, hold the feet at the Department to the fire on this matter. That will make our task easier.

I appreciated the references to some interesting developments. The pilot in Strathclyde, which the hon. Member for Motherwell and Wishaw mentioned, is particularly useful and interesting. In the short time I have left, I would like to mention one more—an online speech therapy app called Beautiful Voice. It has finished a useability pilot, and is run by a mixture of entrepreneurs, therapists and academics with virtually no Government funding, apart from sometimes a bit of research funding. From our experience as a family, it has been useful. Given the shortage of speech and language therapists, anything that can enable people to undertake therapy in their own home is something that I hope the Minister will look at. The Beautiful Voice app, which is available online, is delivered in conjunction with Hobbs Rehabilitation and the MiNT Academy, so there is an academic background. I hope the Government will try to find out more about that and get behind it.

With thanks to everyone, I hope that we continue to keep up the pressure. I know that it is not for want of intention, but the fact is that there is still a way to go to get us to where we want to be. If it can be done elsewhere, this is a classic case in which some investment up front—in thrombectomy, for example—and support for some of these therapies can save the country money in the long run. Above all, it can save human life and it can save and improve human experience, which is more important than anything. I am very grateful for the opportunity to debate this issue.

Question put and agreed to.

Resolved,

That this House has considered World Stroke Day.

Oral Answers to Questions

Robert Neill Excerpts

Tuesday 1st November 2022 Commons Chamber

[Maria Caulfield]

As the hon. Lady knows, there is an ongoing legal case about Primodos, but I am very happy to meet her and the campaigners because I am keen to hear their experience. Unfortunately, I cannot comment further while there is an ongoing legal case.

[Sir Robert Neill (Bromley and Chislehurst) (Con)]

I refer to my entry in the Register of Members’ Financial Interests. Last Saturday was World Stroke Day. Will my right hon. Friend the Secretary of State commend the work of the Stroke Association and its “saving brains” campaign? And will he meet members of the all-party parliamentary group on stroke to discuss how we can increase the provision of life-saving thrombectomy services across England and Wales?

[Helen Whately]

I am very happy to commend the work of the Stroke Association, and I would be delighted to meet my hon. Friend to discuss this further.

Health and Care Bill

Robert Neill Excerpts

Consideration of Lords amendments
Monday 25th April 2022 Commons Chamber

[Edward Argar]

The hon. Gentleman is right to highlight the work we are already doing, which I will address in a moment, and the number of nurses we have recruited. I believe we have now recruited 29,000 or so en route to our target of 50,000 more nurses by the end of this Parliament.

[Sir Robert Neill (Bromley and Chislehurst) (Con)]

Will my hon. Friend give way?

[Edward Argar]

I will make a little progress, if I may—a few more paragraphs—as I am very conscious of allowing time for Back-Bench colleagues to speak.

Building on this work, we recently commissioned NHS England to develop a workforce strategy. We will set out the key conclusions of that work in due course. In addition, we have committed ourselves to merging Health Education England with NHS England to bring together responsibility for service, financial and workforce planning in one organisation. We will continue to grow and invest in the workforce. There are record numbers of staff, including nurses, working in the NHS.

[Sir Robert Neill]

I am grateful to the Minister for giving way. He will know of my interest as chair of the all-party parliamentary group on stroke, and he will be aware of the particular concern of the Stroke Association and others about the number of qualified therapists to provide the therapy people need after a stroke. Will he commit himself to that being part of the workforce strategy and to moving swiftly? This is already a pressing problem for stroke survivors who are not getting the care they need.

[Edward Argar]

I reassure my hon. Friend that my right hon. Friend the Secretary of State has made it clear that he wishes the whole health and care workforce landscape to be considered by Health Education England.

The growth in our workforce comes on the back of our record investment in the NHS, which is helping to deliver our manifesto commitments, as I said to the hon. Member for Strangford (Jim Shannon), including our commitment to 50,000 more nurses by the end of the Parliament. The spending review settlement will also underpin funding for the biggest ever intake of undergraduate medical students and nurses.

Although I might not be able to say anything sufficient to fully convince my right hon. Friend the Member for South West Surrey (Jeremy Hunt), I put on record my gratitude to him not only for the insight, expertise and knowledge he has brought to our debates on this issue but for the typical courtesy he has displayed throughout our interactions and conversations. I do not know what he will say in a moment, but I have tried to pre-empt him. I hope that he may be tempted to stick with it.

I hope that the House will recognise that the Government are already doing substantial work to improve workforce planning, and that placing a requirement such as Lords amendment 29B on the statute book is therefore unnecessary.

Covid-19: Deteriorating Long-Term Health Conditions

Robert Neill Excerpts

Thursday 10th March 2022 Westminster Hall

[Sir Robert Neill (Bromley and Chislehurst) (Con)]

I beg to move,

That this House has considered people with deteriorating long-term health conditions during the covid-19 pandemic.

It is a pleasure to see you in the Chair, Mrs Cummins. I thank the Backbench Business Committee for allowing time for this debate on what I believe is an important topic: dealing with the deterioration in people with long-term conditions during the covid-19 pandemic. On several occasions in Westminster Hall and the Chamber, we have discussed the various impacts of the pandemic on the health service and various sections of society, but this issue has not been highlighted before, so I am grateful for the opportunity. I thank hon. Members who have supported the debate.

It is worth remembering that we are dealing here with a range of conditions, and I refer to my entry in the Register of Members’ Financial Interests. As Members know, I have a family interest in rehabilitation for survivors of stroke, which I will certainly touch on. However, we are not simply talking about stroke. There are many other conditions that affect people, including cardiovascular conditions, neurological conditions such as multiple sclerosis, and cystic fibrosis—to name but a few. They have all been affected in one way or another by the consequences of the pandemic. That is why a number of the organisations who support people with such conditions—I am grateful to various charities, to which I will refer in a moment—have come together to assist us in bringing together some information for the debate, which we think needs greater public airing.

There are hundreds of thousands, if not millions, of people in the UK with long-term conditions, which range from stroke and dementia to Parkinson’s and spinal injury. They have all been particularly affected, and often acutely affected, by the pandemic. Sadly, some people have lost their lives during the pandemic, and we must be honest and recognise that. Some people may be clinically vulnerable as a result of their condition. In other cases, people will be more vulnerable because of other factors that are linked to their condition. In both circumstances, however, they have suffered because of the effects of the pandemic, and we need to turn that situation around.

We all know that, for many people in society, the lockdowns and other restrictions that we had to have meant social isolation and the suspension or adaptation of things that they were used to doing. However, the pandemic has had a much greater impact on people with long-term conditions than on the rest of us, because it meant missing out on crucial support from informal carers—the family and friends who come in and help—and fewer opportunities to use the cognitive, physical and social abilities that are so important for rehabilitation. Trying to keep one’s mobility going is one example. If someone is unable to do that for a number of months, it is inevitable that the situation can deteriorate and the adverse effects of the condition progress. That is a real and measurable impact.

Some conditions are progressive, meaning that they get worse over time, whereas others are not. However, even where they do progress over time, it does not mean that the level of progression of the condition cannot be arrested and delayed with support and therapy. It can make a difference for everyone.

Of course, there is an impact on mental health as well as physical health. For example, the Stroke Association’s research suggests that 69% of stroke survivors feel more anxious and depressed than before the pandemic. Similarly, people suffering from MS and other neurological conditions have found it tougher during the pandemic. Some 29% of people with MS have had appointments cancelled or delayed, and 53% said there had been a reduction in specialist support.

The British Heart Foundation has raised particular concerns, to which I am sure we will return, about delays in diagnosis and treatment for people with heart conditions. That includes preventive measures—diagnosis and then drugs that can prevent worsening cardiovascular conditions.

The situation is similar, too, for people in the UK living with cystic fibrosis. It is a smaller number—some 10,800 in the UK—but again, they are particularly vulnerable. Many found that specialist staff with respiratory expertise were being redeployed elsewhere, which created challenges for the specialist units dealing with them. People have had real difficulties right across the board.

The pandemic also meant the suspension of many community rehabilitation services. That is important, because those services are often delivered by a range of therapists. In the case of stroke, for example, that will involve physiotherapists, speech and language therapists, clinical psychologists and occupational therapists. For other conditions, people will have dieticians, podiatrists and others. Community rehab services underwent an enormous change in the pandemic, and with many staff being redeployed elsewhere, we need a strategy for getting them back. We need a strategy right across the piece for recovery from the pandemic in relation to these long-term conditions. I have made calls in this House in the past for a long-term strategy and plan to deal with stroke, but the same applies to many of these other conditions too, and they all ought to be linked together.

In the case of stroke, about half of stroke survivors had therapy appointments or home care visits cancelled, and of course many people—this applies to other conditions too—felt unsafe going into hospital for appointments, so we need to be catching up fast. Virtual therapy can work in some cases. For example, my wife’s speech and language therapy was able to be done online to some degree, but she cannot do the physiotherapy online in the same way, which leaves a significant gap. If I may, I will start with stroke and then move on to the other conditions, simply because stroke is the one that I am most familiar with.

The rehabilitation for stroke survivors is just such an important part of the pathway. We sometimes think of it as something that happens only in the first weeks and months after a stroke. That is not the case. Research increasingly shows that, with good rehab, people can continue to improve over a significant number of years after their stroke. Unfortunately, we are not delivering the level of services for the length of time that we would wish and that the Government want to deliver them for. NHS England’s national stroke service model outlines the aspiration for all stroke survivors to receive rehab support for as long as they can benefit from it. It should not be time limited but, as of April 2021, 58% of services were time rather than needs based. That does not seem to have improved; the situation has been made harder by the pandemic.

Of course, not only is rehabilitation important for the individual’s quality of life but it makes a cost saving. If we could get more people on the stroke pathway receiving early supported discharge rehabilitation, that could save about £1,600 over five years. That may not seem a vast amount, but when we think about the significant number of stroke survivors in this country, it is a really worthwhile saving, even in relation to that one condition.

We have done great work in improving acute stroke care, but what we have not done at the same pace is keep up with the rehab and life after stroke. That has been the Cinderella end of the service, and I think that that is true for many other conditions too. There was a lack of consistent provision even before the pandemic, and unfortunately the pandemic has made that situation worse.

I will quote one stroke survivor’s carer referring to what happened after their family member’s stroke in early 2020:

“My mum has severe dysphasia and with no speech therapy for 5 weeks while with me, and limited speech therapy while in hospital, her progress is not what it should be. This is severely impacting on her recovery and wellbeing.”

I know personally the importance of consistency in speech therapy and other matters. A stroke survivor says:

“I have felt my mobility worsen as my usual exercise activities were not available”.

Nobody disputes that some restrictions were necessary. What I am saying now is that we need to have an urgent plan, with funding behind it and a set of measures and goals, and a means of measuring attainment of those goals, to ensure that we catch up across the piece.

The latest snap figures suggest that we are struggling to meet even our own aspirations. Just one third of community rehab teams meet treatment time targets. Over 43% have waits of 15 days or more and, alarmingly, stroke survivors wait, on average, 10 weeks to see a psychologist. One of the things that people really do not appreciate about strokes is the significant psychological impacts that can occur. Unless we get the psychological issues resolved as best we can, that has an impact on the survivor’s ability to get the maximum benefit from the other therapies available. That is why it is really important. There is a real opportunity to join those various things together, to allow people to regain the skills that they have lost, and to hone and keep the skills that they retained after their stroke, or other condition. That would bring both social and economic benefits for all.

Community rehabilitation services for all these conditions have been hugely overstretched. Just 17.3% of stroke patient received the guideline recommended levels of support in 2021. We have discussed in the House before the real problem with a workforce strategy. Allied health professional representative bodies have all said that they are willing to step up to the plate, but they need the numbers. It is particularly difficult to get speech therapists, neuro- psychologists and so on. We need to do more on that.

I recognise that the Government are doing a lot more to improve things in many areas of the NHS, but we need to do that on rehabilitation as well. In addition to the other benefits that I listed, rehabilitation ultimately means fewer visits to GPs, less delayed discharge, and less demand, in the end, for acute care in the health sector and for social care as people get older and struggle with other issues. It reduces demand right across the piece.

The 2021 paper “Moving forward stronger” had contributions from some 20 charities and professional bodies representing a range of conditions. It was headed up by the Alzheimer’s Society, which called for a fully funded national rehabilitation strategy to run for two years, and for the NHS to appoint a national clinical lead to implement it. I welcome the fact that NHS England has appointed Jennifer Keane as its first director of rehabilitation. That is good news. The devolved Administrations do not yet have one; I hope that they will soon follow that example, and that this debate will enlighten some of the priorities that I hope the new director will have in drawing up her programme of work. We ought to have strategies for rehabilitation in local areas, as well as at a national level, to ensure that things are delivered on the ground. We have part of it but, although we have the director, we do not as yet have the strategy for her to work to and implement. That is the bit that I hope the Minister will assure me is coming next.

I referred to strokes, but I will touch briefly on some other conditions. I mentioned MS, which affects about 130,000 people in the UK. If we look at neurology overall, about one in six people in the UK is living with a neurological condition of one kind or another. Again, management throughout the pathway can really improve outcomes for people with those conditions. I mentioned the number of MS appointments that were cancelled. One in four people surveyed by the MS Society had not seen an MS nurse or neurologist in the past 12 months but needed to, so there is a glaring gap in provision.

I talked about a workforce strategy. Here is another area of the workforce. Adjusting for population, France and Germany have over seven neurologists for every two in the UK. We need to up recruitment into those specialist skills. That is a significant difference from our two largest and nearest comparative western European advanced economies. There should not be that level of divergence between us and France and Germany.

An audit of 51 UK MS services in 2020—while the pandemic was going on, but before the whole consequences had worked their way through—found that, on average, neurologists had caseloads of 1,815 patients with MS. The recommended caseload is 615, but the average caseload is nearly three times that recommendation, demonstrating the need to redouble our efforts on workforce. Some 64% of professionals said that it was not only recruitment that was an issue, but also staff leaving the neurology workforce. We need a strategy for recruitment and a strategy for retention.

For stroke services, when my wife was in the rehab unit, we could see quite a marked turnover of staff. They were good people, but we were unable to keep them, unfortunately, even in a trust with a specialist unit and rewarding work, very close to London. The situation is probably even harder in other parts of the country.

For many people with cystic fibrosis, the isolation has been particularly acute, because of their particular vulnerabilities. They had to shield as they were at acute risk. That has made it harder to bring forward their return into society. The Cystic Fibrosis Trust awarded 713 covid-related grants between April and September 2020, including 101 due to loss of work, and 96 due to financial difficulties, because people were unable, due to the need to shield and the lack of support, to carry on as they were otherwise doing. We cannot condemn people to that twilight situation for very much longer.

Finally, I turn to cardiovascular conditions. I am plucking out only four conditions, but there are others. We could talk about Alzheimer’s and dementia, and many other things—perhaps other hon. Members will.

The British Heart Foundation suggests that in the first year of the pandemic England saw around 5,800 excess heart and circulatory disease deaths—some because of medical factors, but some because of the difficulty in getting acute treatment. Beyond that, there are 61,000 people in England who had been waiting more than six weeks for an echocardiogram—a heart ultrasound—at the end of November 2021, which is 20 times than before the pandemic. The Minister may have more up-to-date figures, and I hope she will be able to tell us that they are coming down, but, if not, we need a strategy to make that happen.

Analysis from the Institute for Public Policy Research found 470,000 fewer new prescriptions of preventive cardiovascular drugs were issued between March and October 2020 compared with the previous year. That potentially translates into 12,000-odd extra heart attacks over the next five years or so that might otherwise be preventable. If people are not diagnosed and given the preventive drugs, the risk of acute attack becomes that much higher.

NHS England’s statistics show that the number of people in England waiting more than six weeks for a diagnostic echocardiogram had climbed to 64,962—very specific—at the end of September. The key point is that that is 44% of those waiting. The number fell slightly by November, to 61,000, and I wait to see how much more it has fallen by now. At the end of February 2020, there were 3,238 people waiting. That is a massive jump, demonstrating the scale of the mountain we have to climb to get back to where we are before the pandemic. At the end of December 2021, in all, some 300,000 heart patients were waiting for care of one kind or another, be that emergency, urgent, elective or routine, in so far as anything is routine in such treatment, and some 29% had been waiting for more than 18 weeks.

I know the Government do not want that to be the case. They have real ambitions to reduce such waiting times, as I think all parties in this House do, but the point of this debate is to highlight how significant the issue is to make sure it is no longer the bit of the health service that gets forgotten about because it does not grab the headlines in the same way that waiting lists for acute care, operations and other things do. It is just as profoundly important for people’s lives, the lives of their families and for the community as a whole. That is why I am grateful for the chance to raise these issues.

I hope the Minister will respond and set out what the Government intend to do by way of a specific strategy and set out a timeframe, its objectives, how it will be implemented, how its success will be measured, how it will deal with the workforce, and how funding will be made available. I hope that we will have a useful debate going forward, Mrs Cummins, and I am grateful for the time to put these matters before the House.

--- Later in debate ---

[Gillian Keegan]

I thank the hon. Gentleman for his intervention and I am very happy to respond by letter. However, I do know—I have had conversations about it—that these prioritised electives will be prioritised. Somebody whose sight can be saved through an operation would, I imagine, be a key priority for our NHS colleagues.

At the October 2021 spending review, the Government announced a further £5.9 billion of capital funding to support elective recovery, diagnostics and technology. That funding will drive investment in technology to improve patient experiences of care and help patients manage their experience.

The NHS has been working on rolling out 44 community diagnostic centres, which will massively increase diagnostic activity. As we take the road to recovery, we are also reforming and transforming how care and health services are delivered for patients, including through dedicated surgical hubs and more convenient and efficient community diagnostic centres.

Finally, I want to thank hon. Members for the points that they have made in the debate.

[Sir Robert Neill]

I am very grateful for the Minister’s detailed response and for her commitment to trying to improve these matters. She referred to a delivery plan for recovery of elective services, but is not the logical thing to ensure that the voice of those with long-term needs and of rehabilitation is not lost, and that we also have a specific delivery plan for rehabilitation and for catching up on the backlog? I did not hear mention of that. Are we going to have that?

[Gillian Keegan]

I mentioned the work that Jenny Keane will be doing following her recent appointment. She will be responsible for work on rehabilitation and discharges, as well as other areas covered by NHS continuing healthcare and the better care fund. That work is ongoing but does not include a specific commitment at this point to a strategy, as outlined.

[Sir Robert Neill]

Can the Minister tell me why not?

[Gillian Keegan]

I think it is only fair to say that, obviously, Jenny Keane has just started her work in this area—it is very new—but I know that she will be dedicated to ensuring that we make progress on the plans that I have set out. I hope that they reassure hon. Members that we will continue to support people who are living with long-term conditions and, by learning the lessons from the pandemic, ensure that they have access to the right services, at the right time, to enable them to live the fullest and happiest life they can. A lot of work is ongoing. We need to get behind that work and, obviously, support the team who are looking to deliver it. I thank everybody very much for their contributions.

[Sir Robert Neill]

I am very grateful to all those who participated in this debate, from both the Front and Back Benches, for the tone of the debate and their contributions. I particularly appreciated hearing about the personal experience of the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne). All of us bring our experiences to bear on these matters, and that is hugely important.

I welcome the Minister’s commitment—I do not doubt it—politically and personally. I am glad that we have a director in place. May I just gently say that perhaps the first task that the director should be given is actually to produce a strategy? A number of excellent initiatives have been referred to, but we need something to pull them all together and join them up. The Minister knows as well as I do that the way government works is that if we do not have something that gives us a proper framework and a proper set of measures to deliver on and something to hold people’s feet to the fire with—even for those with the best of intentions—things do get lost, so I urge her to take away that message. With the director, one part of the solution has been put in place, but we need a framework and a strategy for that director to work to. I am sure that many of us here today will happily work with the Minister, her officials and the NHS to help to deliver that. But I hope that she will not think that that is enough—there is still more to do.

Question put and agreed to.

Resolved,

That this House has considered people with deteriorating long-term health conditions during the covid-19 pandemic.

Mental Health Act 1983: Detention of People with Autism and other Lifelong Conditions

Robert Neill Excerpts

Thursday 20th January 2022 Commons Chamber

[Sir Robert Neill (Bromley and Chislehurst) (Con)]

I am grateful to my right hon. and learned Friend for giving way, and for the passion and knowledge that he brings to this topic. He refers to out-of-date legislation and how things have moved on. He will know from his experience as Justice Secretary that if we thought that we were applying the same regimes in terms of detention and use of restraint to people who had been convicted of offences after the passing of 60 years, we would rightly be outraged. Should we not be rightly outraged now that this is being done to people who have committed no offence and have not had the protection of due process that those going through the justice system have?

[Sir Robert Buckland]

I have good news, because it is Government policy to update the Mental Health Act. That is the plan that I and others, when I was in Cabinet, agreed on and I know that it is what the Minister will speak about. Reforming the Mental Health Act is Government policy because, goodness me, we have work to do. Between 2006 and 2016, the number of detentions rose by a staggering 40%. We owe thanks to the work of people such as the outstanding Sir Simon Wessely, whose independent review in 2018 gave the Government the clear course that I know they are adopting and following.

I particularly welcome the disaggregation of autism and learning disability from mental health in law and the end to their being classed as a mental disorder under section 3 of the existing Act. According to the Government’s policy, there has to be a clinically established concurrent mental health condition before detention can be allowed, and there will be a 28-day limit. All that makes immense sense, and I particularly look forward to the Government’s introducing a statutory duty to provide adequate community-based services, such as supported housing. In the White Paper that the Minister introduced before Christmas, we saw really healthy and useful reference to supported housing. It is my belief that, without that, we cannot create effective community-based services.

We still do not have a fully clear picture of the current commissioning landscape across England, but we know that people are being left in NHS-funded detention, because the lack of resources for local government means there just are not enough local government-commissioned community services for people to go home, back to their families and back to their local areas. Legislative change cannot come soon enough, so I would be extremely grateful if my hon. Friend the Minister could confirm the Government’s intention to bring forward that legislation, whether it will be first via the pre-legislative scrutiny process and, if so, when we can expect its introduction.

As time is short, I want to speak briefly about the Transforming Care agenda. We know that, when all agencies work together at the same pace, it is excellent, but the trouble is that we still have agencies dragging their heels or causing problems that mean people are spending longer in detention than they need to. The readmission of patients who are being discharged is another depressing example of our failure to break the vicious cycle in many cases.

We know what “good” looks like; we have the NHS England “Building the Right Support” service model and National Institute for Health and Care Excellence guidance. We know that there are pockets of good practice that the Government are actively promoting and supporting, but more needs to be done to join that up. If we are to see these figures starting to come down, consistent with the Government’s own priorities, the time for action is now.

There are, therefore, two things that the Government can do. They can not only bring forward the legislation, but fulfil their pledge to add more substance to the strategies they have outlined. The £74 million, pledged in the 2020 Budget to help with what are known as the double running costs when people with a learning disability or autism are discharged into the community, is extremely welcome. I know there are funding commitments in the NHS long-term plan to help the development of community support. However, as the recent Health and Social Care Committee inquiry noted, we still are not in the place we need to be. We still do not have that level of support that will make the discharge of patients a much more seamless and successful process. I know that ending those perverse incentives and this artificial division between the NHS and local government is part of the integration agenda, and I look forward to the White Paper that my hon. Friend will be publishing very soon, but I want everything to be joined up, in a way I was acutely conscious of when I was Justice Secretary.

I will end on this note: I was acutely conscious of the need for greater speed when it came, for example, to the approval of the recommendation of clinicians, which was the responsibility of my Department. Prior to the onset of covid, I collaborated directly with the then Health Secretary to jointly pursue the Mental Health Act reform agenda. My abiding regret is that I was not able to do more, and I want to say that I am sorry that I was not able to do more, but here I am in my place asking my friends to carry on the work, to pick up the ball and to take it further for all the people we represent and their families. By calling this debate and by making that direct request to Government to act, I hope that together we can make the necessary changes and save lives.

Oral Answers to Questions

Robert Neill Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Sajid Javid]

I am sorry to hear about the hon. Lady’s constituent, and of course a Minister will meet her.

[Sir Robert Neill (Bromley and Chislehurst) (Con)]

T10. I refer to my interest as chair of the all-party parliamentary group on stroke and as the husband of a stroke survivor.Mechanical thrombectomy can be a game-changer for sufferers of strokes, greatly reducing the levels of disability they are left with. NHS England committed itself to a full roll-out of mechanical thrombectomy availability by 2022, but we are lagging seriously behind. Where are the plan and the investment to bring the programme back up to date and on track?

[Maria Caulfield]

I know that my hon. Friend has a personal interest in improving stroke services. I can reassure him that the national stroke service model was published by NHS England and NHS Improvement in May this year, and that as of 1 April there are 20 operational integrated stroke delivery networks, bringing together key stakeholders to improve the diagnosis, treatment and rehabilitation of those who have suffered a stroke.

Health and Care Bill

Robert Neill Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Matt Hancock (West Suffolk) (Con)]

rose—

[Sir Robert Neill (Bromley and Chislehurst) (Con)]

rose—

[Edward Argar]

If I may make a little progress, I will then give way to my former boss, the former Secretary of State, and then, if I have time, to my hon. Friend.

To reiterate, as my right hon. Friend, the Prime Minister, said on 7 September, nobody—nobody—will be “worse off” than under the current system. Currently, around half of all older adults in care receive some state support for their care costs. This will rise to roughly two thirds under these reforms. This clause would also make a number of minor technical amendments to other sections of the Care Act 2014.

--- Later in debate ---

[Edward Argar]

I am grateful to the former Secretary of State. He is absolutely right. We deal in the reality and we should compare the reality of the system that we have in place now with what we have proposed here, which not only moves us forward, but is funded and sustainable.

[Sir Robert Neill]

Can my hon. Friend help me on two short matters? Can he give us an assurance that there will be no adverse impact on local government financing in relation to this, and that he will talk to the Local Government Association, if necessary, in this regard? Secondly, he says that it is part of a package. My right hon. Friend the Member for Ashford (Damian Green) referred to the impact assessment. Does he agree that it is only fair that, at the very least, we have an impact assessment before the Bill completes its passage through both Houses?

[Edward Argar]

Yes, of course, as we move through this reform process, it is absolutely right and vital that we work with our partners in the Local Government Association and local authorities of all political complexions. In respect of the impact assessment, I do believe that it is important that we have an impact assessment before this legislation completes its passage through both Houses.

Autism and Neurodiversity Research Funding

Robert Neill Excerpts

Tuesday 16th November 2021 Commons Chamber

[Simon Hoare (North Dorset) (Con)]

rose—

[Sir Robert Neill (Bromley and Chislehurst) (Con)]

rose—

[Robert Buckland]

I will let my hon. Friend the Member for North Dorset (Simon Hoare) in first before my hon. Friend the Member for Bromley and Chislehurst (Sir Robert Neill).

[Robert Buckland]

I am very grateful to my hon. Friend. There is no doubt that covid has had an impact on backlogs in all parts of the health system, including diagnosis. Having said that, there are significant advantages in the use of remote technology for people with autism and brain conditions. For them, very often the journey to a clinic, hospital or health centre is in itself traumatic and anxiety forming. I see remote technology as a real liberator for many people with autism, so the potential there is immense.

Sadly, the point my hon. Friend makes about the impact of covid is one that, without increased capacity and increased staffing, we will have to wrestle with for a number of years. On the point he makes about joined-up Government, I well remember saying on many occasions to anybody in Government who wished to listen that Justice could not do this on its own. As a downstream Department, it needed Education, Health, the DWP, the Ministry of Housing, Communities and Local Government and, frankly, all arms of Government to work together to identify some of these problems at the root to prevent them from becoming part of criminal justice, but I will speak more about that in a while.

[Sir Robert Neill]

My right hon. and learned Friend is making the case most powerfully and demonstrating, as other hon. Members have said, why it is a tragedy that he is not still on the Front Bench.

I welcome the very significant initiative that my right hon. and learned Friend made in relation to this when he was the Secretary of State—something that, as he will know, the Justice Committee warmly welcomed. Does he agree that it is very important now that we maintain the momentum for this, and in particular that the moneys available to the Ministry of Justice in the spending review are put into important areas of this system that for too long, until his work, were overlooked?

[Robert Buckland]

I am very grateful to my hon. Friend the Chair of the Select Committee. It was encouraging to see that the revenue settlement for the Ministry of Justice over the next three years was a pretty good one, with a just over 4% increase year on year. Obviously, it is now going to be for Ministers, in their allocation process, to work out precisely what they want to spend within that envelope. I very much hope that the announcements we made as a result of the call for evidence—published as part of the autism strategy document in late July, which I cleared together with my right hon. Friend the Secretary of State for Health—will be followed through on.

More than that, it became increasingly clear to me, as I read the response to the call for evidence and as I followed the debate, that screening people coming into the criminal justice system and the prison system is an essential prerequisite of understanding the best way to handle them. I think a screening process for brain condition would reveal acquired brain injuries. It might reveal an undiagnosed condition—maybe attention deficit hyperactivity disorder, attention deficit disorder, dyslexia even. Let us do that at this stage and work out what is going on in people’s minds, so that we can not just better manage them, but actually help them along the path of rehabilitation.

Do you know, Madam Deputy Speaker, that my worry is that, time and again—not just in the prison system, but in the probation service—regimes are set up and orders are made with the best of intentions, and the people with these conditions are set up to fail, because they are not able actually to access, understand or compute that in a way that perhaps neurotypical people can? That is not their fault; it is a fact of who they are and what they are. That is why we need to change the approach that we take. I do not want to see people set up to fail. I certainly do not want excuses for criminal behaviour, but I do want smart answers on ways in which we can meaningfully rehabilitate people. I have seen it happening. In Parc prison—a private prison, I have to say to those on the Labour Benches—in south Wales I was awestruck by the work being done on the neurodiversity wing. Prison officers trained in the right skills were working with some of the most difficult and complex prisoners in that estate and achieving results that might not to the naked eye look terribly remarkable but which, by the measure of the people they were dealing with, were extraordinary. We need to replicate that sort of work, which is being done in one corner of the estate, across the entire prison estate.

The wider debate is all about replicating the best practice we see across Government and local government, and across private enterprise and business as well, because I do not want this debate to be just about what the Government can do—me with my metaphorical hand out, saying, “More money please.” This is about society realising that if we are going to crack the issue and make a difference, we need carefully targeted research into what works.

Covid-19 Update

Robert Neill Excerpts

Monday 14th June 2021 Commons Chamber

[Matt Hancock]

The hon. Lady shakes her head, but it is a matter of fact that supply has been the rate-limiting factor throughout. We will do everything we can to support vaccination using the doses that we have. As she well knows, the UK, thankfully, is right at the front of the global race to get vaccinated, and that is because we bought early in very large bulk. Of course, we have worked to make that supply as big as possible as fast as possible. We go as fast as we can, but we cannot go faster than we can.

[Sir Robert Neill (Bromley and Chislehurst) (Con) [V]]

Thank you for calling me, Mr Speaker, and for what you have said tonight as well.

Has my right hon. Friend not recognised that just a few weeks—or “a little longer” in the Prime Minister’s parlance—make the difference between survival or closure for some businesses? Will he recognise therefore that forcing businesses to remain closed for a further period without financial support being extended for the same period is unjust, unconscionable and unsupportable? Will he take that back to the Chancellor and the Prime Minister, please?

[Matt Hancock]

I happily will, but I urge my hon. Friend to see the financial support that is in place and continues to be in place, most of it through to September. It was extended over that period in case we had to make an extension to the road map, and while I fully understand the impact on business—of course I do—I also can see the impact on saving lives. The advice is that this change will save thousands of lives because the protection of the vaccine, especially against dying of covid, is very, very strong, but the vaccine coverage is not yet comprehensive, especially with those second doses, so we need to get that done.

Covid-19:International Travel

Robert Neill Excerpts

Monday 24th May 2021 Westminster Hall

[Sir Robert Neill (Bromley and Chislehurst) (Con)]

It is a pleasure to see you in the Chair, Ms Fovargue, and I congratulate my hon. Friend the Member for Don Valley (Nick Fletcher) on securing this important debate.

I very much agree with many of the observations that have been made by hon. Members from different parties. There is an important message that the Government have to grasp and be honest with the public about: if there is a point in the vaccination programme, it is to save lives and to enable a safe return to normality as swiftly as possible. International travel is a part of normality, be it for family reunions, as has been eloquently said—many of us will know it from our constituencies—for tourism or, importantly in constituencies such as mine with a big financial services sector, for business. Nor should we forget cultural and educational exchanges. We must have investment and a clear strategy for getting back safely to that normality. I am grateful to the 220-plus constituents of mine in Bromley and Chislehurst who for a number of reasons signed the petition.

I appreciate the point made by the Chairman of the Select Committee, my hon. Friend the Member for Bexhill and Battle (Huw Merriman). First, we must say that we do not demonise those who seek to go on holiday; secondly, we must give real recognition to the value of the sector to the economy; and thirdly, we must be prepared to invest in technology. I am glad he picked up on the point about the investment in Border Force and the border.

A constituent of mine who works in the travel sector was made redundant and has now set up a small business herself. She is one of the 60%+ people who were working for travel management companies and have been made redundant since the pandemic. In her endeavour to get back on her feet, she points out the very good work being done in technology—artificial design intelligence, for example—by organisations such as VeriFLY seamless travel. The technologies that they have come up with are used in the United States already. They already work with US airlines and have technologies in operation at Denver International airport. They have pilot schemes and have discussed trial schemes with British Airways. We need to get behind and encourage that.

We must deal with the variants by being fleet of foot and adapting. If we can do that by investing in technology, and if, as was said, we can invest in better separation of people coming from different classifications of countries at the terminals, that is a safe means of moving things forward. If we are going to live with the virus or its variants for some time, hopefully with diminished toxicity, the investment is a long-term one that should be worth paying for.

May I also point out the importance of in-bound tourism to the UK? It is, as has been observed, worth about £28 billion in earnings. It is the third largest service export sector. There are real difficulties there because of what appear to be confused guidelines, an arbitrary approach, and a lack of transparency and clarity about the traffic light system and the criteria whereby countries that are sometimes—frankly, taking an objective view —better than us in terms of tackling infection are put on the amber list as opposed to the green one. Also, we need to recognise that the infrastructure of the sector needs to be supported. There is the question of continuing business rates support, for example, for those still operating on the high street. I have seen a firm in my constituency, which had been in business for 30 years, go under. That is a lifetime’s work gone.

What can be done to continue furlough and support on a sector-led basis? We need a new sector-specific scheme of recovery grants for travel agents. We need particularly to be able to look at the position of in-bound operators because they bring in, through travel management companies, some 50% of international visitors to the UK. The loss of that income to towns and cities across the United Kingdom has been estimated at up to £18 billion a year. Let us be frank. Although domestic tourism is worthy and certainly to be encouraged, and we all enjoy it, it will not make up the shortfall because the spend per head of domestic visitors is consistently significantly less—some £239 to £696 a head on average—so that will not plug the gap, and firms and businesses and towns, villages and cities dependent on tourism will suffer gravely and needlessly.

Our European neighbours, including Ireland, are being more supportive of the sector through their support regimes than we are at the moment, and they appear to be more fleet of foot as to how they put in place safeguards for the safe reopening of international travel. We need to learn from that. With the huge success of our vaccination programme, we need to be in front of the pack rather than playing catch-up. We need that for the long-term sustainability of a critical sector for our economy.