Stroke: Aftercare

Robert Neill Excerpts

Wednesday 21st April 2021 Westminster Hall

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

I beg to move,

That this House has considered the National Stroke Programme and aftercare and rehabilitation services for stroke patients.

It is a pleasure to serve under your chairmanship, Sir Edward, and bring this debate to Westminster Hall. It is an important topic in which, as will become apparent, I have a personal interest. However, it is worth setting out the national significance of stroke and in particular stroke aftercare, because over recent years we have made huge advances in public awareness of the symptoms of stroke—the messages to look out for the signs of it, and to get urgent help, have cut through. The acute treatment of stroke has vastly improved, and many more people, thank heavens, are able to survive it. All those are good things. There have been real advances in medical science and technology in that regard.

The area where, I am sorry to say, we lag behind is what happens next. The NHS is brilliant at lifesaving and acute work, but it is in the follow-up for those who survive stroke and are left with the consequences where, it seems to me, we have more to do. In this debate, I want to concentrate on that and draw it to the attention of the House—and, I hope, to the attention of the wider public too.

I mentioned that I had a personal interest in this, Sir Edward. As some hon. Members may know, in July 2019 my wife, Ann-Louise, suffered a severe stroke—15 on the national stroke scale. We were fortunate that we had brilliant acute treatment at the Princess Royal University Hospital in Bromley and some good aftercare. She came through, but the truth is that she was left with a number of impairments thereafter because of the position of the stroke. Like so many stroke survivors I have met since, she continues to fight bravely and determinedly to come back from the stroke, and to get back to where she wants to be. It can be done, but it is a long and hard road. It requires courage and patience, but also consistent professional support, and it is that last thing that I think we need to do more to achieve.

In our case, Ann-Louise was unconscious for about three days. We were fortunate that the Princess Royal University Hospital at Farnborough Common is a regional centre of excellence, as part of the King’s College Hospital NHS Foundation Trust, and therefore she received superb treatment. However, she of course needed rehabilitation, which she received at the Ontario unit of Orpington Hospital, again provided by excellent and dedicated people.

However, the sad truth was that the unit was not resourced to deliver the level of consistent rehabilitation that it would wish to provide for Ann-Louise and other patients. For example, during the several weeks she spent there, it was not possible to deliver the therapies per week to the level set out in the National Institute for Health and Care Excellence clinical guidelines. I am sorry to say that is by no means an unusual state of affairs.

Frankly, there was a difficulty with the availability of therapists because of an inability to cover maternity leave, sick leave and so on, and there were shortages, particularly of speech and language therapists. It was never possible for Ann-Louise or the other patients to consistently receive the hours for five days a week that are set out in the NICE guidelines.

In the end, we were able to get private treatment and private rehabilitation for Ann-Louise at the Wellington Hospital in London. Again, dedicated people did great work there. However, the truth is that many families are not in a position to do that. I was very struck by one lady who was in the same bay as Ann-Louise in Orpington Hospital. She was only in her mid-40s, I think. She had a 16-year-old daughter and the consequences of the stroke that she suffered were much more severe than those of Ann-Louise’s stroke. She was there when we arrived and she was still there when we left, and frankly it was not possible to see any significant improvement in her condition. It is for people like her that one worries even more, because they are not in a position to seek some of the help that we were able to seek.

Ann-Louise eventually came home the day after the general election in 2019, so we are talking about a period of some weeks. As people may know, she was then entitled to a measure of aftercare in the community—it works out at about six weeks of occupational physiotherapy, and speech and language therapy—but thereafter it stops. I think that what we manage to do very often is to get people fit enough to be discharged back to their home, and to establish themselves initially at home. However, I do not think that we deliver on what is recognised by all the clinicians and well set out by the Stroke Association and others—consistent, long-term, programmed care over a longer period of time. That is what we want to see, and it is what is envisaged in the various programmes and plans that the Department of Health and Social Care has put in place for stroke. I think that is the area that we need to draw attention to.

After a period of time in our trust, which is a well-run trust, in effect one bids for further speech and language therapy. After another period and after a referral, hopefully one will get about three sessions, spread over a number of weeks. If targets are met, one may be in a position to seek a referral for perhaps three further sessions. However, if some of the targets are not met, and not everyone can meet them the first time around, then, because the resources are limited, very often that therapy will stop. That does not seem to me to be right or fair to people who are working terribly hard to come back from a life-changing experience.

Therefore, although there are dedicated professionals—nothing I say is to take away from the dedication of the professionals involved—we are not delivering on what we set out to do. That is a tragedy, because two-thirds of stroke survivors leave hospital with a disability. Stroke is the leading cause of adult disability in the UK. It affects about 1.2 million people in this country. Nearly 100,000 strokes happen in the course of a year. It is therefore a major issue, which needs to be addressed.

We have had in the past a national stroke strategy. There is a stroke plan, as part of the national plan. And now being developed—it is the subject of this debate—is a national stroke programme. All those plans and strategies are laudable but, as I have said, we are not actually able to deliver consistently on the targets that are set out in them, and if we cannot meet what is in the current plans, the concern is how we will meet the more ambitious targets for much more integrated stroke care that are set out in the strategy beyond that.

What we are looking at, according to all the clinicians whom I have talked to over the past 18 months or more, is really this: we have to provide effective support and rehabilitation. A lot of people think, and there is of course some evidence, that improvements are made in the first few weeks and months. Those weeks and months are critical, but there is also growing evidence that people can continue to improve, and improve significantly, beyond that, and actually we can find improvements going on over a number of years. But for people to achieve that, they must have the support.

Stroke is not a simple type of brain injury, which is essentially what it is. It varies according to the severity, where in the brain it has occurred and many other factors, and it will have varying consequences for each individual. Therefore, if we are truly to enable people to recover from stroke, they must have a personalised programme of care, rehabilitation and support, and that must be long term. Long-term personalised care is essential, but at the moment that is not happening. Sadly, the Stroke Association research suggests that some 45% of stroke survivors feel abandoned after their stroke. What is important in that context is not just the physical consequences of stroke; there are real psychological consequences as well, because it is life-changing.

My wife was a professional opera singer and a director of music at her local school. One can imagine what it has been like for her to have an impairment of speech; it weighs immensely heavily. We have met many other people who have had things that have, in effect, changed the nature of who they are. If they are to get back to who they are and can be, they need the really significant help that I have described, but they also need help with morale and the psychological impacts that there can be. That is one of the areas in which we have not been able to deliver to the level that our aspirations set out.

We are to move to the integrated national stroke service model. I am told that it is to be published imminently, but I hope that my hon. Friend the Minister will update us on that. Can we know when that is signed off? Can we know when it will come into force? If there are to be pilot schemes, where will they be? How long will that take to happen? What resourcing will be made available to support that integrated strategy? What is the plan to seek to recruit more specialist therapists, from all the disciplines, to stand behind it? All those are things that we need to have, and I hope that the Minister will be able to help us on that. Otherwise, the danger is that it becomes an aspiration, rather than a reality, for stroke survivors and their families.

Clearly, early supported discharge and integrated community stroke services are the aspiration, but at the moment, in an area such as mine, people will find that some services are provided through the hospitals. If people have more than one impairment, they may have to go to different hospitals—some for ocular work, some for vocal rehabilitation and some for physical rehabilitation. Some services will be provided through the GP, the networks and the clinical commissioning group—in Bromley, we have Bromley Healthcare, which does an excellent job—but others will be provided through a different hospital trust or health trust under contract; yet others will be provided through the local authority, social services and sometimes charities and voluntary groups. We have several stroke clubs and stroke groups in our area that do great work—the voluntary sector is amazing—but we cannot and should not depend on them to deliver part of the core service.

That is quite a minefield to negotiate. If it is difficult to negotiate for a professional family such as ours, think how difficult it is for people who may not have the resource and experience of the system, if I may put it that way, that we and others in our position have to fall back on. Pulling things together meaningfully, so that there is almost a one-stop shop that people can go to as a single point of reference and where they can call in expertise, seems to me and many experts in the field to be critical.

I referred to the importance of psychological rehabilitation. The psychologists I have met believe that much more needs to be done. I also referred to the importance of meeting our targets and the difficulties in some areas, such as speech and language therapy. For speech and language therapy nationally, the figures for meeting the NICE stroke guideline of

“45 minutes of each relevant…therapy for…5 days per week”

stand at 55.2%—just over half—and in some places they fall below that. There is a huge amount more to do on that issue, and a deal more also seems to be required in supporting early discharge. The proportion of patients treated by a stroke-skilled early discharge team nationally is 41%, and in some trusts the percentage drops into single figures. That is just not acceptable, as I know the Minister will recognise. What are we going to do to get those numbers up, so that we can move on to the next stage securely?

We need to think longer-term about this. We had the great good fortune to be introduced to the National Hospital for Neurology and Neurosurgery at Queen Square in London, which does amazing work. One programme there, an intensive aphasia course, is headed up by Professor Alex Leff. It is really full on, but that proves the point—this is one of the things that our current system does not deliver—that rehabilitation has the best outcomes when it is very intensive. Spreading it out to an hour one week, an hour the next and maybe another hour in two or three weeks does not come anywhere near to delivering the level of intensity necessary to enable stroke survivors to relearn skills for the neuroplasticity that is so important for recovery of the brain to kick in. Frequent use, repetition and intensity of the therapy is so critical.

That programme is funded as part of a research project, but as far as I know it is the only one of its kind in the country. That does not seem fair. If it is that good and well documented—it is; I have seen it—surely we should seek to roll out that type of intensive treatment across the piece. Somebody should not have to go privately to get the intensiveness necessary for their loved ones to get the level of recovery that they can achieve. I hope that we can look at that, too.

I hope that that is a start to the debate. We have an hour, and I know that several hon. Members wish to participate—I am grateful to them for coming—so I hope that I have set the scene. I look forward to the Minister’s response, but I hope that once we have considered the debate we will not leave it at that. We could have a greater awareness of the topic in Parliament—I was struck by how little debate there has been in the House and how few questions have been asked on it. When I looked at the list of all-party parliamentary groups, I noticed that there is no group on stroke, although there are groups on very many other serious, life-threatening and life-changing conditions. Perhaps that is a call for hon. Members who might be interested to think about the subject and keep it in mind as parliamentarians.

Having opened the debate, I will perhaps leave it there. I might say something at the end after the Minister has finished, but I have endeavoured to stress the importance of this, because it does change lives. People with the right support can come back. So much can be got back. There is always hope afterwards, and if people have the support to achieve that hope, they can restore their lives in huge measure. It is surely our responsibility as a society to enable them properly, with the aid of the skilled clinicians that we have, to do just that.

--- Later in debate ---

[Sir Robert Neill]

I am grateful to all hon. Members who have participated in the debate. I know that time is short. I am grateful to the Minister for the tone of her response. We will want to press her, in the most constructive way, on some of the detail of the funding, how we actually get the nuts and bolts done and how we deliver services on the ground. The aspiration is clearly there—we all share it—but we want to see that delivered. We are very happy to work with her on that; perhaps we can speak offline on how we might be able to achieve that.

I am grateful for all the expertise and the experience that hon. Members have laid out. I conclude by thanking everyone who takes an interest in stroke care, above all the carers. We ought to remember the informal carers—the families—who do so much, as well as the professionals. They need their recognition at the end of this debate too.

Covid Contracts: Judicial Review

Robert Neill Excerpts

Wednesday 24th February 2021 Commons Chamber

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

The judge very clearly found that there was a breach in relation to one matter: the 17-day average delay. He rejected the suggestion that there was a systematic failure. He rejected the suggestion that there is any impropriety in the system for awarding the contracts and did not impugn any of the contracts themselves or the process by which they were awarded. Most lawyers would know that this was a technical breach, as it has been described, albeit a breach. Is not the real moral of this that when those of us in politics seek to comment upon judgments, it is a good idea to actually read the judgment first and understand the law on which it is based, rather than grandstanding inaccurately, as has too often been the case here?

[Edward Argar]

I am grateful to my hon. Friend for his comments. He is absolutely right to highlight what this judgment actually said. It found, in what had to be a binary judgment—either it was complied with or it was not—that the Government failed to comply with the 30-day publication timing for all contracts. He is right: the judge rejected the suggestion of any policy of deprioritisation. I read the 40 pages of Justice Chamberlain’s judgment, including the setting out of the different cases put by the two parties, the discussion of it and then, crucially, his findings on it. I would advise all Members who take an interest in this issue to do exactly the same thing, because legal judgments are rarely as clearcut or as simple as some commentators and others might wish to suggest.

Mental Health Act Reform

Robert Neill Excerpts

Wednesday 13th January 2021 Commons Chamber

[Matt Hancock]

The hon. Gentleman is right that GPs are the absolute frontline in treating mental ill health, not least because the first presentation of mental illness is often at GP practices. Funding for those services is increasing and it is important that that continues.

As GPs form larger groups—for instance, through primary care networks—the ability to have more specialist help is strengthened. I want to see closer integration between primary care, mental health trusts and acute trusts within the NHS. Throughout its history, the NHS has held mental health trusts separately from the provision of other services. It is increasingly clear that their integration, rather than separation, is the way forward.

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

I warmly congratulate my right hon. Friend on the statement—and my right hon. Friend the Lord Chancellor, who I am delighted to see on the Treasury Bench with him.

The abolition of the appalling practice of using prison as a place of safety for those who are mentally unwell is particularly welcome. That was unfair for the individuals and for the prison staff who had to deal with them under often-unsatisfactory conditions. It frequently happened because at the end of a hearing, magistrates or judges had endeavoured to find a hospital place, but none was available at the end of the day. What practical steps and resources will be put in place to ensure that a hospital place is identified before the defendant appears in court, so that they can be taken swiftly and seamlessly to an appropriate safe place, rather than prison?

[Matt Hancock]

Ensuring that that sort of link-up is standard practice across the criminal justice system is critical, and that is one area that the Lord Chancellor and I are working on. Ultimately, so too is the provision of enough places, because we can only send somebody to a place if the place exists. That consists of two pieces of work. The first is building more mental health hospitals, and the second is ensuring that people leave mental health hospitals when they can be better cared for in the community. Often it is cheaper and better for a patient to be treated in the community, but provision of community services must be in place so that that discharge can take place. A significant amount of work is going on to try to improve that process.

Public Health

Robert Neill Excerpts

Wednesday 6th January 2021 Commons Chamber

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

We should vote to pass legislation that severely restricts the freedom of our fellow citizens and the legitimate activities of lawful business only if there is the most compelling necessity, the measures are proportionate and there is proper parliamentary scrutiny and oversight. On balance, and having seen in my constituency data on the exponential growth in infections caused by the new variant of the virus, I am persuaded that there is a compelling necessity for the regulations. As for proportionality, again, on balance there is evidence to support the bulk of the measures—even, regrettably, the closure of schools.

Inevitably, however, because the measures were produced in haste, some elements frankly fly against evidence and reason. They need to be reviewed, and swiftly. The obvious example is the prohibition on two people in the open air playing golf or tennis. There is no rational basis or evidence for that, and it is a mistake to include those things. It is very clear that it is not necessary in Scotland—they have not done that in Scotland—and I do not think that those activities are safe north of the border and unsafe south of it. The decision also creates a problem for many local authority leisure centres that are struggling for income, and it ought to be revisited. Similarly, the disproportionate effect of the ban on alcohol off-sales on micropubs and small, independent public houses, as opposed to the off-licence chains, ought to be revisited.

That brings me to the point about parliamentary scrutiny. I will live with those flaws in the regulations for the broader good if there is timely scrutiny and review. Leaving it until 31 March without any review would be unconscionable. I welcome the fact that the Prime Minister said earlier today that there would be the intention to bring matters back to the House as the vaccination programme proceeds. He also said that there was a legal obligation to remove redundant restrictions in the regulations as the vaccination programme proceeds. I hope the Minister will indicate what the mechanism is for that, because an obligation has to have a means of being enforced. In this instance, that means coming back to this House. If we can have that, on balance, I could give these regulations my support, which has not been the case in previous instances.

We cannot use the gravity of the situation as a reason to overrule the normal requirements of proper parliamentary scrutiny. That is necessary in the interests of democracy and the rule of law. I hope that the Minister will be able to give me those assurances as she winds up the debate.

Covid-19 Update

Robert Neill Excerpts

Wednesday 30th December 2020 Commons Chamber

[Matt Hancock]

We have put in more support to help care homes with the challenges that covid throws up, in relation to both testing and other things such as PPE that are so necessary. I am very happy to arrange a meeting between the hon. Gentleman and the Minister for Care, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), to see what more can be done, and in particular whether the burden that he describes—the time taken to do these vital tests—can be minimised in some way.

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

I welcome the work that the Secretary of State is doing, and particularly his answer to my hon. Friend the Member for South Thanet (Craig Mackinlay) about the importance of getting enough vaccinators. Even within London boroughs, I am conscious of a difference in the speed of roll-out, even to very vulnerable people. In my constituency, I have a number of recently retired medical people—doctors, clinicians and nurses—who would willingly volunteer if they were asked. In addition, will the Secretary of State make, or has he made, approaches to private healthcare providers? As I understand it, many of them have capacity and, I am told, they would be willing in some cases to make their staff available on a pro bono basis to help the NHS to roll out this vaccine.

[Matt Hancock]

Yes, I am pretty sure that that has been done. If it has not, I will absolutely check and get back to my hon. Friend. If anybody who is clinically qualified comes forward, we are very enthusiastic to hear from them. NHS Professionals, the body that is responsible for extra staff in the NHS, is organising the distribution of those who want to come back into service in order to help to vaccinate, and we look forward to hearing from people.

Covid-19 Update

Robert Neill Excerpts

Monday 14th December 2020 Commons Chamber

[Matt Hancock]

I appreciate the sensitivity with which the hon. Lady raises this case. Of course I would be very happy to ensure that it is looked at properly by the JCVI, but the decision, as I am sure she will understand, is rightly for the JCVI.

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

The Secretary of State has to recognise that the decision in relation to London will have a crippling effect upon the hospitality industry in the capital, not least because this is the time of year when they might most hope to make good the losses that they have already suffered—[Interruption.]

[Madam Deputy Speaker (Dame Eleanor Laing)]

We have lost Sir Robert for the time being, but would the Secretary of State like to answer half the question?

Covid-19 Update

Robert Neill Excerpts

Thursday 15th October 2020 Commons Chamber

[Matt Hancock]

I do not think the hon. Gentleman was listening. I pointed out just previously not only that the national system in the last week has more than doubled the number of contacts that it has reached—I pay tribute to it for that—but that it is teamwork between the national and local systems that works best. It is the combination of the large-scale private organisations and the public sector—people working together—that is able to deliver, and to deliver a better service. I will tell him this: there was a time in the last few days when we had requests from local systems to bring some of the contact tracing back into the national Serco system so that it could help to reach more people. That sort of teamwork is what I look for, instead of the negative, derisory, divisive approach of the hon. Gentleman up there.

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

Would my right hon. Friend care to reflect that a number of us in London regard it as neither targeted, nor proportionate, nor appropriate to use a London-wide average in so large a metropolitan area where so little commuting is now taking place? Will he reflect on that in the future, and will he speak today to the Chancellor of the Exchequer to see what support can be given to hospitality businesses in the London suburbs that are suffering as of now as a direct consequence of his decision?

[Matt Hancock]

Of course, across London there is a huge amount of travelling to work. Although of course in different boroughs the rates are different—my hon. Friend is absolutely right about that—and in his patch they are lower than the London average, nevertheless, unfortunately, they are rising sharply. We considered a borough by borough approach, but because of the integrated nature of London and because, unfortunately, cases are rising fast across London, we decided that the best approach is for the whole of London to go into level 2 together.

Oral Answers to Questions

Robert Neill Excerpts

Tuesday 5th May 2020 Commons Chamber

[Matt Hancock]

There are lots of things that we will need to learn when this crisis is over. The hospice system has always had a mixed model of funding—a very strong history of philanthropic support, as well as support and financial funding for the services it provides that the NHS commissions. The funding has started to flow. If there is a specific problem locally, I would like to know about it, and then we can get to the bottom of it.

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

What progress he has made on ensuring that all key workers are able to access a covid-19 test.

[The Secretary of State for Health and Social Care (Matt Hancock)]

We expanded testing to all symptomatic essential workers and members of their households last month. As capacity continues to increase, we have been able to go further still, with all those who have symptoms and who have to leave home to go to work—and members of their households—now able to access a test. This is all part of the overall testing strategy, with the 100,000 tests that are now available.

[Sir Robert Neill [V]]

Testing of staff and residents at care homes in my constituency is being delivered by referrals either through the Care Quality Commission or through the pilot partnership that has been set up between our hospitals trust and our clinical commissioning group. In relation to the CQC, will my right hon. Friend examine why test results are taking five to seven days to come back, rather than the estimated 72 hours? In relation to the pilot scheme, where tests are being delivered efficiently, why are care home managers given the names of residents who test positive but, for data protection reasons, not the names of staff who test positive? That is creating obvious uncertainty.

[Matt Hancock]

I am glad to see the roll-out of testing to care homes, and we are able to go further for both residents and staff. It is an incredibly important part of the response and one of the reasons why testing is so important. My hon. Friend raises two important issues of detail in the roll-out, and I will ensure that they are looked into.

Oral Answers to Questions

Robert Neill Excerpts

Tuesday 27th November 2018 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

4. What steps he is taking to support people to lead healthier lives.

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

17. What steps he is taking to ensure that people take greater personal responsibility for leading healthier lives.

--- Later in debate ---

[Matt Hancock]

There are many things we need to do to diagnose cancer early, and of course public health is part of that, but there is a much bigger agenda, and that includes more screening. We have seen an increase in the number of people invited to screening, but we need to get the screening right, so I have instituted a review of all our screening processes for cancer and other diseases.

[Robert Neill]

Will my right hon. Friend look at the work done by Connect Well Bromley, a partnership funded by the local clinical commissioning group but delivered by Bromley Third Sector Enterprise and Community Links Bromley? That partnership sets out what is in effect a social prescribing programme of activities and services to deal with wellbeing issues at an early stage. Is that a model for elsewhere in the country?

[Matt Hancock]

Yes, it is. I have been briefed on the example that Bromley is setting, which has been brought to my attention by its brilliant local representative, my hon. Friend. Social prescribing systems such as this one are on the rise, because the evidence shows that social prescribing helps to keep people healthy and out of hospital.

Health and Social Care Committee

Robert Neill Excerpts

Thursday 1st November 2018 Westminster Hall

[Dr Wollaston]

I thank the hon. Lady for drawing attention to that. Our report mentions that the prison population is ageing, particularly as a result of older sex offenders coming into our jails. It is about dealing not only with healthcare in our prisons but with social care. We call on the Government to look specifically at how we commission for that age group and their special needs. She will also know that the average age of death in prison is 56. We really have to look at the excess mortality, which is 50% higher for people in prison than for the background population.

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

It is a pleasure to see you in the Chair, Sir Henry. I very much welcome my hon. Friend’s statement and the report, in which I thank her for involving Select Committee on Justice. The evidence that she received entirely mirrors that which the Justice Committee is receiving for our inquiry into the make-up of the prison population in 2022. Does she agree that it is absolutely essential that we turn around the inadequate provision of health services across our prison estate, not only because it is morally right but because it is impossible to effectively rehabilitate people when there is endemic ill health in many parts of the prison population? That means that people are discharged back into the community often in poor health and leads to a cycle of reoffending that costs the community more, as well as destroying and blighting lives.

[Dr Wollaston]

I absolutely agree with what my hon. Friend has said and I welcome the ongoing interest that the Justice Committee is taking in this issue. He will know that one very depressing aspect of this situation is that report after report is published highlighting the issue, but we are just not seeing the progress needed. There needs to be real accountability and consequences for progress not being made on all these issues.