Stroke Services

Steve Brine Excerpts

Tuesday 5th December 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

What a pleasure it is to see you, Madam Deputy Speaker; it has been a while. I knew that my hon. Friend the Member for Southend West (Sir David Amess) would get in a mention of Southend becoming a city. I was only disappointed that it did not happen earlier in his speech, but he managed it in the very last line. I will show great diplomacy and leave that matter to the Ministers responsible. I congratulate him on securing another Adjournment debate—we have done this before—which is on stroke services this time. As ever, he set out his case brilliantly and with such passion. He gives newer parliamentarians a real lesson in how to handle debates in this House.

As my hon. Friend said and as so many of us know, stroke is a devastating disease for patients and their families. He is right that there are currently 1.2 million stroke survivors in the UK, with more than 1,350 in my hon. Friend’s constituency alone. The hon. Member for Strangford (Jim Shannon), who is in his place as always at these debates, is absolutely right that stroke is predominantly a condition that affects older people. But it does affect younger people. I have met people of my age and younger who have been affected by stroke. Obviously, it is clinically debilitating, but it also comes as a great shock to their friends and families, who are taken aback by this happening to young people.

So many NHS staff work in multidisciplinary teams on stroke, and I pay tribute to them. There are nurses, consultants and speech and language therapists—the speechies, one of whom I am married to, so I will get brownie points for this—as well as physios, occupational therapists and specialist nurses, who all do so much when somebody suffers a stroke. The Stroke Association, which has already been mentioned, is an absolutely first-rate charity and a real partner for the Government. I also commend my hon. Friend the Member for Southend West for his strong work in driving improvements to stroke services both nationally and within his constituency. I know that he has taken a long interest in health matters, including stroke, as an MP. I reiterate his comments about the high-quality service provided by Southend stroke unit—more on that in a moment.

My hon. Friend will no doubt agree—he said this of course—that, in general, stroke services across the country are performing really well. Let me just reiterate some of the figures. Thirty-day mortality has dropped from 30% in 1998 to just over 13% in 2015-16—a huge improvement. The percentage of patients scanned within one hour of arriving at hospital, which is so critical, has increased from 42% in 2013-14 to over 51% in just three years, and the percentage scanned within 12 hours has increased from 85% to 94% in the same period.

There are many public health campaigns that we remember throughout the years, but the Act FAST campaign that public health campaigners and the Stroke Association have done is something we see and do not forget, and that, of course, was the intention.

Excellent progress has been made in the treatment of stroke over recent years. It is important that this programme continues and that the gains are built on, especially given the demographic changes we know are coming down the track with our much talked off and much publicised obesity challenge and our ageing population. That is why we published the cardiovascular disease outcomes strategy in 2013.

There is ongoing work in virtually all parts of the country to organise acute stroke care to ensure that all stroke patients have access to high-quality specialist care, regardless of where they live or what time of day or week they have their event. Although the national stroke strategy comes to an end shortly, as my hon. Friend said, NHS England continues to lead an effective programme of work on prevention and treatment. We are continuing to work closely together to improve acute treatment through the centralisation of care in centres that can provide the highest level of care and treatment at all times of the day and night.

Decisions on whether the strategy should be renewed are, of course, a matter for NHS England, but in liaison with Ministers. My understanding is that NHS England does not have current plans to renew it in the same form, but it is a subject that I, as the relatively new Minister, encouraged, of course, by my hon. Friend’s debate, plan to discuss with NHS England early in the new year. I would welcome my hon. Friend’s involvement —and that of other Members—if he wishes to feed into that.

[Jim Shannon]

I thank the Minister for his comprehensive response. One thing that is sometimes overlooked is research and development—the work that is done by universities in conjunction with health groups to try to find better ways of caring for people with strokes. Does he have any information on how critical that is to the whole care package that is given to those who have had strokes?

[Steve Brine]

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

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

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

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

[Maggie Throup]

Will my hon. Friend give way?

[Steve Brine]

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

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

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

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

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

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

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

Question put and agreed to.