World Stroke Day
Matt Western Excerpts(4 months, 4 weeks ago)
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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.
Junior Doctors’ Strikes
Matt Western Excerpts(1 year ago)
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Matt Western (Warwick and Leamington) (Lab)
Junior doctors are the backbone of the NHS. I would never describe those whom I have met as “militant”; they are hard-working and of all ages. Somehow, this is the second strike that junior doctors have staged in the last 13 years—there was none in the previous 13 years, under a Labour Government. Will the Secretary of State confirm: has he not set out his own precondition, and that is that he will not meet them until they call off the strikes?
Steve Barclay
There are two different things there—one on which the hon. Gentleman is correct and one on which he is not. He is correct that we have said that a precondition for meaningful and constructive talks is that the trade union suspends strikes. That is a precondition that the other trade unions were more than willing to accept, and it is applied in other sectors such as education. We have been clear on that.
The hon. Gentleman is not correct on my point about militancy, which referred to the junior doctors committee specifically. We stand ready and recognise the real pressure that many within the junior doctors community have faced. The NHS has been under significant pressure coming out of the pandemic. We recognise that there are issues on which we want to work and have constructive engagement with them. It is just regrettable that some in the junior doctors committee of the BMA want, as they have said in media interviews, to take a more overt political agenda, rather than work with us to focus on the real issues that many junior doctors are concerned about.
Oral Answers to Questions
Matt Western Excerpts(1 year, 2 months ago)
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Neil O’Brien
We are working to increase the amount of funding going into pharmacies so that they can do more clinical services. I will look closely at the issue that my hon. Friend raises.
Matt Western (Warwick and Leamington) (Lab)
Maria Caulfield
As the hon. Gentleman knows—we discussed the issue over the telephone last week—the decision was taken to wind down the Rosalind Franklin Laboratory because the number of PCR tests has reduced significantly and NHS laboratories can take that capacity. There is a residual service and additional use of the laboratory is being considered.
Oral Answers to Questions
Matt Western Excerpts(1 year, 9 months ago)
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Steve Barclay
I have had quite a few meeting requests this morning, and I am always keen to meet colleagues. My hon. Friend will be well aware that part of the reason for having integrated care boards within the place-based approach is that commissioners can determine the best mix of services in the locality, including in Burton.
Matt Western (Warwick and Leamington) (Lab)
The Minister of State, Department for Health and Social Care (Maria Caulfield)
NHS Digital publishes information on average waiting times, and the data for May shows that the median average total time spent in A&E for all patients was three hours and six minutes.
Matt Western
Across the west midlands, 38 people died waiting for ambulances between March and May 2022. In the same period in 2021, two people died; before 2019, in the corresponding period, there were no deaths. A week ago Sunday, 80 people were waiting in accident and emergency in my constituency. What are the causes of these problems?
Maria Caulfield
The west midlands is more affected than many regions of the ambulance service. There are a number of causes, the first of which is that we are living with covid, which has not disappeared. If we look at the in-patient rates, we see that they have increased significantly; last month, they were 17.9 per 100,000 and they are now up to 24.4 per 100,000 in the west midlands, which is experiencing significantly higher rates than other parts of the country. [Interruption.] If the shadow Secretary of State wants to hear this, I can tell him that we also have a significant number of staff sicknesses from covid; this time last year, it was about 4% of staff but when I spoke to some trusts this weekend I heard that it was up to 6%. That has a knock-on effect on acute and emergency services and ambulance services being able to respond.
Ambulance Pressures
Matt Western Excerpts(1 year, 9 months ago)
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Steve Barclay
First, I am happy to join my hon. Friend in paying tribute to the work of the local staff in her ambulance trust. She raises an important point about the fleet, and I was very interested in this issue four years ago when I was ambulance trust Minister and discovered that there were, I think, 32 different types of ambulance. When I was out with crews over the past fortnight, one of the issues we discussed was the merits of tailgates so that people are not suffering work absence and musculoskeletal injuries because they are trying to push heavy loads on to an ambulance. I am interested in exploring with her and colleagues how we get the right standardisation and the right fleet in place. Indeed, we have been targeting additional money to support that work.
Matt Western (Warwick and Leamington) (Lab)
Since March, West Midlands ambulance service has been on the highest level of alert, and I understand that it was joined by the other ambulance services across England last week. In May, Mark Docherty, the director of nursing for West Midlands ambulance service, predicted that the service would collapse by 17 August—that is a month away from now—if hours lost by crews delayed outside hospitals kept increasing, which of course they have. Can the Secretary of State give some specific answer on what he is doing to address the issues in the west midlands, and also in our care homes, which are a root problem of trying to get people out of hospitals?
Steve Barclay
The hon. Gentleman is right that the west midlands in particular has been under significant pressure, and 111 ambulance service response times are significantly challenged, which is driven by wider system pressure and delayed handing over of patients. The measures taken through the national support that is going in include handover delay improvements, on which works is taking place across all integrated care boards. NHS England has allocated an additional £150 million to support the system, and an extra £20 million of capital is going into fleet. Given that I am new in post, I am happy to meet the hon. Gentleman to discuss any specific issues about the West Midlands ambulance service’s performance.
Ambulance Services and National Heatwave Emergency
Matt Western Excerpts(1 year, 9 months ago)
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Maria Caulfield
We are working urgently on this issue—as, I am sure, are the health services in Wales and Scotland, which are facing the same problems. We are all working hard to address them. As I have said, we have procured a contract with a value of £30 million for an auxiliary ambulance service to increase capacity, should we need it. I will be meeting all ambulance trusts in the coming days to make sure we have the resilience we need, not just to catch up with some of the pressures that existed before covid or to deal with the pressures that those trusts are facing now, but to future-proof them for the coming winter months.
Matt Western (Warwick and Leamington) (Lab)
Joyce, a 96-year-old survivor of the Coventry blitz, sadly fell in her care home back in April, and lay in agony screaming for 10 hours. At the time of the 999 call, there were 63 people awaiting ambulances, and on that day, over 1,100 hours were lost due to hospital handover delays. Clearly, a major factor in those delays is the handover capacity in our A&E services and in wards. The Government have had 12 years to sort out the issue of social care, so does the Minister support the calls from various leadership candidates to make tax cuts and remove the national insurance increase that was supposed to support social care?
Oral Answers to Questions
Matt Western Excerpts(1 year, 10 months ago)
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Matt Western (Warwick and Leamington) (Lab)
Sajid Javid
I am afraid that it was not clear to me which tests the hon. Gentleman was talking about; all I heard was “300,000 tests”. So if he cares to write to me, I will respond properly to his question.
Covid-19 Update
Matt Western Excerpts(2 years, 3 months ago)
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Mr Deputy Speaker (Mr Nigel Evans)
I call the incredibly patient Matt Western.
Matt Western (Warwick and Leamington) (Lab)
I add my voice to the congratulations to Jonathan Van-Tam and all those across our universities and science sectors who have contributed so much. I hope that others will be similarly rewarded.
The Secretary of State is aware of the shortage of testing kits. He mentioned in his statement that the 120 million have now increased to 300 million. As my right hon. Friend the Member for Leicester South (Jonathan Ashworth) said, the Opposition are desperately keen for businesses to stay open and for young people to remain in education. I am aware that there are separate supply lines to universities for testing, but there is concern about supply in future weeks. Can the Secretary of State confirm—guarantee, perhaps—that in the coming weeks there will be no issue with the supply of testing kits to our higher education sector?
Sajid Javid
The hon. Gentleman is absolutely right to thank not just JVT for his service, but those across our academic sector who have supported the Government, people and the NHS throughout the pandemic. I am privileged to work not just with JVT, but with so many of them, and I see every day the value they add and how they are helping us all to get through the pandemic.
The hon. Gentleman is right to raise the issue of testing. It is not 300 million; the 300 million lateral flow tests were in December, but for the month of January we have planned at least 400 million, which is four times as many as in the original pre-omicron plan. That makes us confident that we have the lateral flow tests we need. The university sector and the education sector more broadly, including schools and colleges, rightly have a separate supply line. It is still run through my Department, but we work very closely with the Department for Education to make sure that the sector has the supply that it needs.
Public Health
Matt Western Excerpts(2 years, 4 months ago)
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Justin Madders (Ellesmere Port and Neston) (Lab)
Having had the dubious pleasure of spending an inordinate amount of time in various Committee Rooms over the past 18 months to scrutinise regulations introduced by the Government as part of their response to the pandemic, I must confess that I have had withdrawal symptoms following the reshuffle, so I am pleased to have the opportunity to speak on these regulations today.
I am sorry to say that, on too many occasions, regulations were debated well after they came into force, so it is positive that at last we seem to be getting into the habit of having debates and votes before regulations become law. I would not want that to be seen as a ringing endorsement of the Government’s approach to parliamentary scrutiny, as two of these sets of regulations were published only at 3 pm yesterday, less than 24 hours before this debate began. I know things move quickly, but some of these regulations have been the subject of consultation for many months. There is no excuse for their being dropped in at the last minute.
The decision to reveal the precise detail of these regulations at the last minute has probably generated more opposition than is warranted. I have had many representations from constituents about the entry to venues regulations on the basis that they represent a compulsory vaccine passport. Let us be clear that they do not. A negative test taken in the 48 hours before entry can be used as an alternative, which addresses many of the legitimate concerns that have been raised with me about civil liberties and discrimination. I am pleased that my party’s persistence in pushing for a negative test as an alternative has been accepted, because it gives me enough confidence to support these regulations.
Matt Western (Warwick and Leamington) (Lab)
Across the House, many of us have been calling for greater transparency from the Government. The more we hear from the chief medical officer, the more concerning it is. If the Government had been more transparent up front, I am sure there would be greater support across the House.
Justin Madders
Indeed. If we look at what has happened in Wales, there has been a similar system for some time, which seems to be working reasonably well. People have been required to produce tests when travelling abroad and several venues in England have been doing that on a voluntary basis. It is not the slide into dystopia that some people fear, but the situation has not been aided by the Government not being as up front as they should about what the regulations mean. Many people already routinely take lateral flow tests before they go out.
However, there are some outstanding questions and concerns. There is no doubt that some constituents feel that the regulations are the start of a slippery slope and that we will soon have to show vaccination papers to get in anywhere. I will be clear: I do not support such a move. Given that the Government cannot even bring themselves to mandate wearing face coverings in pubs, I would be surprised if they moved in that direction, but I want confirmation when the Minister winds up that the Government are not planning any extensions to where the regulations will operate. We also need a clearer explanation of where the line is drawn and to which venues the regulations apply. Do places such as this, which fall into the definition of a public hall indoors with 500 or more people who stand up and move around, come within the ambit of the regulations? My reading suggests that they do. If we want to gain the public’s confidence, we should show that the rules apply to us equally.
Another concern that has rightly been raised is whether a charge will be introduced at some point to obtain lateral flow tests. That would obviously undermine tests as an alternative to showing vaccine status. Charging people to obtain tests would be an absolute disaster from a public health perspective. That goes way beyond the remit of the regulations, but I hope we can get confirmation from the Minister that there are no plans to charge for tests.
The Government need to do rather better at setting out what they consider the cost of the regulations to be to businesses. Again, I note there has been no impact assessment for the entry regulations. Who will pick up the cost of enforcing them? There is nothing I can see about supporting businesses to check people, let alone providing resources to local authorities, which are meant to enforce the regulations.
What will be the position if there is a national shortage of tests? We are told that there are tens of millions of them but, as we know, there are challenges in getting them out to the people who need them. In those circumstances, will the regulations be suspended, or will people be pushed down the vaccination route?
That said, the evidential burden for a negative test seems particularly broad. I think that will assist in reducing the burden on businesses, but it also increases the risk of fraudulent tests doing the rounds. That would undermine the whole point of the regulations. We do not want the worst of all worlds: an expensive bureaucratic system that does not actually help reduce transmission because it is not properly enforced.
Regarding the vaccination of NHS staff, there is plenty of evidence to suggest that a small but significant proportion of covid admissions is the result of people acquiring the infection in hospital. I have seen figures to suggest that it has been as high as 15% to 20% of all covid admissions, although once staff started to receive the vaccination, the figure dropped dramatically. There is therefore evidence to show that the regulations will have an impact on covid admissions and the wider pressure on the NHS. I know it is difficult, but on balance, the regulations should be supported.
However, that should not be the end of the story. We have had a workforce crisis for years. Covid has accelerated cases of burnout and only a few weeks ago, the Government passed up the opportunity to grasp the nettle by refusing to implement a long-term workforce strategy. That is why we need an awful lot more work on the regulations.
The Government have an uphill struggle to earn people’s trust and explain why they consider the proposals necessary, to convince the public that what is before us will be the limit of restrictions and that we will not be talking about extensions or changes at some point in the future. Judging by the comments of many Conservative Members, the Government have failed to persuade a number of their Back Benchers, so it is little wonder that we are all being bombarded by emails from our constituents expressing concern. That exposes the wider truth that the Government have vacated the space where leadership should be. They are compromised by their own failure to follow the rules, riddled with internal disagreements about the route ahead and unable to provide the authority to persuade a sceptical public that the measures are needed.
Health and Care Bill
Matt Western ExcerptsMonday 22nd November 2021
(2 years, 4 months ago)
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Edward Argar
I am afraid I will not, because I have only a couple of minutes in which to try to address these points, and I did give way a dozen or so times in my opening remarks.
Equally, I recognise, as always in this House, the strength and genuine sincerity of the views and the points put by hon. Members on both sides, genuinely highlighting and wishing to explore certain aspects of new clause 49 to understand exactly what it does and how it works. I have complete respect for the strength of those views.
I believe that, as my right hon. Friend the Member for West Suffolk (Matt Hancock) set out very clearly, this is a significant step forward. It will make a huge difference, and it must be treated as part of a package of measures rather than in isolation. As he quite rightly highlighted, we must look at the floors as well as the cap, at the support that is available, and at the increases in those floors from £14,250 to £20,000 and up to £100,000.
Edward Argar
I am afraid I will not, because I literally have only one minute, and I did give way multiple times in my opening remarks.
I believe that the measures in this Bill, which we have debated with these amendments today, give the NHS what it needs to further integrate to deliver the local services it needs and, crucially, move us a huge step forward in tackling the challenge posed by social care for future generations.
Question put, That the clause be read a Second time.