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.