Item 6 on our agenda is the Member debate under Standing Order 11.21(iv) on care and support for stroke survivors, and I call on Dai Lloyd to move the motion.

Motion NDM7463 Dai Lloyd, Neil Hamilton, Huw Irranca-Davies, Adam Price, Andrew Davies, Nicholas Ramsay

Supported by Caroline Jones, Llyr Gruffydd, Mark Isherwood, Neil McEvoy

To propose that the Senedd:

1. Notes the publication of research by the Stroke Association into the experiences of stroke survivors during the COVID-19 pandemic, which found that stroke survivors and carers are struggling to access the services and support they need.

2. Notes that admissions at acute stroke units in Wales fell 12 per cent between April and June 2020 compared to 2019.

3. Believes that despite the COVID-19 pandemic, stroke survivors should be able to continue to access the acute care, rehabilitation, mental health treatment and support they need to make the best possible recovery.

4. Calls on the Welsh Government to ensure local health boards in Wales continue their work to improve stroke care in Wales and do not allow COVID-19 to delay much needed structural changes.

5. Calls on the Welsh Government to publish a new national plan for stroke services upon the expiration of the current Stroke Delivery Plan to ensure care for those affected by stroke is strengthened throughout Wales in the future.

Motion moved.

Diolch, Dirprwy Lywydd. As chair of the cross-party group on stroke, I am pleased to introduce this motion on how COVID-19 has impacted on the 70,000 stroke survivors in Wales and their carers. I am grateful for the support of Members across my Senedd screen and look forward to their input, as, in the time allotted, I cannot possibly cover all bases.

Now, the cross-party group on stroke meets regularly and I'm regularly astonished by the number of people attending and the breadth and excellence of experience of all attendees, be they survivors of stroke or the foremost consultants in Wales. And the Stroke Association not only provides huge support to the cross-party group, but, more importantly, invaluable work with survivors of stroke themselves, as well as carrying out the research that outlined the huge impact of COVID on stroke survivors and their carers. The situation is desperate and there is huge suffering. The figures are there, and doubtless will be quoted by Members. Their truly heroic work goes on in our communities and our hospitals, and epic tales of heroism, of pioneering and inventive medical genius regularly peppered our cross-party group review into various aspects of stroke delivery over the last couple of years. Thank you to all who contribute to that in-depth review.

We've been inspired by the experiences of those surviving stroke, by their heart-rending tales, their suffering, the heartbreak, seeking services, and the huge pressure on carers, and the nurses and doctors going that extra mile, and incredible treatments such as thrombolysis and thrombectomy being provided, and then COVID struck, and the significant challenges of accessing services during a pandemic when everything is closed, and trying to get physiotherapy, speech and language therapy so that you can recover whilst the nation is in lengthy lockdown. Virtual support has increased during the pandemic, but stroke rehabilitation services and mental health support have suffered terribly in the face of COVID.

Wales needed a new stroke delivery plan before COVID; after all, early treatment is key to recovery. COVID has stretched already-struggling stroke services as it laid bare the fragile state of health and social care services, and mercilessly flayed our phenomenal staff and carers who are naturally programmed to go over and above the call of duty for stroke and so many other conditions.

I know the Welsh Government has been discussing successor arrangements to the stroke delivery plan. Such arrangements must address the huge present challenge of care for stroke, as well as progressing the tremendous medical advances that Wales must embrace. The new stroke delivery plan must include progress on hyper acute stroke units—HASUs—and developing the expertise of thrombectomy on an all-Wales 24/7 level.

Stroke costs over £1 billion in Wales today. That will rise to £2.8 billion per year by 2035. Wales has exciting opportunities under the new and enlightened leadership of the new national clinical lead for stroke, Dr Shakeel Ahmad. Thrombectomy is a marvellous invention: hooking out a clot from an artery in the brain to transform paralysis back into normal function—truly reflective of Lazarus's biblical experience, absolutely amazing, and we do a little of it in Wales now, but we need to do far more of it, and we need that comprehensive network of hyper acute stroke units—HASUs—dotted around Wales to do this, to clearly transform acute stroke care. We can do it.

Finally, nearly 40 years in health has taught me there is always more than one crisis at any one given time. I salute the heroic efforts of our staff. In the midst of this huge pandemic, Government cannot forget the future of stroke services: it must implement the cross-party group recommendations. Please support the motion. Diolch yn fawr.

The impact of stroke can be considerable, as Dr Dai Lloyd has just explained, not just for the patient, but also for their family, in ways that can be challenging and terrifying, particularly—as has just been said—at this time of the pandemic and lockdown. Many people will experience a range of consequences after having a stroke: the physical challenges of fatigue and paralysis in those cases where mobility is impaired, cognitive changes affecting memory, communication and concentration, and the psychological impact of depression and anxiety. Many recover, but others don't, and, as we know, the impact is dependent on the range of consequences that an individual experiences, and for how long those challenges will remain.

Colleagues will also talk about the range of care and support needed for those who have a stroke, and rightly so. But one of the areas of this debate that also causes me concern is the level of support for those who find themselves quite unexpectedly caring for a loved one who's had a stroke, particularly given the current restrictions and the current difficulties of accessing support, including language therapy. It's hard to imagine the sense of shock when a family member has a stroke, the feeling of panic and worry as someone is admitted to hospital and having to face a future life with a potentially different set of expectations. Suddenly being thrust into the role of carer, having to manage the range of consequences that that loved one will experience, plus potentially life-changing implications for the family, financial concerns—all of these affect families of sufferers of strokes. For family members it can be truly daunting, which is why the support offered by groups like Chepstow stroke club in my constituency is so important for supporting families. How many people in Wales are now caring for someone living with the consequences of stroke, and how do we support the needs of those without whom that caring role could not be provided? Are we doing well enough in providing all that we can to those who care for a loved one, and, if not, why not?

Whilst I'm very supportive of this debate today to allow us to explore the support and care for those who experience strokes, we should be mindful that it is one of those big public health indicators that ought to concern us. There are a number of factors that contribute to a stroke, as has been cited—high blood pressure is one of them. Often that's linked to lifestyle choices, and we know, during the pandemic at the moment, the importance of people exercising and making sure that they're keeping well.

In conclusion, Dirprwy Lywydd, we have to get better at radically responding to this public health challenge. If COVID has taught us anything, it's that we need to take the past 10 months as a wake-up call. Public health has to be a bigger focus in the next Welsh parliamentary term. People's lifestyle choices aren't just freedoms without consequence—we're continuing to suffer the impact of the decisions we take about our own health, and, sadly, for many, a stroke is that consequence. Let's make sure that we give sufferers of stroke and their families the support they need at this time as we, hopefully, come out of the pandemic.

It's a pleasure to follow on from Nick and from Dai, and from the work of the cross-party group this year, who have worked with the support of the Stroke Association, providing the backbone of the secretariat, to go out and listen to people who themselves have experienced stroke during the pandemic, but also their family, their friends, their carers and their loved ones as well. It has been tough, and the statistics show how tough it will be, and I'll turn to them in a moment. But what it clearly shows, as both Dai and Nick and others will say as well, in following me, is that we need now that refreshed new stroke delivery plan, because, even before now, even before the pandemic, we didn't have universally good, universally strong provision of stroke support and care services, let alone those hyper acute stroke units across Wales. We hadn't seen the progress that we wanted to see, so, if the pandemic has done anything, it has shown even more acutely the need to progress on these measures. We haven't seen as much progress as we wanted to, and I think, in bringing forward a new national plan for stroke, which we so much need—a delivery plan—we need those hyper acute stroke units to be right at the forefront of that.

Let me put some of the facts that we found through the survey that we did of people experiencing stroke. Sixty-five per cent of stroke survivors in Wales told the Stroke Association they had received less care and support during the pandemic. It showed as well that, despite 50 per cent—half of stroke survivors—having therapy appointments cancelled, only less than a quarter went on to receive therapy over the phone or online. Now, I am grateful, I have to say, for having a brilliant Stroke Association in my area who, through the years, have been tremendously good at providing support and signposting support for local people in the Bridgend area, but look at what has happened during the pandemic. Not only is that support more threadbare, but the ability as well of those Stroke Association support services to signpost as well has been lessened as well. And the mental health impacts: nearly 70 per cent, seven out of 10, of those surveyed are quite anxious or depressed, and nearly 57 per cent of carers felt overwhelmed or unable to cope.

So, I think the message is very clear: services were stretched already; those hyper acute units, we haven't seen the progress that we wanted to see; the therapy services that were not universally consistent and good right across Wales. So, if anything now, on the back of the CPG's work, on the back of the Stroke Association's work and on the back of this pandemic, we call on Government as a cross-party group to put a new urgency behind this work, and for local health boards to actually take forward their work on hyper acute units as well, and support services. Diolch yn fawr iawn, Dirprwy Lywydd.

The past year has, of course, been difficult for everyone in their different ways but, for many stroke survivors in Wales, it's meant putting their recoveries on hold, and people who are desperate to regain mobility, independence and fitness have, as Huw referred to now, seen cancelled therapy sessions—around half of those surveyed by the Stroke Association experiencing that. As he mentioned as well, more than two thirds said that they'd been feeling anxious and depressed since the pandemic. No-one should feel hopeless after a stroke and, of course, it's not just the stroke survivors who are affected; carers for stroke survivors have also been feeling the impact, with two thirds of them also saying that they were carrying out more caring duties during lockdown.

A big part of stroke recovery are the social clubs and meetings, so that people can share their experiences and help each other on that road to recovery. These were important in terms of therapy, yes, but also broader socialising and, of course, as fundraisers for those little extras that can make such a big difference in enabling stroke survivors to recovery. Now that fundraising, of course, has come to an abrupt halt, and the face-to-face socialising has all now gone online, as we all have, but what I've been told is that for many, particularly in rural parts of Wales, far too many stroke survivors are finding that their broadband service isn't good enough for a Zoom call and that increases the sense of isolation. That's particularly the case, of course, when you have speech difficulties in light of your stroke, and need that practice to recover.

We've all faced the frustrations of buffering and lagging internet connections at some point, and we've experienced that in our Plenary session this afternoon, but imagine that when your speech is already compromised and, of course, your resilience is low. It's demoralising to say the least. The same applies for people leaving hospital and unable to access services because of their geographic remoteness. So, my call in this debate is simple: we need a stroke service that recognises these specific challenges in more remote and less well-connected parts of the country. We need parity of service, because for far too long there's been a high level of variation in treatments and support at different stroke units in Wales. 

Of course, the pandemic has been exceptional across the health service, but let's not kid ourselves that things were perfect for stroke survivors beforehand. In recovering previous services available to stroke survivors, we should also be looking to strengthen them with a new national plan for stroke survivors. It's been almost four years since the Government had a stroke delivery plan that agreed to deliver hyper acute stroke units that would improve survivability, and despite some good work by Betsi Cadwaladr and other health boards, none have been delivered so far because the commitment by this Government wasn't matched with the funding necessary. So, these hyper acute units remain on the drawing board because of a lack of leadership from Government in that respect.

So, in conclusion, let's make sure that despite this awful pandemic, we see some good come out of this crisis, and for stroke survivors, let's ensure that they get the services they need in all parts of the country, and that we finally start to deliver on aspirations and strategies.

The coronavirus pandemic has had a drastic impact on our health and care systems. Not only have waiting times for treatments vastly increased, but we have also seen fewer people seeking help for fear of contracting a disease that has killed millions of people in the past 12 months. So, whilst this issue has affected all services, it's keenly felt in stroke services.

Stroke is one of the leading causes of death and a leading cause of adult disability in Wales. Each year, around 7,500 people in Wales die from a stroke. Thankfully, thousands more survive, yet they are left with life-limiting disabilities that require a great deal of care and support. And it's believed that just over 2 per cent of the Welsh population are stroke survivors: that's around 66,000 people in need of services such as rehabilitation and mental health support.

Pre-pandemic, these services were already struggling to meet the needs of survivors, but since coronavirus took hold on our shores, around two thirds of survivors have not received sufficient care and support. It is little wonder, therefore, that in a survey of stroke survivors and their carers, over two thirds of survivors have felt anxious or depressed, and nearly six in 10 carers felt overwhelmed or unable to cope—hardly surprising when half of all appointments have been cancelled. We weren't doing great pre-pandemic, but we now have the opportunity to build back better.

We must have a new stroke delivery plan, and the new plan must put an end to the regional variance that has existed since the introduction of the last delivery plan. But more importantly, we have to ensure that we focus on implementing the recommendations of the stroke cross-party group to reconfigure our existing units into hyper acute stroke units. I urge Members to support this by supporting the motion. Thank you. Diolch yn fawr.

Thank you. Can I now call on the Minister for Health and Social Services, Vaughan Gething?

Thank you, Deputy Presiding Officer, and I want to thank Dai Lloyd and Members for bringing this important issue to the Chamber, and for Members' contributions. I have listened to what the speakers had to say and I am generally supportive of the motion.

We are aware, as indeed many speakers have set out, of the impact that COVID-19 has had on stroke services since the earliest days of the pandemic. You'll recall that I have frequently highlighted the reduction in admissions of people coming into our hospitals with stroke, not because the public health had rapidly and miraculously improved, but because people were avoiding the service. We have worked diligently with our health boards, guiding planning activity to try to alleviate this impact.

Last May, in our essential service guidance, stroke and transient ischaemic attack services for the population were recognised as being essential in the face of the overwhelming pressure upon our NHS. The framework we provided was designed to help organisations and services to deliver stroke services during the pandemic and the subsequent phases. We wanted to maintain the integrity of stroke services and patient outcomes, alongside acute COVID-19 care. That framework includes guidance on secondary prevention and rehabilitation to minimise long-term disability, support for carers, and, indeed, life-after-stroke services. We have consistently set out messages with the public to try and encourage all of us to continue to attend emergency departments for serious or life-threatening illnesses, such as stroke, throughout the pandemic.

We do, of course, remain committed to improving support for stroke survivors, and welcome the Stroke Association's 'Stroke recoveries at risk' report. Last year, we announced an additional £1.4 million for rehabilitation services for all people at risk of losing their independence, and we published our rehabilitation framework to help organisations to plan for those rehab services during and following the COVID-19 pandemic.

I note the calls for a new stroke delivery plan. Clearly, it isn't possible to develop such a plan in the time left to us before the pre-election period, and I don't think we could honestly rely on a new Government, yet to be formed and determined by the voters of Wales, to adopt a strategy decided before they're elected. It's possible that a new Government may want to focus on matters differently. So, that will be for a new Government.

We have rolled forward the current approach, and that would mean that the current approach is in progress. That means it's been extended to March 2022, and a new plan would be ready at the start of a new Senedd term, to be ready for implementation from March 2022 when the extended plan comes to an end. That will allow for reflection on the lessons learned and new models of care used during the pandemic.

It must also fit in, and, I believe, take advantage of the opportunities set out in 'A Healthier Wales'. These include the development of the national clinical framework and the NHS executive function, and I welcome the recognition Dr Lloyd provided for the clinical lead for stroke services in Wales, taking on board the excellent work done by his predecessor. And it should also properly consider the recommendations of the cross-party group on stroke, and the Stroke Association's 'Stroke recoveries at risk' report.

I welcome the focus many Members have had on stroke service reform, and in particular the hyper acute units. We already have a number of these in place across Wales and the challenge is having more of them to cover the rest of the country. That will require specialisation and fewer admitting stroke units in the country, but the evidence is clear that, in doing so, we will improve outcomes, and that specialisation must also go hand in hand with the improvement in wider community and rehab services that all speakers have recognised.

So, I welcome the debate, and on a personal note, I'll just remind Members that my own father recovered from several strokes and eventually lost his life to a stroke, so I do understand the need and the benefit from a further improvement in stroke services. While I'm not able to support the motion in its entirety, I'm certainly supportive of the sentiments and where Members from across the Chamber politically want to go. The Welsh Government will therefore be abstaining in the vote later today.

Thank you. I now call on Rhun ap Iorwerth to reply to the debate. Rhun.

Thank you very much, Deputy Presiding Officer, and thank you to everyone who has participated in this very important debate. I would like to thank the Stroke Association for the work they have done over the last few months. The document on stroke recoveries at risk that was produced back in September is a very valuable contribution in terms of measuring the impact of the pandemic on services.

We know that the pandemic has made it more difficult for those affected by stroke to access the services that they need. We know how important effective and early treatment is, and not only is that difficulty in accessing care impacting on how well people recover physically after stroke, but it also has an impact on their mental health and well-being too. Now, the situation has been described very effectively by those who've contributed to this debate today, and I thank them all.

The motion before us calls for us to ensure that health boards are supported in maintaining stroke services at these difficult times, given the context of the pandemic. But the main demand on the Welsh Government is clear: we need a national stroke plan. Because what the pandemic has done, if truth be told, is to place even more pressure on services that were already under pressure, and now, more than ever, we need a plan showing a way forward to ensure that people, wherever they are in Wales, can access stroke services of the highest quality.

I'm grateful to the Minister for his comments. I also recognise the huge pressures that he referred to on services as a result of the pandemic, and that, inevitably, has had an impact. I, of course, also note that the Government and the Minister have told us that the current plan will be extended until 2022 because of COVID, and that work is ongoing on what will happen following that. But I don't hear that work is being done now to prepare for a national delivery plan of the kind we need, to be actioned by whoever is in Government. And I would like to see consensus being built across political parties, and that work could commence on that plan now. And that's the kind of commitment that I would've hoped to have heard from the current Minister, who, I assume, hopes to be Minister following the election too. We need that new plan, we need something that is more robust in terms of a commitment, rather than just continuing beyond 2022.

Deputy Presiding Officer, the cross-party group has done a lot of work on this. It's almost a year since the group consulted on how the current stroke plan has been delivered and that report was published in April. The fact that our main focus at that time was on the general response to the pandemic that had just hit us doesn't take away from the importance of that report and the conclusions reached by our inquiry. Yes, it identified very good practice, elements of the current plan that have been very successful, particularly, one has to say, in terms of the preventative work, but there is still too much inconsistency in terms of the service. It's clear that there's a lot of work to be done to strengthen governance structures in relation to stroke service delivery. 

And once again, we've heard how important it is that we move up a gear in terms of this work, to ensure that stroke sufferers in Wales receive the support that they need. I am confident that the Minister—who agrees with the sentiments, as he said, of this motion, although he didn't quite give the answers we would've hoped to have heard—has heard the arguments made very clearly. Once again, it's very important that they're aired here in the Senedd.

Thank you. The proposal is to agree the motion. Does any Member object? [Objection.] I see an objection; therefore, we'll vote under this item at voting time.

Voting deferred until voting time.