Stroke Services

Opposition Day — [16th Allotted Day] – in the House of Commons at 1:31 pm on 11 July 2007.

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Photo of Michael Lord Michael Lord Deputy Speaker (Second Deputy Chairman of Ways and Means) 1:31, 11 July 2007

We now come to the first debate on the Opposition motions. Mr. Speaker has selected the amendment in the name of the Prime Minister.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health 1:40, 11 July 2007

I beg to move,

That this House
notes that stroke is the third most significant cause of death and the leading cause of adult disability;
believes that stroke prevention and care have received insufficient attention despite £2.8 billion in direct care costs to the NHS;
welcomes the report of the National Audit Office (NAO), Reducing brain damage: faster access to better stroke care, HC 452, and the subsequent Report from the Committee of Public Accounts (PAC), of the same title, HC 911; further welcomes the Government's publication of a consultation on a national stroke strategy;
commends the Stroke Association, the Different Strokes charity and the Royal College of Physicians in raising awareness of stroke and the needs of stroke patients and survivors;
calls for the rapid implementation of the NAO and PAC recommendations thereby saving over 10 lives a week, delivering high-quality stroke care and securing value-for-money for NHS resources;
is concerned at the continuing deficiencies in stroke care and wide disparities in access to specialist stroke services disclosed in the 2006 National Stroke Audit published in April 2007; and urges the Government to give priority and urgency to the measures needed to deliver improving outcomes for stroke patients.

I am grateful to my colleagues for permitting me to use Opposition time to raise the important issue of stroke. I declare an interest as chair of the all-party parliamentary group on stroke, and I am also grateful to the Secretary of State and his colleagues for their support of the all-party group and for the Government's amendment. Unfortunately, I cannot prefer their amendment to our motion, because the latter faces up to the reality of international comparisons in stroke care and the wide discrepancies and deficiencies in it across the UK. I wish that we could have had a combined motion, because the purpose of this debate is not to engage in partisan argument, but to raise the priority of stroke care. It has been more than four years since we have had a debate on stroke in this House, including in Westminster Hall, so it is right to do so now.

I wish to pay tribute to some people who have been instrumental in raising the priority of stroke. There are voluntary organisations, including patient representative groups such as the Stroke Association and Different Strokes, and national organisations, such as the Royal College of Physicians, which through the National Sentinel stroke audit has brought forward much vital information about the quality of stroke services and helped to push forward the improvements that have been occurring. I do not want to leave out clinical leaders such as Tony Rudd at St. Thomas', Peter Rothwell in Oxford and Gary Ford in Newcastle, or the work of the Department of Health in the past 18 months, led by Roger Boyle, the national clinical director, and the team of officials.

Nor should we ignore the role of the National Audit Office. The report that it produced in November 2005 was a remarkable example of the value of the NAO, not only in considering issues of value for money and public expenditure, but in examining how services can be improved in ways that have radically changed attitudes in the Government about what can be achieved in stroke care.

Photo of Edward Leigh Edward Leigh Chair, Public Accounts Committee, Chair, Public Accounts Committee

My hon. Friend kindly mentions the NAO report and I am proud of the work that it and the Public Accounts Committee have done in this area. I hope that we can do for stroke what we did for methicillin-resistant Staphylococcus aureus in bringing it to the forefront of the political agenda. I hope that we are now doing that for dementia, as well. Will he comment on our particular view that so many people are left debilitated, and therefore become an increased cost to the NHS, because of the lack of early scans in hospitals?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I am grateful to my hon. Friend for the work of not only the NAO but the Public Accounts Committee, which has followed up on the issue in the same way as it followed up the original inquiry into health care-acquired infections. It revisited that subject and made further important recommendations, which have helped to raise the importance of the issue. He makes an important point: one of the NAO's recommendations was the need for immediate access to screening.

At the conference organised by the NAO last October, at which my hon. Friend Mr. Leigh spoke, Professor Anthony Rudd outlined the 2006 National Sentinel audit results and explained that across England, Wales and Northern Ireland, 226 hospital sites were offering CT scanning, but only 18 per cent. were able to provide scanning within four hours. On weekdays, the vast majority of trusts were able to do a scan within 48 hours, although 7 per cent. could not. However, at weekends, 35 per cent. were taking longer than 48 hours. So scans for stroke patients are being delayed, even though we know that time lost is brain lost in those circumstances.

At that same conference, Professor Norrving from Lund university in Sweden said that his country had a virtually 100 per cent. delivery rate for CT scans within 24 hours and Professor Bladin from Melbourne, Australia described how all patients at his hospital have immediate access to scanning. Those international comparisons should serve to demonstrate to us what a dramatic difference there is in the quality of stroke care being provided in this country compared with some of the leading examples across the world.

Photo of Tim Boswell Tim Boswell Conservative, Daventry

My hon. Friend is rightly concentrating on acute care, but does he agree, given his stated interest in public health, that it is important for the health and welfare of the nation that, wherever possible, we avoid stroke incidents at source? There is still a huge national problem of undiagnosed, undetected and unremediated hypertension. Will he encourage the Department to do everything possible, through GPs and otherwise, to ensure that that is tackled, alongside the acute services to which he rightly draws attention?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I am grateful to my hon. Friend. I was not intending to dwell on that important point, but the evidence, not least from Stroke Association surveys, is that the public have far too limited an awareness of what stroke is. They have become confused about the issue and perhaps just a bare majority understand that a stroke is a brain attack. Even fewer have a clear understanding of what leads to a stroke. In recent examples, such as the Food Standards Agency's campaign on salt reduction, raising the public awareness of the need to reduce salt intake has been focused on the risk of a heart attack. That is valid, but it was done on the basis that the public did not understand the relationship between salt intake, hypertension and stroke. In fact, in terms of mortality and morbidity, stroke is the greater risk, so we need to work harder on that.

The quality and outcomes framework for general practitioners rightly includes the management of hypertension, but—as my hon. Friend suggests—many people do not yet know their blood pressure and, in cases in which it is appropriate, are not properly monitored or attempting to address the problem through diet and exercise or even medication. We need to make that happen, because reducing the incidence of stroke must be one of our key priorities. The awareness of stroke and how to prevent it should form part of our strategy, and the NAO made that clear.

Hon. Members:

Hear, hear.

Photo of Andrew Turner Andrew Turner Conservative, Isle of Wight

My hon. Friend draws attention to the need for better care for stroke sufferers. Some 110,000 people suffer from stroke each year, and last December I was among them. I was extremely lucky, because I received excellent care from the specialist stroke unit at St. Mary's hospital on the Isle of Wight. I owe them so much for that and would like to thank them all publicly for it. Does my hon. Friend agree that other people in other places need care as good and as local as ours is on the island?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I am delighted, on behalf of colleagues on both sides of the House, to welcome back my hon. Friend. I know that he has already been active in his constituency, but we are delighted to have him here. I share entirely his view, and we should not forget the many staff working in stroke care who are delivering excellent care. However, we need to be aware of the lack of stroke physicians and services. As the Sentinel audit recently made clear, we have limited numbers of consultant nurse posts and a quarter of hospitals have no specialist stroke nurses available. Those are essential parts of the process of delivering high-quality stroke care. However, I entirely share my hon. Friend's view about the need to match what has been achieved on the Isle of Wight.

Photo of David Jones David Jones Shadow Minister (Wales)

Does my hon. Friend not agree that one of the most lamentable aspects of the National Sentinel audit to which he refers is the state of affairs prevailing in Wales? Only 45 per cent. of eligible hospitals in Wales have a specialist stroke unit, compared with a figure of 97 per cent. in England. The conclusion reached was that patients in Wales are more likely to die from stroke, and that, if they do survive, they will have higher levels of disability than patients in England or Northern Ireland. Does that not reflect the lamentable state of affairs in Wales and a failure on the part of the Welsh Assembly Government?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I am very grateful to my hon. Friend for making that point. I was about to come to the findings of the 2006 National Sentinel audit of stroke care. The first of its top 10 recommendations is that

"The Welsh Assembly Government, Commissioners, Managers and Clinicians should urgently address the growing divide in quality of stroke care between Wales and the rest of the United Kingdom. The highest priority should be given to the development of specialist stroke services, both in hospital with full provision of stroke units and in the community."

I am afraid that it felt compelled to say that the very low rate of stroke unit admission in Wales was unacceptable. My hon. Friend, given his responsibilities, will be pressing for precisely that priority to be given in Wales. It is important for us to recognise that today's debate—from our point of view—is about stroke services in the United Kingdom, not just in England. I hope that the Government hear that message and communicate it to the Welsh Assembly Government. I know that my hon. Friend will do exactly that.

In looking at the Sentinel audit, I do not want to diminish the progress that is being made, in part, precisely because stroke physicians have been pressing for it. For example, there has been an increase in the number of specialist stroke units in hospitals in England—up to 91 per cent. from 79 per cent. in the previous audit—but only 62 per cent. of patients are admitted to a specialist stroke unit. However, that is an increase on previous figures. There has been an increase in the number of neurovascular clinics, which means that transient ischaemic attacks—mini-strokes, as it were—are increasingly followed up in clinics. However, we need to do more. As I said, there are too few stroke physicians and too few specialist stroke nurses, and only 22 per cent. of hospitals have an early supported discharge team.

One central issue in the development of stroke care is acute care—treating stroke as an emergency. Here, I pay tribute to the Stroke Association, which ran a campaign entitled "Stroke is a medical emergency" and uses the FAST protocol—the face, arm, speech test protocol—developed by Gary Ford and his colleagues at Newcastle university. The publishing and dissemination of such developments across the country is a vital part of raising awareness of the fact that stroke is an emergency.

Of course, we must not allow the situation to arise whereby, when stroke symptoms develop, they are identified, an ambulance is called for and it takes the victim to an accident and emergency department, only for time simply to pass and brain function to be lost. We must take urgent action to ensure that that does not happen. I have been involved in the all-party group on stroke, of which I am now chairman, since its inception in early 2003, and we have argued for the taking of such action since early 2004. The protocols and structures required have become increasingly clear; indeed, on visiting other places throughout the world—the NAO visited Australia—one can see precisely how they can be achieved.

The Sentinel audit tells us how far we have come. In Australia, after immediate CT scanning, all those patients for whom thrombolysis is appropriate get access to it. About 10 per cent. of stroke patients get such access. According to the audit, however, in the preceding year 218 patients in this country were thrombolysed, representing 0.2 per cent. of all such patients. That is an enormous disparity. Some 18 per cent. of hospitals in this country still have no specialist acute stroke unit, and only 10 per cent. of hospitalised stroke patients are admitted directly to an acute stroke unit.

Those two elements are central: patients should be admitted directly to a unit capable of undertaking immediate CT scanning; and, where appropriate, they should undergo thrombolysis. In any case, such patients should be admitted directly to specialist stroke units, and should in virtually all cases spend their time in hospital in such a unit. We have known about these issues for some time, but we have by no means made sufficient progress on them. The NAO report was clear on the benefits that could accrue from treating such cases as emergencies.

The point was brought home to me some three or four weeks ago, when I attended the memorial service for Sir Arthur Marshall. After the service, a gentleman named Ivan came up to me and said, "You're interested in stroke and involved in Westminster's all-party group on stroke—I'd like to help. I used to work at Marshall Aerospace, and I woke up one night a year or so back and I couldn't speak, couldn't feel anything and couldn't move the left side of my body. I was taken to Addenbrooke's hospital"—Addenbrooke's is in my constituency—"and I had a CT scan straight away and I was thrombolysed." Presumably, he is one of the 218 patients to whom I referred earlier. I looked at him and said, "Well, it's clearly gone very well." The extent of his subsequent loss of brain function is that occasionally he has pins and needles in his left hand. Previously, he would probably have had full left-side paralysis. So, dramatic differences have been made, and we need to be aware of the scale of what we can achieve if we take such steps.

Photo of Hugo Swire Hugo Swire Chair, Speaker's Advisory Committee on Works of Art

My hon. Friend is making a very good point. It is absolutely critical that we get patients scanned as quickly as possible, but in rural areas such as my own in Devon, that is not always possible. Will he join me in congratulating Devon air ambulance on its continuing work? It gets no money from the Government whatever, but it plays an absolutely critical role in getting people from remote areas to the hospitals that can treat them quickly.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I am very happy to share my hon. Friend's support for the air ambulance service, which also plays a central role in parts of East Anglia. As I drive into Exeter, I always note the shop that the service has there. Perhaps I will stop next time I pass it, in order to support Devon air ambulance. The fundraising for the service provides a dramatic benefit. The health service supports the paramedics and the other medical and clinical aspects of the service, but putting the helicopter in the sky and maintaining it is funded entirely from voluntary support.

The NAO report makes certain things very clear. For example, it estimates that admitting stroke patients to, and treating them in, a stroke unit could save up to 550 lives. It says that transient ischaemic attacks should be followed up rapidly in a clinic, given that there is a 20 per cent. risk of a stroke immediately following a TIA. Such action can forestall and prevent major strokes. For many patients who suffer from artery occlusion, sclerotic artery surgery produces benefits within 14 days. Interestingly, the PAC and the NAO identified that such changes, which would substantially improve outcomes for patients, would not cost the NHS more. If all those measures were implemented, there would be an overall saving to the NHS, not an additional cost. The aim is a change in the design of services, and to get the NHS to respond by prioritising service delivery, which would be better for patients and better for the NHS in value-for-money terms.

Where do we go from here? One purpose of the debate is to raise the profile of the issue of stroke. Another purpose was to try to make sure that the Government publish their consultation on a national stroke strategy before the House rises for the summer, but I am delighted to say that the Secretary of State did that on Monday, which means that we can debate it. Happily, plenty of Opposition Members are present, and a few Labour Members are too, but I hope that more colleagues are listening to the debate, or will read it.

I want to encourage colleagues in all parties to include in their constituency engagements a visit to their local hospitals to talk about the stroke services that are provided. In addition, I hope that hon. Members with a branch of the Stroke Association in their areas will talk to its members—for myself, I am patron of the Stroke and Dysphasia Association in Cambridgeshire. We should all make sure that we have conversations with everyone involved over the next three months, as the consultation on the national stroke strategy ends on 12 October, which means that the scope will be limited when we return after the recess.

I welcome the Government's publication of the document "A new ambition for stroke". Clearly, it was a very inclusive process, and many of the people I know to be leaders in the field were engaged in the working groups that led to the document. It is very important that the Government show that priority is now attached to stroke. Unfortunately, a top-down system such as the NHS needs to show top-down priority, so it is important that the Department of Health has published a document.

I do not want to be at all churlish but, although the document published on Monday sets out very well the sort of ambitions that we must have for a stroke service in the future, there were few surprises or novelties on top of what the National Audit Office produced 20 months previously. I am therefore slightly at a loss as to the purpose of having a consultation on a national stroke strategy now, given that the document makes it clear that the Government know what they think the stroke service should be like. As I understood it, the Government's document was intended to turn the NAO recommendations of 20 months ago into an action plan. It was supposed to show how we should get from here to there, but in many respects the document that has been produced does not achieve that.

As some of my hon. Friends made clear earlier, the availability of CT scanning is absolutely fundamental. Does the national stroke strategy make clear how, for example, diagnostic contracts and the like will be used to ensure that CT scanning is available 24/7? The strategy presents the model of a hub-and-spoke system, as we always knew it would, but its parameters are still too wide. For instance, we need to be clear about the scale of population to be covered by such a system, and the length of time that people will stay in each hyper-acute stroke unit. We also need to be sure that such questions are followed up in individual locations.

A month ago, Manchester started work on producing its local service plan. The document that has been produced there says that patients admitted to a hyper-acute stroke unit should be scanned and given immediate treatment—including thrombolysis, if necessary—and also be given access to the earliest possible rehabilitation. However, what is interesting is that the document suggests that people need spend only 24 hours in such a unit. I have visited many places across the country, and talked to a lot of senior managers. They tend to imagine that creating better acute care for stroke sufferers will involve concentrating stroke units into larger units at specialised hospitals. In contrast, the people in Manchester have not adopted that approach. Instead, they seem to be saying that the hyper-acute phase needs to be concentrated, but that patients should be referred back to their local hospitals 24 or 48 hours later; each such hospital should have a specialist, multi-disciplinary stroke unit, where hospital treatment can be concluded and people discharged early.

That is different from the approach adopted by many in the NHS around the country. Sir Ara Darzi's report, "Healthcare for London: A Framework for Action", does not appear fully to have taken on board the thinking in Manchester, as it continues to propose a limited number of specialist stroke units in a limited number of specialist hospitals. That does not have to be the structure at all.

Photo of James Gray James Gray Conservative, North Wiltshire

My hon. Friend is making an extremely interesting point. In my area, Chippenham hospital has one of the best stroke rehabilitation units in the country, and it recently won the Sentinel award for the best in England. However, it is not in the same PCT as Swindon's Great Western hospital, which is where the acute unit is located. A number of patients have been stuck in the acute unit because Wiltshire PCT cannot afford to move them to the rehabilitation unit down the road. Is that example not especially worrying?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

I am grateful to my hon. Friend, as he has illustrated very well the point that I hope I was making. His intervention leads me to the related point that a critic of the national stroke strategy would want to make sure that the incentives and levers available are being used to deliver the standard of stroke care that we want to achieve. For some time we have argued that unbundling the tariff—that is, dividing the acute phase from the subsequent rehabilitation phase—is important. The Department of Health has done that, but the structure proposed in Manchester would require dividing the tariff into three phases: the hyper-acute first 48 hours, the subsequent initiation of rehabilitation and support, and then rehabilitation in the community.

The tariff is anything but clear about how it will support and incentivise the process of commissioning. Unfortunately, if it does not reflect the best possible standard of care, it can substantially inhibit the introduction of such care. For example, a manager at Kingston hospital told me that his hospital wanted to be able to provide acute stroke care in the form advised, but that the tariff did not support that. We therefore need to concentrate on the tariff: although I hesitate to talk about something that can be a preoccupation for NHS anoraks, it is very important that we get it right.

The document "A new ambition for stroke" contains many elements that read extremely well and are clearly the right things to do, but one or two criticisms remain. For example, GP protocols for the referral of patients after a transient ischaemic attack were set out first in the national service framework for older people in 2001. They were supposed to be implemented across the country by April 2004, but now they are being repeated in a document published in July 2007. It is not good enough for policy makers to publish documents which reiterate the standards of service that we want to achieve but find that progress is inadequate and that the available levers to ensure that those standards are achieved are not being used.

Obviously, the Secretary of State cannot add very much to a document that he published on Monday, but his foreword says that it is the "first step" to a national strategy. It is not the first step—it is about the 13th, and we need the strategy to be turned, rapidly, into action. I have talked to ambulance service staff across the country, and they know that in a few months they will be delivering emergency patients in acute need to hospitals. That is already happening in some places, but it will be no good if the NHS fails to treat patients as emergencies from that point onwards. The evidence is absolutely clear that such patients must be treated in specialist units, and that subsequent support by multi-disciplinary rehab teams in the community is vital.

Too often, stroke patients tell us that they feel that going out into the community is like falling off the edge of a cliff. They leave a supported service in a hospital context and move to a place where the social services and the NHS services do not join up and the necessary teams do not exist. From the Healthcare Commission's report, we know that six months after leaving hospital 50 per cent. of patients feel that they are not getting the standard of care they should, and that 12 months afterwards the number has risen to 80 per cent. Half the stroke patients who want to be involved in a local support group are not; 28 per cent. feel that they are not getting help when they need it to deal with mobility problems; 49 per cent. do not receive help with emotional problems when they need it; and 26 per cent. feel they are not given help with speech problems when they need it. It is tragic that large numbers of physiotherapists and speech and language therapists cannot find jobs in those services when they leave college, even though we know there is a specific need for them to provide such therapy for stroke patients. Their participation is needed in community multi-disciplinary teams.

At the risk of borrowing a phrase, the purpose of the debate is to say that a lot has been done, but there is a lot more to do.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

It was just to welcome the new ministerial team to their onerous but rewarding duties.

As I said earlier, the Secretary of State's document is not the first step towards a national stroke strategy; the strategy should rapidly be put in place, because we already have the evidence base for it. International comparisons tell us just how far we need to go and how important it is that we make rapid progress. Even on adjusted mortality data, there are differences of between 10 and 30 per cent. between the UK and a range of European countries. We have higher than predicted levels of mortality from stroke, so we need to bring the rates down and match the best in Europe and, in this context, the best in countries such as Australia. We need to do it now.

I share Professor Roger Boyle's view, expressed in his introduction to "A new ambition for stroke". He said:

"As a nation we spend more money than most on stroke services—and a greater percentage of our health budget—yet, overall, we have worse outcomes."

We spend £2.8 billion a year on direct care costs in the NHS—a large part of the overall budget—and, in terms of stroke services, we have a real possibility of using that money more effectively. We should adopt the recommendations of the NAO and the PAC and work with stroke patients, the Stroke Association and others to deliver better services. We must enable stroke physicians, stroke nurses and staff across the NHS to provide the quality of stroke care that they know is achievable, but that they feel unable to achieve at present.

I commend the motion to the House.

Photo of Alan Johnson Alan Johnson The Secretary of State for Health 2:13, 11 July 2007

I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:

"commends the dedication and energy of the doctors, nurses, therapists and other professionals working tirelessly to help the 110,000 people affected by stroke each year;
notes the significant recent progress made in stroke care with falling premature mortality rates and more people treated in stroke units than ever before;
further commends the work of the National Audit Office, the Committee of Public Accounts and the All-Party Parliamentary Group on Stroke in scrutinising progress on stroke care and recommending further improvements;
welcomes the opportunities offered by new treatments and the growing evidence on effective rehabilitation;
celebrates the investment of £20 million in the UK Stroke Research Network to help ensure stroke medicine fit for the 21st century;
further welcomes the additional training places made available in stroke medicine;
further welcomes the new guide and tools available to support improved commissioning of stroke services;
thanks the Stroke Association, Different Strokes, Connect, the Royal College of Physicians and over 100 individuals for their work in developing proposals for a new stroke strategy;
and commends the consultation document 'A new ambition for stroke.'."

I start by paying tribute to Mr. Lansley for his work over many years, both in a personal capacity and as chair of the all-party stroke group, in raising awareness of the terrible impact that strokes can have upon individuals and their families. He was kind enough to point out that we pay tribute to his work in our amendment, but he rather modestly neglected to mention the all-party group in his motion. I welcome the spirit in which the hon. Gentleman opened the debate. This is an issue where parliamentarians can get together to move things forward. There are many such subjects in health, but this is one of the most important on which we need to find consensus.

On behalf of Members on the Government Benches, I echo the hon. Gentleman's welcome back to Mr. Turner. We have missed him since December and are pleased to see him back looking so fit and well.

Every year, 110,000 people in England have a stroke, which is one every five minutes, so given the time available for this debate, between 15 and 20 people could have a stroke during its course. With 50,000 deaths, strokes represent the third biggest killer after cancer and heart disease—killing three times as many women every year as breast cancer. Strokes are the greatest cause of severe disability. More than 300,000 adults in England suffer lasting disabilities as a result of a stroke. The cost to our economy runs to billions—but that is, of course, immaterial when set against the terrible turmoil that befalls survivors and their families, whose lives can be devastated, literally overnight, by such attacks.

I disagreed little with the comments of the hon. Member for South Cambridgeshire; his analysis was right, in terms of both the debilitating nature of strokes and, more important, the need to give stroke prevention and care much greater attention and priority. It is true that the Department of Health has focused particularly on cancer and heart disease, which are the country's two biggest killers, and we have made huge progress. Cancer deaths are down by 15.7 per cent. since 1997, saving more than 50,000 lives; while cardiovascular deaths are down by almost 36 per cent., saving almost 150,000 lives.

At the same time, attention has been paid to the third major killer. In 2001, as the hon. Gentleman mentioned, we published the national service framework for older people, pledging that every trust in England would have a specialist stroke service—a necessary target that has been achieved. We have also helped to improve standards. A recent study by the Royal College of Physicians showed that 95 per cent. of stroke units now have most of the necessary elements for a good-quality service, compared with just 72 per cent. in 2001. Our efforts to improve public health—on smoking, fitness and obesity—have played a vital role in our quest to reduce the number of strokes. Since 1993, deaths from strokes have fallen by 30 per cent. for over-65-year-olds and are down by 23 per cent. for those under the age of 65.

I fully accept, however, that there is more we must do to remedy the failings highlighted in the reports by the National Audit Office and the Public Accounts Committee. We are able to build on strong foundations. We now possess far greater knowledge about lifestyle factors and how they can cause strokes than we did 10 years ago. We have learned more about techniques in rehabilitative long-term care and how acute care can be managed in the community. Technology has advanced considerably, particularly for brain imaging and scanning, so we can now dramatically reduce the number of people killed or left severely disabled by a stroke. Through greater investment and reform, the NHS infrastructure is now equipped to provide the rapid response reactions that strokes require.

In response to the NAO and PAC reports, Professor Roger Boyle, the national director for heart disease and stroke, produced an excellent report, "Mending hearts and brains". I point out to the hon. Member for South Cambridgeshire that it is a consultation document to enable us to arrive at a strategy, and I shall take his comments into account as part of the consultation. Yes, there are issues in respect of tariffs that we have to tackle, and the all-party group has raised many issues that are not fully covered in the text of Roger Boyle's report, but the document turns an NAO-PAC issue into something that has had input from a vast variety of physicians, as well as from discussions with the Stroke Association and other voluntary groups, so that we could present it before arriving at a final strategy by the end of the year.

After detailed follow-up work by Professor Boyle and his six clinically led specialist project groups, my Department published a draft stroke strategy. I take this opportunity to thank the many leading clinicians and voluntary sector organisations who took part in the project groups, especially the Stroke Association, Connect and Different Strokes. I hope that Members on both sides of the House will give the document careful consideration and take the advice of the hon. Member for South Cambridgeshire to use the impending recess to contribute fully in their constituencies so that we can produce a final strategy by the end of this year.

I do not believe that improving our performance in this area is related purely to funding. As the hon. Gentleman said, England spends more on stroke services than many other nations, both in absolute terms and as a share of total health spending, and yet we do not get the best results. Many hospitals and primary care trusts, such as King's College hospital, which I visited on Monday, are already achieving great things. We know that clot-busting thrombolytic drugs can make the difference between someone who has suffered a stroke leaving hospital on their feet or in a wheelchair. However, overall in England last year, a tiny percentage—less than 1 per cent.—of patients received thrombolysis. King's has already achieved rates of 18 per cent. this year. The hon. Gentleman referred to Australia, which is achieving 10 per cent. As a result of a dramatic reconstruction along the lines suggested in the consultation document, Ontario is now achieving 37 per cent. thrombolysis, which is up from 3.2 per cent. just four years ago.


Connect, the communication disability network, is a charity which has as one of its aims to promote the voice of aphasia - a communication disability caused by stroke, among other things. Alan Hewitt

Submitted by Alan Hewitt

Photo of Hugo Swire Hugo Swire Chair, Speaker's Advisory Committee on Works of Art

I think that I am right in saying that there are 640 patients per stroke consultant, compared with 360 patients per cardiac consultant. Does the Secretary of State hope to reassess and address that figure in some way?

Photo of Alan Johnson Alan Johnson The Secretary of State for Health

Yes, it is absolutely essential that we do that. I will come on to say something about that when talking about the report. That is obviously a mismatch. I believe that Professor Roger Boyle says in his report—he certainly said it to me—that the whole stroke area is where heart disease was 10 years ago. We need to bring it up to today's levels, particularly in terms of the number of consultants and clinicians who specialise in the area. The key to success will be ensuring that more people do the right things at the right time at all stages of the patient pathway. Strokes, perhaps more than any other illness, are time-critical, so speed is of the essence.

There are three elements to the consultation report. First, there is prevention. Historically, strokes have been a poorly understood condition. They are inevitably linked to the over-65s and to old age. In the past, the fatalistic approach was to wait until a stroke occurred and then deal with the consequences afterwards—at great personal cost to the victim, and, incidentally, greater expense to the health service. About one in four long-term beds in the NHS are occupied by stroke patients.

Some strokes have genetic causes, but many people suffer needlessly because they do not recognise that they are risk or know what they can do to lessen that risk. Early action can help to prevent many strokes. We must ensure that better co-ordinated support is available for those at risk so that they are encouraged to monitor their blood pressure and cholesterol, take regular exercise, stop smoking and reduce their salt intake.

We must refute the myth that strokes affect only older people. One in four victims are under 65. We must also promote awareness among communities that are most at risk. People from African, Caribbean or south Asian backgrounds are twice as likely to suffer a stroke as the rest of the population. We have already funded some pilot publicity campaigns, together with the Stroke Association, and will look very carefully at the results.

Some people do not know how to recognise the symptoms of a stroke, either in themselves or in others. That can prove tragic when someone has suffered a minor stroke—known as a transient ischaemic attack or TIA. TIAs indicate a serious problem: part of the brain is not getting enough blood. Without treatment, around one in four people will go on to have a full stroke—most within the following few days. Provided that people are aware of that, it can be prevented—sometimes with something as simple as aspirin and sometimes with an operation to unblock the arteries in the neck. We need a radical transformation of attitudes and actions to prevent strokes from occurring. The consultation document sets out an ambitious new vision: people who are assessed as being at high risk of a stroke should be seen by specialists and scanned within 24 hours.

Secondly, we must ensure that there are quicker emergency treatments for those who have suffered from a stroke. Advances in technology mean that we can dramatically reduce the number of people who die or are left with severe disability after a major stroke—again, provided we get to them quickly enough. There is a window of only three hours in which patients must be seen, scanned and treated. With 2 million neurons lost for every minute of delay, we need a much faster pathway to treatment, as identified in Professor Boyle's report. With all paramedics properly equipped to identify the patients in greatest need and proper specialist care readily available, we can resolve the problem.

On Monday, I saw the impressive speed with which people were moved from the accident and emergency department to a stroke unit at King's, having been seen by a specialist and given a scan on the way. Professor Boyle says that if strokes were treated as emergencies, more than 1,000 stroke victims every year would regain independence, which makes a compelling case for reconfiguring acute services to ensure that highly specialised care is concentrated at centres that can offer round-the-clock expertise.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

That is an interesting point. I was talking to the chair of Peterborough and Stamford Hospitals NHS Trust, which does not directly serve my constituency, but serves people around Cambridgeshire. The service design that he and people in a number of other places are looking for is direct admission of emergencies to the acute specialist stroke unit. I know that in Addenbrooke's hospital in my constituency, people are brought to the accident and emergency department and then transferred to the specialist unit, but direct admission is what we should be aiming for. It does not make sense for the specialist team to have to go down to the accident and emergency department to collect somebody.

Photo of Alan Johnson Alan Johnson The Secretary of State for Health

That is interesting, as was the view expressed about Manchester. King's has a triage nurse in the accident and emergency department. I guess that, in effect, the system means that someone is in the stroke unit as soon as they come in, although it happens to be located in a different place. The philosophy is to get people through the system as quickly as possible, making sure that scans are available and that TIA is taken into account if appropriate. Having specialists available 24 hours a day, seven days a week is the key issue at King's and other such centres.

We should also look at improving ambulance response times. We are consulting about upgrading strokes from category B to category A events so that ambulances arrive within nine, rather than 18 minutes.

Thirdly, we must ensure that there is better aftercare for those who have suffered strokes. The best way to improve care for such people is by engaging with them and ensuring that they feed into the consultation, which is why we have produced an easy-to-read version of the document for stroke survivors who have communication difficulties. Often, stroke survivors say that they wish to be at home during the rehabilitative stages. Early supported discharge schemes get people home more quickly, provided that there is better rehab care available.

Recovering from a stroke can take many years. Our strategy needs to ensure that the NHS is able to remain on hand, helping patients to gain increased independence, with enhanced support available from local specialists, providing them with action plans and progress reports. There is still a huge gap between the number of cardiologists and the number of stroke specialists, as was mentioned in an intervention. We need to increase the work force capacity to resolve that, and we have already worked with the Stroke Association to fund an additional three specialist posts. We will invest in training 10 further specialists this year alone.

Having brought about huge reductions in cancer and heart disease, we must now promote the treatment of strokes to become our top priority. In the 1970s, England was the heart disease capital of Europe, but that has changed. We can, will and must ensure that a similar transformation takes place in this area. With record investment, new technologies and health professionals who are already gearing up to tackle this challenge we will succeed, thus truly transforming the lives and prospects of thousands of people and their families who are affected by this debilitating condition. I commend the amendment to the House.

Photo of Sandra Gidley Sandra Gidley Shadow Minister, Health 2:29, 11 July 2007

I, too, welcome the debate. However, the difficulty with going third, especially after Mr. Lansley has carried out his usual detailed and forensic analysis of the subject, is that quite a lot of one's material has been snitched. However, it is worth repeating several points. This will be one of those occasions when hon. Members on both sides of the House will speak as one, and I hope that we can work together.

Photo of Sandra Gidley Sandra Gidley Shadow Minister, Health

Well, I was going to start on a positive note.

According to a recent audit by the Royal College of Physicians, the death rate from stroke in a range of age brackets has fallen by approximately a third, which must be good news. Well over 90 per cent. of English hospitals now have a dedicated stroke unit. The vast majority of health boards and NHS trusts have achieved their targets, and stroke registers have been established in more than 60 per cent. of GP services.

Now comes the "but". We have heard about the problems caused when stroke patients who are admitted to hospital receive insufficiently rapid access to a stroke unit. I shall outline problems all along the patient pathway later, but there are general problems that have a great impact on stroke services. For example, people have difficulty accessing therapists and social workers. Although we are training loads of physiotherapists, we are not deploying them where they could benefit patients. It has been pointed out that the tariff for supporting stroke patients is inappropriate and there is no financial incentive for hospitals to provide stroke services subsequent to initial treatment. Most importantly, there is little public awareness of the problem. A quarter of hospitals have no form of senior stroke nurse specialist, yet the national clinical guidelines on stroke say that specialist stroke services should be available in the community as part of an integrated system of care to facilitate early supported discharge.

The new Health Minister who will sit in the other place recently had something to say about stroke services. In May, he pointed out that of the 30 hospitals in London providing stroke services, only four treated more than 90 per cent. of patients in a dedicated unit. He said that although patients should receive a CT scan within three hours, in only seven out of 30 hospitals did 90 per cent. of patients receive a scan within that time.

The number of patients receiving clot-busting drugs has been highlighted. My immediate assumption was that the situation was due to a lack of resources, but as hon. Members have pointed out, "A new ambition for stroke", which the Department released on Monday, rebuts that because, importantly, Professor Roger Boyle states:

"As a nation we spend more money than most on stroke services—and a greater percentage of our health budget—yet, overall, we have worse outcomes."

That raises serious questions. Given that the money and the national service framework for older people have been in place—a whole chapter of the NSF is dedicated to stroke services—what went wrong, and why was the money not targeted properly? We have hospitals such as King's that provide a brilliant service, so why have stroke clinicians and workers in other parts of the country had difficulty getting together and achieving the same sort of outcome? Have they been blocked by hospital management, or was there no initiative on the ground? If we are to move forward positively, it will be worth considering such basic questions to determine what has happened and how we can learn from the mistakes that have been made.

The problem with the NSF for older people was that no funding was attached to it. Perhaps money was in the system, yet people did not know how to access it. I surveyed several PCTs to determine whether stroke targets were being met. It was clear that a number of proactive people had used the NSF as a lever to get local health commissioners and PCTs to go a little further. Such a thing can be done, but we need to learn why in many cases that has not happened.

The real tragedy is that, according to the Stroke Association, approximately 80 per cent. of strokes are preventable. I am pleased that several Health Ministers are in the Chamber. It would be nice to have official notice of which Minister is responsible for public health and their specific responsibilities —[ Interruption. ] I welcome the Minister of State, Department of Health, Dawn Primarolo, to her job. It is difficult when people do not quite know which Minister to go to about what.

The public health aspect of stroke is important because there are many simple steps that can have an impact on outcomes relating not only to stroke, but to heart disease and cancer. According to the National Stroke Association, about 20,000 strokes a year could be prevented if health professionals and the public gave sufficient attention to awareness of people's blood pressure, determining whether people have a normal heartbeat, and stopping smoking. Other steps that can be taken are the usual culprits in messages on public health and healthy living: cutting down on alcohol, keeping cholesterol under control and following a healthy diet. It has been proven that simple things such as eating more fruit and vegetables can reduce people's risk of stroke. I hope that greater emphasis will be given to such messages.

Photo of Alan Johnson Alan Johnson The Secretary of State for Health

I cannot resist mentioning this. Will the hon. Lady have a word with the Lib Dem authority in Hull, which has cancelled the free healthy school meals service that was specifically aimed at tackling obesity and raising educational attainment? It is a great shame that the service has been cancelled, but perhaps she can influence the leader of the council.

Photo of Sandra Gidley Sandra Gidley Shadow Minister, Health

I notice that the programme was aimed at children, among whom the rate of stroke is low. I understand the Secretary of State's point about establishing healthy eating patterns, but I would like to know whether the meals were being eaten, because if healthy meals are not eaten, we have to look at the problem in a different way. If he sends me more details, I will follow that up.

Exercise is another factor. It is worrying that only 37 per cent. of men and 25 per cent. of women meet exercise guidelines. Even moderate activity can reduce the risk of stroke by up to 27 per cent. As has been suggested, people need to recognise the symptoms of stroke, so a public awareness campaign is needed. It is obvious when someone has had a full-blown stroke, but TIAs can result in minor symptoms. Patients who have had a TIA need to be examined by a doctor, because if they are treated properly we can reduce the overall impact of stroke.

We see the problem when we look at the timeline. A patient will first seek a GP appointment. The good news is that patients are supposed to be able to get an appointment within 48 hours. Although there can be problems if people do not ring their surgery at a certain time of day, access to GPs has generally improved. However, if a patient is not aware that their symptoms could be serious, they might write them off as something not worth worrying about.

There can be a lack of awareness among GPs. Even among GPs who are aware of the symptoms, a fifth do not refer TIA patients for further investigation, as was revealed in a recent survey. There have been attempts through the quality and outcomes framework to improve the situation, but things do not seem to be working at the moment. Only 55 per cent. of GPs say that they would refer TIA patients immediately.

If a patient is referred, there can be delay in accessing a clinic and getting the requisite tests. Only a third of people with TIA are seen in a clinic within 14 days, but the recommended time set out in most clinical guidelines is seven days. Attention is being given to improving patient pathways, but I hope that the obsession with the 18-week target, which in itself is a good thing, does not mean that attention is diverted away from the seven-day target, which also needs to be reached.

Photo of David Taylor David Taylor Labour, North West Leicestershire

Will the hon. Lady acknowledge that there has been great improvement in some hospitals? Just a few weeks ago, a family member who had a suspected small stroke went from the general practitioner's surgery to accident and emergency and on to a specialist stroke unit in another hospital in the city of Leicester within an hour or two. That shows the sort of service that can be provided, even by a large accident and emergency unit covering a million people in Leicester and the county of Leicestershire. That is a beacon for others, is it not?

Photo of Sandra Gidley Sandra Gidley Shadow Minister, Health

I understand that the hon. Gentleman has not been here for the whole debate. I do not know whether he was here for my opening comments, but his point was acknowledged: some places are beacons of excellence, and we should work towards ensuring that their standard applies in all places. If he has an excellent service locally, he is one of the lucky ones.

To return to the subject of the clinics to which patients who have had a TIA are referred, many of them are now run as one-stop shops. That can be a good thing, but sometimes, once tests have been performed, there is a delay in communicating the results to the GP. That is another part of the pathway that needs looking at. If attention is paid to the pathway, there is a strong chance that we will significantly reduce the number of people who have to call an ambulance because they have had a stroke. I, too, pay tribute to the Stroke Association for its campaign to have stroke treated as a medical emergency. In Hampshire, all the hospitals, the ambulance service and community nurses are working together to try to ensure that services are much more joined-up. They also work with groups that come into contact with patients soon after they have had a stroke, including St. John Ambulance and the Red Cross, to make sure that they are aware of the FAST—face, arm, speech test—campaign.

People have to recognise that they have had a stroke, and that can be a problem in itself. More public awareness would be helpful. Once the patient's condition has been recognised, there is still the problem that only 10 per cent. of hospitals have a system, like that at King's, which enables thrombolytic drugs to be administered quickly enough. As that system saves lives, we should really focus on it when considering how we can improve our services.

The clinically optimal model for stroke care is for care to be delivered in a specialised stroke unit, but we need clarity about what a stroke unit is. That might sound an odd question, but many stroke units have a high proportion of rehab patients, and a relatively small proportion of their resources are used to treat patients in their first couple of days in the unit. All the evidence seems to show that treating patients early delivers much better outcomes, so in many hospitals it may be a case of shifting attention or of providing slightly more resources for treatment at the earlier stage, because when the impact of the stroke is minimised, the long-term costs are reduced. According to Professor Boyle, that would make financial sense.

The hon. Member for South Cambridgeshire mentioned problems accessing scans—sometimes, people may be unlucky if they have their stroke at the weekend. The provision of stroke services is very much a lottery. In some parts of the country, systems are in place, everything works well and the process is smooth, so people in those areas will have a good outcome. In other parts of the country, the process is not so joined-up, and that is where joined-up working is really needed.

I want to talk about aftercare. A third of acute stroke patients are left dependent or moderately disabled and our aim must be to reduce that figure, and taking some of the steps outlined earlier in the debate would make that possible. During their hospital stay, patients have access to help and care, but when they go home, they must suddenly readjust their lives. Figures for south London show that three to 12 months after discharge, only 26 per cent. of patients in need received physical and occupational therapy, and 14 per cent. received speech and language therapy. If an individual cannot do the things that they are used to doing, or cannot communicate properly, it is very frustrating for them. That leads to problems with depression, and to problems for other people in the house who have to adapt to the condition, too. We have a network of local stroke clubs that do excellent work in helping people to feel that they are, in many ways, once more part of society, and I pay tribute to them.

Photo of John Horam John Horam Conservative, Orpington

I entirely agree with the hon. Lady about stroke clubs. She mentioned south London, which includes Bromley, an area that I represent, where there is a shortage of space for stroke clubs. It would be helpful if the Secretary of State put pressure on primary care trusts to give more space to those very simple groups, which do a huge amount of good.

Photo of Sandra Gidley Sandra Gidley Shadow Minister, Health

I appreciate the hon. Gentlemen's problem. Some of our local clubs are well funded by the people involved, but I appreciate that in other areas of the country that arrangement is not feasible or practical. Anything that helps the rehabilitation process should be considered. Often, there are rooms available that are not being used, and they could be used for such purposes. I ask that attention be given to aftercare. Perhaps we could use more therapists; we should consider carefully whether more of them will be needed for the future. The Select Committee on Health recently produced a report on work force planning, which highlighted the fact that there does not seem to be much in the way of such planning. The recent example of the training, and lack of recruitment and use, of physiotherapists highlights the problem. We also need to assess how much occupational and speech therapy we will need in future. We must ensure that people have access to those services, so that they can live a full, proper and useful life.

Photo of Ian Gibson Ian Gibson Labour, Norwich North 2:47, 11 July 2007

May I welcome the Front-Bench team to the debate? It is nice to see them. I have not spoken with, or against, the Secretary of State for Health since the debate on top-up fees; I had fond memories while I listened to this debate.

An exhibition is on at the Wellcome Trust's science foundation on Euston road. It is about all parts of the vascular system—the heart, veins, arteries and so on—and it takes us right from the day when William Harvey first showed that blood coursed around the body through arteries and veins. We have to remember that there was a time when people did not understand that; we have come such a long way since.

I suffered a mini-stroke some three years ago, a month after I played Kenny Dalglish off the football field as part of the parliamentary team; I remember that well. It showed that strokes can happen to people who are fit and lively and that people do not see them coming. I did a lot of things that I should not have done; I say that now that I know first-hand what a stroke can look and feel like. After a hectic, busy week, in which I remember voting in the House on fox hunting—for the 20th time or something like that—I dashed off to Tel Aviv. I travelled overnight and had no sleep, and then I found myself out in Gaza with my right hon. Friend Mr. Denham, who is now Secretary of State for Innovation, Universities and Skills. We were shown around, and at night we dined and sang a few Irish songs; it was quite a jolly occasion. I went to bed wobbling a little, but I knew that that was not down to drunkenness. I absolutely knew what the problem was, but I thought, as all men do, "I'll sleep it off, and then I'll be okay again." The next morning, I had a little problem shaving and so on. I phoned up my right hon. Friend, and then the fun really started.

I remember that we were in Ramallah at the time and were heading out to visit the Gaza strip. There was a bit of a hoo-ha—a fight—about which ambulance I should travel in. I instinctively wanted to be in a Palestinian hospital and ambulance, for various political reasons. We went through several checkpoints with guns pointed at us, and I was taken out of the Palestinian ambulance and stuck into an Israeli one. I have never seen anything like it—when we went into the Palestinian hospital at gunpoint with Israeli soldiers, the whole accident and emergency department emptied immediately.

The treatment was amazing, with an immediate scan, although we had probably taken about four hours to get from the hotel, through the checkpoints and so on. It was marvellous to meet UK surgeons who had given up their holidays to work with young people with heart problems who came in from the Gaza strip. The House can imagine the difficulties that that causes. We are fighting hard to get a heart unit in that Palestinian hospital, because those surgeons still go out there.

I take the opportunity of this gentle debate to say something about the subsequent treatment and what happened at the Norfolk and Norwich university hospital, which does not always win plaudits. It was one of the first PFI hospitals and it takes a lot of knocks, but the service is amazing, particularly in the stroke unit. I speak to the consultants quite often. I was lucky, given the delays in my treatment.

Norfolk and Norwich university hospital's excellent 36-bed stroke unit was set up in 2002. It services about half a million people in the Broadland district, Norwich and south Norfolk. Before it opened, patients were scattered in various surgical wards. In the short time it has been open, the unit has brought them all together and it offers language therapists, physiotherapists and specialist nurses.

The unit has a great record for treating TIAs—mini-strokes. Major strokes after TIAs are quite likely in a small percentage of cases. They are medical emergencies and should be treated as such, just like an acute coronary syndrome of some sort. Immediate, co-ordinated care, is essential on those specialist wards, and I am pleased that we have such a unit in Norwich. It is ambitious, and I shall speak about its plans.

Access to the unit and assessment is an interesting point. I welcome the Secretary of State's recommendations in "A new ambition for stroke". We have some fantastic services in the UK, and that will add to them, and to the one in Norwich, in particular. It is time to build on our successes. Stroke must be treated fast. Time is of the essence, and the document highlights the fact that the fastest access to treatment will lead to the greatest success.

Like most hospitals, Norfolk and Norwich university hospital admits stroke patients via their GP or accident and emergency, so patients may be assessed several times before they see a stroke specialist. An experiment is being conducted at Edinburgh university, where the specialist stroke nurse carries a portable phone and exchanges information with those in the ambulance. Attempts are being made to staff ambulances with people who understand strokes and can diagnose and even treat them immediately by administering drugs. The nurse at the hospital can be ready for the specialist process of stroke triage and can administer the first line of defence—clot-busting drugs—and arrange for CT scans before the patient arrives. About 30 patients have been through the procedure, which is highly successful. The experiment, which involves no great expense, is just a better way of doing things.

Other research programmes are under way at the hospital. At present it is thought that stroke treatment must be administered within three hours. An international stroke trial is investigating whether that period can be extended.

I am very involved in stem cell research, and I declare an interest as a member of the UK Stem Cell Foundation, which Sir Richard Sykes chairs. Another member is Sir Richard Branson. If one knows the right people who are interested in this area, it is possible to collect £90 million overnight, from great champagne merchants and so on. We are trying to induce the Medical Research Council to talk to us about conducting joint experimentation and joint assessment of treatments. I think that that will eventually work out, after a few initial problems.

Stem cells seem to migrate to the damaged part of the brain, which is interesting because it might repair some of the cells. There is great hope that stem cells might be one way forward. That is why I am so pleased that the House has passed legislation, which has proved difficult in other countries.

Work is also being done on atrial fibrillation irregularity—the abnormal heart rhythm that the previous Prime Minister, for example, had. That can often increase the risk of stroke. Much exciting work is going on in the UK. We are examining the effects of increases and decreases in blood pressure. Amazing rehabilitation work has been done. I missed only one day of work after my mini-stroke, but I went to the rehab unit to see how it worked. Amazing treatments are available, both in hospital and in the community, depending on the patient's requirements.

Some of the drugs that have been invented, many of them in the UK, are essential to help people get through the difficult periods. Warfarin, for example, and statins are often used. I bet that at least 80 per cent. of the Members of the other place are on statins and do not talk about it. I know quite a few people who are, and there is nothing wrong with that. Whether statins need to be made so widely available is a matter for debate, but they are handed out to try to prevent heart or blood problems of some sort.

Yesterday afternoon the unit at Norfolk and Norwich hospital presented to the PCT new plans for better services in ambulances and for educating people. Many people still do not know the difference between a stroke and a heart attack. There is a great deal of confusion about that.

I have mentioned the multidisciplinary nature of the unit's work. The people involved are passionate about their work. The unit works with a unit for older people, and the combination of services, which is a small initiative, seems to help to produce results. The system will be a roaring success with such dedicated, highly trained people working in those units. Much good work is being done but much more, as we have heard, is still to be done. With the services of the scientists and medics in this country, we are just about world class. When we have the debate next year, I think the Opposition will have to admit it.

Photo of Hugo Swire Hugo Swire Chair, Speaker's Advisory Committee on Works of Art 2:58, 11 July 2007

I join in the universal gratitude in the House at seeing my hon. Friend Mr. Turner, who has just absented himself. He is the living evidence that with the right medical care and the right mental attitude, one can recover pretty quickly from a stroke. It is great to see him back.

The word "stroke" is perhaps the wrong word to describe a terrible affliction. It afflicts people in different ways, and some doctors now refer to it instead as a brain attack, which better conveys the severity of it. It is a cruel and tragic affliction, and I very much welcome what we have heard about the change in the perception of sufferers. Most European countries rightly regard strokes first and foremost as a neurological condition rather than as an older people's condition, but we still have a considerable way to go in trying to raise awareness. Three times more women die of strokes than of breast cancer each year. When one thinks about the excellent publicity generated about the appalling disease of breast cancer, it is clear that strokes have not had the same attention to date.

I want to make a couple of points about the need for speedy medical treatment and the importance of suitable rehabilitation facilities. I am extremely glad that the Minister, Mr. Bradshaw, who is now also Minister for the South West, is in his place, because he will no doubt wish to support me in what I say about many of our local facilities, some of which are in his constituency rather than in mine.

My first point concerns the need to get patients and stroke victims to a place where they can be assessed and treated as quickly as possible. I alluded earlier—the Minister was not here at the time—to the incredibly important work of the Devon air ambulance service, which can get people from any part of the county into a hospital within about 15 minutes. It would be most welcome if Ministers at least acknowledged the work of air ambulances, which are funded entirely by voluntary contributions, and perhaps looked at how they can be supported in the longer term. Air ambulances are enormously expensive to run and maintain. Other charities in the county will say that it is more difficult for them to raise money because Devon air ambulance requires so much, but if one lives on Dartmoor or Exmoor or in the other more rural areas of our part of the world, one is very glad to know that it exists.

There is a difference in the statistics on the treatment of stroke victims in the county. Torbay and Newton Abbot hospitals in south Devon have won awards for their stroke treatment. It is interesting to note that on average they CT scan 60 per cent. of their stroke victims within 24 hours. Royal Devon and Exeter hospital, which is in the Minister's constituency, scans only 30 per cent. of its patients within the first 24 hours, although it is in the upper quartile for stroke care. That postcode lottery is simply not acceptable. We need some assurances that the Minister will look closely at seeing how that disparity can be erased as quickly as possible.

Secondly, I want to talk about the shortage of acute stroke units. In my own constituency of East Devon, there is no acute stroke unit, just an eight-bed rehab unit in Budleigh Salterton. There was talk of having another one in Honiton, but that might not now happen, despite the fact that the county has a higher prevalence of strokes, at 2.8 per cent., than the national average of 1.57 per cent. My hon. Friend Mr. Lansley said that only 22 per cent. of hospitals have early support discharge teams. We need to consider that carefully in terms of Devon's provision. Does the Minister agree that an average wait of between five and 24 hours for a CT scan, rising to 25 to 48 hours at weekends, is unacceptable, given that CT scans offer the best chance of a successful rehabilitation?

Rehab is incredibly important. I should like to cite the example of a constituent who has come up against the postcode lottery of the current system. Adam Giles-Wilson has been in contact with me since as far back as April, and I have been trying to help him to sort out his problems. I cannot put it better than the words of his original letter to me:

"I had a 'massive' brain 31 in Sept 04, I underwent a 10 hour operation followed by another 10 hour operation in March 05. I was transferred to Taunton (from Frenchay) learnt how to walk, talk, etc. I was discharged & admitted as an outpatient to my local trust whom I've had to fight with to get any support, I had to fight to get a speech & Language therapist to treat me to teach me how to swallow properly as I was still having difficulties, I was told I was a low priority as I was under 65. I received Physiotherapy by someone not that experienced & unfortunately the treatment I needed was complex so we together saw an 'expert' once every 6-8 weeks"— that is Heather Bright, the clinical specialist in neurological physiotherapy. He continues:

"All throughout my treatment I was paying for private treatment to get me better as quickly as possible & therefore getting me off of the NHS list too. My local trust has just reassessed me again following some specialist treatment by the world expert Mary Lynch-Ellerington. Heather wrote to Mary asking for her opinion which concluded with Mary saying that I could get better & possibly back to 'normal', I realise there are no guarantees but I'm too young to give up & I don't believe the trust should either. I have asked for alternative help i.e. a referral to another nearby trust that could possibly help or funding so I can do whatever & however much I feel I can do."

He goes on to say that he raised £11,000 for the NHS by running the marathon a year after he learned to walk. That is just one example; I am sure that other hon. Members can give similar ones. I am still trying to argue with the new primary care trust that he should receive the treatment that he needs.

What we have heard from Ministers is welcome. I am glad that we are taking strokes and the issues surrounding them seriously and giving them the publicity that they deserve. However, we should not congratulate ourselves too much. I said that the problem is not necessarily age related, and the case that I cited is living proof of that. However, I represent a constituency with a large elderly population, and it is important that they get the same treatment—the same access to scans and, vitally, the same aftercare—as people in other parts of the country. There was much talk at one point about using some of our community hospitals. I am fortunate to have community hospitals in Budleigh Salterton, Sidmouth, Seaton and Axminster, all of which have dedicated staff and good facilities. Perhaps it is to them that we should be looking for this kind of post-care treatment. I am not talking about people going in one or two times a week—there is often 24-hour care, certainly in the early days. The more quickly people come to terms with their disability, however temporary, caused by a stroke, the more quickly they learn how to live with it, combat it and overcome it, and the more quickly they recover and the fewer strains will ultimately be placed on the NHS and local services.

I am glad that this subject is being debated in the spirit of consensus. There is not much politics in it; it is too serious for that. I hope that the Under-Secretary will have a word with the Minister. As I said, he is now also Minister for the South West and will no doubt wish to ensure in that new capacity that we in my part of Devon are treated the same as those in Torbay and south Devon, so that we can reach the extremely good figures that are being achieved there.

Photo of Lee Scott Lee Scott Conservative, Ilford North 3:09, 11 July 2007

I have relatives and friends who have suffered strokes, so I am aware how debilitating strokes can be, in both the short and the long term. I should like to pay tribute to the two local hospitals serving my constituency, King George hospital and Whipps Cross hospital: may they long continue to offer services to my constituents.

Every year, more than 110,000 people in England will suffer a stroke, while more than 750,000 live with disabilities caused by strokes. After heart disease and cancer, strokes are the third biggest cause of death in Britain and the largest single cause of severe disability. Almost one third of patients die in the first month after a stroke, with about one in 20 surviving stroke patients needing long-term residential care. As we have heard, three times more women die of strokes than of breast cancer. The NHS pays out more than £2.8 billion treating strokes. Overall, they cost the wider economy about £4.2 billion in lost productivity, disability and informal care. I fully recognise what has already been achieved, but we need to ensure that the public are fully aware of the dangers of strokes and of the crucial need to call 999 immediately if someone is suspected of having a stroke.

The Healthcare Commission has stated that

"there is still too much variation, too many places and regions that are not responding as well as they could to minimise the harm done by this serious and common condition", and that service providers need to do more. The reality is that patients can face a postcode lottery in the provision and standard of their treatment. There are 640 patients per stroke consultant, compared with 360 patients per cardiac consultant.

The risk of stroke among African, Caribbean and south Asian men has been found to be far higher than that among the general population. That obviously puts a particular strain on hospitals in London. The risk of stroke increases with age, but each year around 1,000 people under the age of 30 suffer a stroke. I recently met some and was quite shocked by how young they were and how debilitating the condition would be for years to come. I hope that they will be fully cured.

The key question that needs to be answered is: what can be done to address the shortage of health professionals with stroke training, which the Public Accounts Committee highlighted as a limiting factor in stroke care provision? If patients are not scanned on the day of admission, they normally have to wait until the next working day. That is a particular problem if they are admitted at the weekend. The sad fact is that only 22 per cent. of victims have a scan on the day they suffer the stroke, and most patients end up waiting for two days or more. In the first few crucial hours after suffering a stroke, it is vital that victims have rapid access to scans to diagnose their condition fully.

It is not acceptable that only half of all patients receive rehabilitation services that meet their needs in the six months following discharge from hospital, and that after a year that figure falls to a quarter of patients. The Department of Health should evaluate the merits of early supported discharge initiatives and other ways of improving access to treatments. The Department should promote the early adoption of treatments that can be shown to reduce hospital stay and improve patients' chances of recovery. Rehabilitation services must take into account the needs of stroke survivors who live on their own. They may be vulnerable to being overlooked by health and social care services.

There are difficulties with stroke patients getting access to physiotherapists and social workers. One third of patients who have difficulty swallowing have not been assessed by a speech and language therapist within 72 hours of admission to hospital. The situation is similar for physiotherapy and for occupational therapy, and for social work it is even worse.

In December 2006, Professor Roger Boyle, the national director for heart disease and stroke, issued the report "Mending hearts and brains—Clinical case for change", which was published by the Department of Health. Professor Boyle noted that the overwhelming majority of cases of heart disease, stroke and related conditions are preventable through healthier lifestyles and preventive medicines. However, he stated that

"as we—like all developed countries—struggle to defuse the obesity 'time bomb', we cannot afford to be complacent about the threat these diseases pose in the future."

We could see vast increases in strokes over future years. Professor Boyle suggested that changes in treatment for heart disease also need to be considered for stroke victims. The report noted that if strokes were treated as an emergency, more than 1,000 victims a year would regain independence, rather than dying or being left disabled. Although not all local accident and emergency units are best placed to treat stroke victims, we need to have services on the doorstep or as close as possible for victims.

A few weeks ago, I joined constituents and my local paper, the Ilford Recorder, to deliver to No. 10 Downing street a "Hands off our hospital!" petition that had been signed by more than 10,000 people. King George hospital is only 13 years old, but it now faces the prospect of losing some of its key services. That would have a detrimental effect on my constituents. We heard earlier from the Prime Minister that no decisions had been taken, but I have a document, which I am willing to make available to the Under-Secretary, saying that unfortunately certain decisions have been made regarding my local hospital. It is an internal document, given to me by somebody who obviously wishes to remain anonymous, but I would be happy to pass it on to the Under-Secretary, because I am sure that the Prime Minister would not have said what he said if he had been aware of it.

Dr. Gibson who is not in his place now, mentioned the treatment he had received while out in the middle east. I should like to mention Bar-Ilan university, which treats Palestinians and Jews in Israel, and the services that it is doing for brain research. Perhaps we could see twinning with that facility, to help prevent people from having to suffer such a terrible condition and to lead to a better future for all.

Photo of Doug Naysmith Doug Naysmith Labour, Bristol North West 3:16, 11 July 2007

I do not really want to say an awful lot, as much of it has been said already by Mr. Lansley, who is a fellow officer of the all-party stroke group, by Sandra Gidley, who is a colleague of mine on the Select Committee on Health, and by the Secretary of State. All three have covered carefully most of the main points, which are pretty well known.

The point that the hon. Member for South Cambridgeshire made—that we have known for quite a long time some of the things that we need to do to improve our stroke care services—is true. Like him, I thought for a while about why we are putting out a consultation document now—and I see that there is great merit in doing so because, despite what my hon. Friend Dr. Gibson said about world-class services, there are only odd islands of world-class services in this country, and we are very far from having a world-class service throughout the country as a whole.

The questionnaire should be used to say to every primary care trust responsible for commissioning services and to every acute trust responsible for providing them, "We want your response in the light of what is in the document prepared by Roger Boyle over quite a long period"—although as we have heard, Professor Boyle has been working on strokes for only a year, whereas he worked on heart disease for a much longer period. If we can get a response back from everyone who is responsible, that will at least mean that they will have read and studied what is in the document. Many of those things have been said before in documents, but I should like the Minister, when she replies to the debate, to give an undertaking to try to ensure that there is a response from all those responsible for commissioning and providing services.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

The hon. Gentleman will have seen that one of the proposals in "A new ambition for stroke" is, in effect, that there should be clinical networks for stroke. From his knowledge, derived from the Health Committee and elsewhere, he will be aware that clinical networks made a considerable difference to cancer services, but I am sure that those involved in cancer clinical networks will have told him that they had access to ring-fenced resources for that purpose. Does he share my view that we need to think about whether that is the right way to go? Simply to wish for clinical networks to come into being but not to give them an opportunity to shape services will probably not be successful.

Photo of Doug Naysmith Doug Naysmith Labour, Bristol North West

The hon. Gentleman makes a good point. There is no doubt that clinical networks have made a real difference in cancer services. The fact that funding was available focused minds and gave them the funds to spend for that purpose. This obviously works. The trouble with having too many priorities, however, is that nothing ends up being a priority. I have had personal experience of a stroke, and it is important to me—and, I think, to many stroke sufferers—that there should be the money available to ensure that the services improve quickly. Otherwise, people who are being asked to commission these services are simply going to say, "Unless we get more money, what are we going to spend less on in order to make the funds available?" Extra funds would therefore be useful. I am conscious, however, that large amounts of extra funds have been put into the NHS over the past 10 years, and a higher proportion is still going in now than ever before. We must ensure that those funds are used wisely, so the hon. Gentleman has made a good point.

I want to make two further points. First, an early scan is essential, as we have heard. Quoting statistics on the percentage of cases scanned within 24 hours is not useless, but it is not much use. What we need is a three-hour target, and it needs to be met to improve our use of thrombolytic drugs. We must also have 24-hour working, seven days a week, to achieve that. In my opinion, any unit that does not offer that should not have the right to call itself a specialised stroke unit.

Secondly, I want to emphasise the how important it is for the break between the acute phase—in the consultation document, this is referred to as "time is brain", which is an apt phrase that should be well used—and the beginning of rehabilitation, which is referred to as "life after stroke", to be short. In many if not most cases, rehabilitation can and should begin within a few days of the initial event. This means that therapies such as physiotherapy, too, must be available and ready to be used seven days a week.

I welcome the consultation document. It lays out many things that we in the all-party group have talked about over the past two or three years, and that we know should be put into effect. I hope that the document will provide the means for bringing that about.

Photo of Anne Milton Anne Milton Shadow Minister (Health) 3:22, 11 July 2007

I, too, welcome the debate today. Stroke is often forgotten, and placed at the unglamorous, unsexy end of health care. I trained as a nurse and worked in the NHS for 25 years, and I am only too aware how great the suffering can be, not only for those who have suffered a stroke but for their friends, relatives, neighbours and other carers.

We have heard many statistics today, and statistics really do matter. They are our only means of emphasising the importance of stroke. It is the third most common cause of death, and the leading cause of disability in adults. Just under 1 million people in this country are living with the after-effects of stroke, and about 300,000 are dependent on others for help with their day-to-day activities. We should remember that for many of those people, even putting on their socks in the morning, or having a piece of toast, cannot happen without the assistance of someone else.

The Secretary of State has apologised for not being able to be in the Chamber at this moment. He talked about the national service framework for older people, in which stroke is mentioned, but stroke is not just about older people. Twenty-five per cent. of the people affected by stroke are under the age of 65. My hon. Friend Mr. Swire referred to the fact that the national service framework did not recognise stroke as a neurological disability. It is recognised as such in most countries, but not here, and that has an impact on services.

I have no doubt that the Government will tell us how much things have improved, and, in the spirit of this debate, it has been important to listen to other Members congratulating the Government, where congratulations are due, on the improvements that have taken place. However, service provision is very patchy. The 2006 National Sentinel audit showed that almost three quarters of people with minor stroke are not being managed in specialist units. Only 15 per cent. of patients are admitted to a stroke unit on the day that they have the stroke, and only one tenth of patients are scanned within three hours. These are all crucial indicators for giving people the level of care that they need to improve their outcomes. Some of the work that needs to be done to improve the figures is recognised in the Government's report, but, despite the successes, we must understand how poor some of those figures are.

If we look a little more deeply into the care of people with stroke, we find that about a third of those who have difficulty swallowing have had no speech or language assessments within the first 72 hours. Early intervention by the non-medical professions is crucial to the outcomes of people following stroke. Those with communication problems can wait up to seven days for that treatment, and it can be even worse for those who want physiotherapy, occupational therapy or a social worker. We are talking here about the acute phase following stroke, not the chronic phase that follows.

For many of our constituents, it is life after the acute phase of stroke that is important, yet that is when they receive the least attention. My hon. Friend Mr. Lansley mentioned that 80 per cent. of people were unhappy with the services and care that they were receiving a year after stroke. Some of our rehabilitation hospitals are doing a superb job, and I make no apology for mentioning Milford hospital, near my constituency, which is threatened with closure, but is held in considerable affection because of the fantastic work that it has done on rehabilitation.

I welcome much of the Government's national strategy consultation document, but it also makes the point that there is

"scope to improve the transition from hospital to the community. Once care in hospital has finished, it can be more difficult to access the support needed".

I would suggest that for those who are languishing in the community and feel that they were abandoned when they were discharged from hospital, that would seem to be an understatement. It would make frustrating reading for people who are battling away to get the services that they need. I am not making a party political point, but I was a district nurse in the early 1980s, and I remember doing a dissertation at college about discharge from hospital, yet here we are, 25 years on, still saying the same things, and wishing, hoping and fighting for changes in the care of people who have had a stroke.

Improvement after a stroke continues well beyond the first year. Access to services such as physiotherapy, occupational therapy, speech therapy and advice from dieticians, psychologists and psychiatrists all form a vital part of the care. I would add to that list the housing requirements of people who have had strokes, such as adaptations of people's homes. People can wait up to three, six or even nine months to have a stair rail put into their house, which can transform their ability to manage at home.

A much disregarded part of care following a stroke is people's mental health, which can be a significant factor in the outcome of someone's illness. Depression, both acute and chronic, can be as debilitating as physical mobility problems. There is also the inability to speak or communicate. The frustration of knowing what word it is one wants to say, but not being able to say it out of one's mouth, is immense, and cannot be understood by any of us who have not suffered it. Depression over the physical limitations on one's body while one's mind remains active can be extremely severe. That is much overlooked and under-diagnosed, and is very rarely treated.

Photo of David Taylor David Taylor Labour, North West Leicestershire

The hon. Lady describes effectively the emotional and mental health difficulties that can be associated with life after a stroke. Does she agree that the social contact already referred to, through stroke clubs and elsewhere, is a crucial part of the rehabilitation process? It is a great pity that so many of these organisations—I declare an interest as president of the Ibstock stroke club—have to depend on raising funds themselves for their premises, day trips and all the other aspects of their work. Surely there ought to be a more coherent plan for financing such vital aftercare work. It does not exist at the moment.

Photo of Anne Milton Anne Milton Shadow Minister (Health)

I thank the hon. Gentleman for bringing up those crucial groups that are out in the community. To some extent, they have arisen because of the paucity of provision for people to form social networks, and they have a significant impact on the outcomes for people following stroke. With regard to the question of mental health, people have to believe that there is life beyond a stroke. If a person is disabled or unable to communicate, it is only those groups that give that ray of sunshine—that light at the end of the tunnel—to make them believe that that is possible.

Photo of Hugo Swire Hugo Swire Chair, Speaker's Advisory Committee on Works of Art

My hon. Friend makes an extremely good point, which we discussed earlier, about long-term care following a stroke, and the importance of rehabilitation being something that goes on 24 hours a day, and is not just hit and miss. Once the patient has undergone care, more often than not they go home. That is where their partner, or anyone they live with, has to take on the burden previously undertaken by the hospital or the rehab unit. Depression is an important matter, but is my hon. Friend alarmed, as I am, by the fact that about 50 per cent. of all the carers looking after people who have suffered from strokes are not receiving needs assessments?

Photo of Anne Milton Anne Milton Shadow Minister (Health)

I share my hon. Friend's alarm that carers are not receiving the needs assessments they require—an issue that has been raised with me by carers groups. Frequently, such an assessment is referred to as a carer's assessment, and unfortunately carers often feel that they are being assessed, when it is actually the carer's needs. I hark back to personal experience; we have been talking about caring for the carers for decades, and it is crucial. We have talked about the mental ill health of people who have had a stroke, but we must also consider the mental health of those caring for people who have had strokes.

Photo of Lee Scott Lee Scott Conservative, Ilford North

Does my hon. Friend agree that it is vital for all the agencies—local authorities and social services—to work together to ensure that the right package is in place? Sometimes, it can increase the distress of the patient when the left hand does not know what the right hand is doing.

Photo of Anne Milton Anne Milton Shadow Minister (Health)

Indeed, the left hand and right hand both have to know what the other is doing. We have talked about partnership working, joint planning and integration, which are all terribly "Government-sounding" words, but we want joined-up services on the ground. The only arbiter of whether that is working is the care that people receive in their homes. Whether the services are joined up enough will be well articulated by patients receiving care, and their carers. It is a vital matter, and for years we have battled over it. I hope that the start of the consultation will produce a real discussion so that we can find some answers as to how we produce a truly seamless service.

Many interventions have made the point that all too often, when people leave hospital they feel abandoned, and the care that they get in the community is something of a lottery. The insecurity of not knowing where care is coming from serves only to increase the burden on carers.

Several hon. Members have spoken in the debate, and I want especially to thank the hon. Members for Bristol, North-West (Dr. Naysmith) and for Norwich, North (Dr. Gibson) for relating their personal experiences. We are discovering this afternoon how many people in the House have been affected by stroke. I also welcome the intervention by my hon. Friend Mr. Turner, who is not in his place at the moment.

Photo of Anne Milton Anne Milton Shadow Minister (Health)

Indeed. The courage of my hon. Friend the Member for Isle of Wight in facing life after stroke is a lesson to us all. We all applaud his coming to the Chamber today and intervening in the debate.

My hon. Friend the Member for East Devon recounted the case of a constituent. There is nothing quite as powerful as somebody's personal story. Those who have experienced stroke can articulate better than we can the burdens and problems that people face. He said that we should use the term "brain attack". There are many terms, but something along those lines emphasises the significant effect of stroke.

My hon. Friend Mr. Scott drew attention to the postcode lottery of care. The hon. Member for Bristol, North-West said that figures can be cited too glibly, but I do not agree. I believe that they can have an impact, and we must continue citing them, because most of us who are able-bodied and have not suffered a stroke have no idea that it is the leading cause of disability in adults.

Photo of Doug Naysmith Doug Naysmith Labour, Bristol North West

I said that to argue that a specific percentage of scans was achieved in 24 hours misses the point, because to distinguish the two types of attack one has to have a scan in three hours; I appreciate that the hon. Lady knows that. I was certainly not casting doubt on statistics and their use in general.

Photo of Anne Milton Anne Milton Shadow Minister (Health)

I thank the hon. Gentleman for clarifying that. He is right about the necessity for treatment in a tight time frame during the acute phase.

As has been said, stroke affects others besides the victims. I urge the Government and the Under-Secretary to remember during the consultation that stroke affects family, friends, neighbours and colleagues. Stroke has devastating consequences, yet it is frequently forgotten compared with high-profile subjects such as cancer and heart attack. Why is much more notice taken of cancer and heart attack when, if we examine the figures for causes of death among women, we find that stroke is well ahead of breast cancer? Remedying the deficiencies in the service could make a significant difference not only to the figures but to literally thousands and thousands of people's lives.

I welcome and acknowledge the impact that organisations such as the Royal College of Physicians, the National Audit Office and the Public Accounts Committee make to raising awareness of stroke. That also applies to charities and voluntary bodies such as the Stroke Association and, in my constituency, TALK, which does a huge amount to support people who have suffered strokes and to make them believe that there is life after stroke.

The consultation document mentions involving the third sector. Funds will need to follow if the Government are genuinely committed to using voluntary associations. The Stroke Association has acknowledged that, and expressed its concern that, as my hon. Friend the Member for South Cambridgeshire said, it is not clear how we move from the document to delivery. The task should not be underestimated. As I said, the issue has been talked about and discussed for some 20 years—yet prevention, treatment and rehabilitation following stroke have never really had the time and commitment they deserve.

I urge hon. Members to join us in supporting the motion. It calls on the Government to act now to save the lives that can be saved; to act now to ensure that we have the community and long-term services necessary to improve the outcomes for people who have had strokes; and to act now to show those who have had a stroke that with the right services, there is life beyond stroke. I commend the motion to the House.

Photo of Ann Keen Ann Keen Parliamentary Under-Secretary, Department of Health 3:41, 11 July 2007

I start by welcoming Mr. Turner back to his place today, and I commend hon. Members for having the courage to talk about their personal lives and how stroke has affected them. The House has led by example today, showing those outside how we can be courageous and how we can reach a consensus, stemming mainly from the work of the all-party group on stroke.

I would particularly like to praise the group's chairman, Mr. Lansley. We joined the House at the same time and have shared many a discussion on the Health Committee. I am pleased to join the team and look forward to further health discussions in future. I think that all members of the all-party group made generous contributions to the document launched by my right hon. Friend the Secretary of State on Monday. I particularly commend the work of Professor Roger Boyle, as members of the group wanted me to thank him and his team for the excellent work they did.

As Mr. Swire mentioned, stroke may not necessarily be the best description. I agree that it is really a cerebral-vascular accident, which is how I was trained to describe a stroke. "Brain attack" and other terms used to characterise this serious condition should also be considered—perhaps as part of the consultation.

The all-party group has raised many important issues for my Department to reflect on for its new strategy. "A new ambition for stroke" is now on the table for consultation. I understand why the hon. Member for South Cambridgeshire asked about the continuation of the consultation. In fact, we now need champions to go out and promote the work because there is so much to do and we need to realise that there are different ways of treating this condition. Much good work can be done if we have those champions in place—and I believe that that will develop out of the consultation. We can build on the good progress made by cardiac units. We need to reflect on the arrangements and positioning of cardiac units, which helps to explain why they have been so successful. That is important for future treatment of these emergency brain accidents.

We are determined to reduce the impact of strokes through our new strategy and to ensure that those who have experienced strokes are well supported through the months and sometimes years of rehabilitation and recovery. That demands a transformation of attitudes. We need to end the pessimism associated with stroke and recognise that it is a preventable and treatable condition. As I said earlier, the courage of hon. Members here today has marked the beginning of the end of that pessimism.

Medicine is very dynamic and has moved on tremendously. We now know that if we can diagnose strokes quickly and treat them appropriately, there is every chance of helping people to a good recovery. That is why it is important to act now. We have seen a reduction in mortality from strokes and an increase in stroke specialist services. Those achievements and a strong evidence base for stroke care mean that we are now in a position to drive forward improvements in stroke services.

Modernising the services will not be a quick or easy task. We have a lot to do on prevention, commonly described as "lifestyle." We are now smoke-free across the countries of the UK, we have obesity and exercise programmes and we are looking at a genuinely healthier lifestyle. People need support to change their lifestyle; it is not easy. People cannot be lectured at, and they need help and assistance. I hope that we continue to provide positive and reasonable health education.

We need to raise awareness of symptoms and improve action on risk factors. We must ensure rapid diagnostics—something that many Members mentioned. We need to improve integration across health and social care, a point raised by Anne Milton, particularly in relation to integration with social services. That is absolutely critical and my ministerial colleagues and I will be working together on it. Much work has been done for carers and I am pleased with the Government's approach in terms of flexible working for carers who are in work, training, a new deal and even pensions.

The hon. Member for Guildford tried not to make a political point in referring to her time as a district nurse. I, too, nursed through the 1980s and 1990s and I, too, do not wish to make a political point, but many of my patients and families were very cold because they did not have a heating allowance. Their pensions were miserable. Many were trying hard to rehabilitate themselves on small incomes and they did not know whether to put on their heating or to eat. Many of the rehabilitation services were not in place. I hope that we share enthusiasm for change and for the improvements that the Government have made.

Change is difficult and we need leadership to bring it about. Much has been said about the organisations providing stroke rehabilitation and care. I want to mention a nurse consultant in Portsmouth, Jane Williams, who had the confidence to close an in-patient ward and transfer the resources to community care. She had the confidence, over three years, to win the hearts and minds of more than five organisations, and did it because it made patients feel better to be in their own homes. Care is now provided nearly 24 hours a day, from 7am till 9pm, seven days a week. Those involved work within an inter-professional team and have a better success rate in Portsmouth than they would have achieved in-house. I am sure that the whole House would want to congratulate Jane and her team.

Ours is an ambitious programme and we know that success is possible. Greater Manchester was mentioned by the hon. Member for South Cambridgeshire, but clinicians have already agreed a strategy to ensure that every stroke patient has the chance to benefit from the clot-busting treatment. Today in London my colleague Professor Ara Darzi has published proposals to develop hyper-specialised stroke centres serving the whole capital. Mr. Scott, who raised important points, may like to participate in the review to see how his local services might be affected. We have asked officials to look into the matter and I will get back to the hon. Gentleman.

It is right to be ambitious as there is overwhelming enthusiasm for the new strategy, not only in this House but from the stroke community. Many people have helped us to develop the consultation document, and I thank all of them. Throughout the country, people with first-hand experience of stroke—survivors, carers and professionals—have told us in no uncertain terms what needs to change. The consultation exercise gives us a chance to listen to a still wider range of voices. I urge Members to contribute and to encourage their constituents to give their views. I will attend my centre at St. Paul's church in Brentford, to which I am a regular visitor. That exercise should give us the opportunity to launch this coming winter a strategy that truly galvanises the revolution in stroke care that we have discussed today.

Much has rightly been made of the audit report. It says:

"Stroke clinicians, managers and politicians can feel proud of the advances that have been made over the last ten years—there are few other conditions that have progressed as rapidly."

We can all be proud of that, and I hope that Members will refer to it when we are in our constituencies.

Jane Williams made the bold decision to go forward with changes in five organisations over three years. We can only imagine how difficult a task that must have been for a nurse consultant. She told me that she did it because it was right for patients—that it was the right way to progress in the management of care. It is now up to all of us to take up that challenge and to do right by patients.

Photo of Tim Farron Tim Farron Leader's Parliamentary Private Secretary, Cross-Portfolio and Non-Portfolio Responsibilities, Shadow Minister (Home Affairs)

On the point that it is important to make the right decisions for patients, does the hon. Lady accept that one size does not fit all? In my part of the world—south lakeland—the stroke unit at Westmorland general in Kendal is proposed for closure. Residents of Grasmere will be more than an hour away from their nearest stroke unit if we close the Kendal unit.

Photo of Ann Keen Ann Keen Parliamentary Under-Secretary, Department of Health

It is unacceptable for the hon. Gentleman to arrive in the Chamber towards the end of the debate and then to raise that point. Let me just say that there must be lots of local accountability, but that that is not all there must be.

Photo of Simon Burns Simon Burns Opposition Whip (Commons)

Does the hon. Lady agree that as this has been an important debate, if Tim Farron were so concerned about the constituency point he raises, he would have been present for the entire debate?

Photo of Ann Keen Ann Keen Parliamentary Under-Secretary, Department of Health

Not for the first time, I agree with the hon. Gentleman.

On that note, I ask the House to support the amendment in the name of my right hon. Friend the Prime Minister.

Question put, That the original words stand part of the Question:—

The House proceeded to a Division.

Photo of Alan Haselhurst Alan Haselhurst Deputy Speaker and Chairman of Ways and Means

I ask the Serjeant at Arms to investigate the delay in the No Lobby.

The House having divided: Ayes 195, Noes 300.

Division number 177 Opposition Day — [16th Allotted Day] — Stroke Services

Aye: 195 MPs

No: 299 MPs

Aye: A-Z by last name


No: A-Z by last name


Question accordingly negatived.

Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.

Mr. Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.


That this House commends the dedication and energy of the doctors, nurses, therapists and other professionals working tirelessly to help the 110,000 people affected by stroke each year; notes the significant recent progress made in stroke care with falling premature mortality rates and more people treated in stroke units than ever before; further commends the work of the National Audit Office, the Committee of Public Accounts and the All-Party Parliamentary Group on Stroke in scrutinising progress on stroke care and recommending further improvements; welcomes the opportunities offered by new treatments and the growing evidence on effective rehabilitation; celebrates the investment of £20 million in the UK Stroke Research Network to help ensure stroke medicine fit for the 21st century; further welcomes the additional training places made available in stroke medicine; further welcomes the new guide and tools available to support improved commissioning of stroke services; thanks the Stroke Association, Different Strokes, Connect, the Royal College of Physicians and over 100 individuals for their work in developing proposals for a new stroke strategy; and commends the consultation document A new ambition for stroke.