To ask Her Majesty's Government whether, in announcing eight hyper-acute stroke units for London, they will give further consideration to the policy that all suspected stroke cases will be sent in the first instance to those units for three days and then transferred to their local stroke centre.

My Lords, after consultation with patients, clinicians and healthcare workers, on 20 July a joint committee of London's primary care trusts endorsed plans to establish eight hyper-acute stroke units in the capital. These will admit stroke patients who, once stabilised, will be treated at one of the 24 supporting units throughout the capital. As this plan has just been established, it is not anticipated that this will be reconsidered.

My Lords, I thank the Minister. I declare an interest in that my husband and I have both been patients of the Chelsea and Westminster, which is not one of the eight but is one of the 24. Is she aware that there is only a three-hour opportunity during which thrombolysis or clot-busting can work? Most of the other stroke units, which are not hyper-acute classified, ask what the point is of taking someone who is beyond that stage to the hyper-acute unit when they could more conveniently and less expensively be treated at their local stroke unit.

Of the 11,500 people who suffer from stroke in the capital each year, only 1,000 of those, it is estimated, would need thrombolysis. However, many of the others would need rapid action to diagnose and treat their stroke. But the noble Baroness raises an important point about those people who present having had a stroke perhaps a day or several days before. At that point, when a patient visits their doctor or a local stroke unit with those symptoms, an assessment would be made whether it was appropriate to send them to one of the hyper-acute units or to keep them and treat them in their local hospital.

My Lords, does the Minister agree that the necessary services for strokes and their acute treatment have been delayed for an excessively long time? The establishment of these eight hyper-acute units is therefore very welcome. However, what action are the Government taking to advise the emergency services, and members of the public at large, to recognise that stroke is an emergency? The three-hour window of opportunity in which it is necessary for individuals to have a scan, before those who have had a stroke due to a reduction in blood supply rather than a haemorrhage can be treated with these clot-busting drugs, is crucial. It is a matter of fundamental importance: stroke is an emergency.

The noble Lord is absolutely right. In a Question in February, I demonstrated the FAST message to your Lordships' House, which is the way in which all of us can diagnose stroke with the face, arms and speech test. This has been promoted by the Stroke Association with the support of the department. The emergency services are part of the strategy in London and are being geared up to take patients with threatened stroke to the new acute centres.

My Lords, is my noble friend aware of the rather depressing news this morning that only a small proportion of the budget allocated for carers' breaks is in fact reaching them? In view of this, will she take account of the extra cost for families of visiting other than in their local area when someone has had a stroke?

I will certainly take note of that. The idea is that the person would be stabilised in the hyper-acute unit and, as soon as they were stabilised, moved to a local unit for precisely the reasons that my noble friend has outlined.

My Lords, will all accident and emergency departments retain staff with the skills to diagnose a stroke?

All the staff in our accident and emergency departments should be able to diagnose stroke.

My Lords, will there be any hyper-acute stroke units outside London? Does she agree that there are many people at risk of stroke who live outside London?

The stroke networks for London are designed to ensure that those living within this region should be able to reach a hyper-acute unit within 30 minutes. The strategic authorities outside London, I am pleased to say, are developing their own units. In the east of England region, for example, there are new 24/7—that is a terrible term; rather, 24-hour services offering thrombolysis services for stroke patients. The same is happening in the south central region, where there are 14 acute combined stroke units. Each area is developing its own strategy.

Are there delays in follow-up treatment due to the shortage of therapists?

Part of the strategy, both nationally and regionally in London, is about recruiting and training therapists. Resources are being made available for that. It is specialist nurses and therapists whom we need to recruit and train to ensure that the 24 stroke centres are properly equipped. I am not going to pretend that all the centres are as we would wish them to be right now.

My Lords, is the Minister confident that there is sufficient evidence to ensure that the London Ambulance Service can reach these units on time?

That is a very important question, as the whole strategy would fall down if that were not the case. We are confident that the service can reach all the centres within 30 minutes. The London Ambulance Service already has an impressive track record in getting heart-attack patients to the centres of excellence that exist to treat them. We are therefore confident that it has the experience to be able to diagnose and get people to the centres on time.

Is the policy proposed by my noble friend really necessary? I speak as one of those suspected stroke cases. The provision that was given to me by the doctor was, "Well, you're over 90. You'd better have a check". So I was sent around, had a check and they said, "Yes, for heaven's sake, look at what you drink and what you eat"—I shall not describe it. You just change it, and I am no longer a suspected case.

I am very pleased to hear that, but every year 110,000 people in England have a stroke; it is the third biggest cause of death. I am very pleased to hear that the noble Lord is in great health.

The Minister is more aware than I am of the necessity of follow-up treatment. Is she able to reassure this House that the follow-up treatment in the local stroke units will be as good as or better than that provided by the Oxford Centre for Enablement, which is primus inter pares as far as I am aware?

I am sure that that is the case. I think that I have already said that we accept that the level of rehabilitation and community care is crucial. We are addressing the recruitment and training of therapists and specialist nurses.