The rapid diagnosis of stroke and the introduction of thrombolysis (the use of clot-busting drugs) are key challenges for the national health service in its treatment of stroke. This is why the Department is developing a new national stroke strategy for England, which aims to support the NHS to modernise services and deliver the newest treatments for stroke.
All primary care trusts caring for people who have had a stroke now have a specialist stroke service and 97 per cent. (196 of 203 hospitals) of hospitals in England who treat stroke patients now have a stroke unit (in 2004 only 82 per cent. had a stroke unit).
Source:
National Sentinel Audit for Stroke 2006 conducted by the Royal College of Physicians.
These data are not collected centrally.
The Government are currently developing a new national stroke strategy for England which aims to modernise services and deliver the newest treatments for stroke, and the aim is to publish it this winter, following a full public consultation.
Stroke mortality is falling. For people under 65, the three year average death rate from stroke has fallen by 23 per cent. over the period from 1993-95 to 2002-04. For people aged 65-75 the death rate has dropped by 30 per cent. over the same period. However, the Government recognise that more needs to be done. This is why we are developing a new national stroke strategy for England which will modernise services and deliver the newest treatments for stroke. The strategy will be published for consultation shortly with the intention of the final version being available by the end of the year.
Stroke mortality is falling. For people under 65, the three-year average death rate from stroke has fallen by 23 per cent. over the period from 1993-95 to 2002-04. For people aged 65 to 75, the death rate has dropped by 30 per cent. over the same period.
The risk factors which increase an individual’s chances of suffering a stroke include smoking, drinking alcohol, poor diet and lack of physical activity. Strokes are also more likely in those who suffer from hypertension and diabetes. Through the public health White Paper “Choosing Health”, the Department has set out a programme of action to help improve the health of the public including action on smoking and diet. This builds on existing work such as campaigns on smoking and diet, National Institute for Health and Clinical Excellence guidelines on the management of hypertension, points for prevention activities in the general practitioner contract and support for the Blood Pressure Association blood pressure awareness campaigns.
The coronary heart disease and diabetes national service frameworks have also driven forward improvements in primary and secondary prevention of risk factors associated with circulatory disease in general. This includes better control of blood pressure and blood glucose, cholesterol management and the use of aspirin.
The Department is also developing a new national stroke strategy for England which aims to modernise services, not just for those who have had a stroke, but also those at risk of doing so.
Over the last 10 years, the main part of the Department's total expenditure on health research has been devolved to and managed by national health service organisations. Details of individual NHS supported research projects including a number relevant to my hon. Friend's question are available on the national research register at
www.dh.gov.uk/research.
The Department's National Institute for Health Research is investing £20 million over five years in the UK Stroke Research Network set up in 2005. The Network is supporting clinical trials and other well designed studies conducted by public and private sector funders, and has adopted the following three studies which involve research into the prevention and treatment of stroke within black and minority ethnic communities:
DNA resource for lacunar stroke
South London ethnicity and stroke study
The South London secondary prevention programme
The Department is also funding the South London Stroke register which assesses the risk of stroke and the natural history of stroke with a focus on ethnicity.
The Department does not hold this information centrally. However, the following hospitals took part in the 2006 sentinel audit of stroke services conducted by the Healthcare Commission.
NHS Trusts
Barking, Havering and Redbridge Hospitals NHS Trust (Oldchurch and Harold Wood hospitals in collaboration with Havering primary care trust)
Barnet and Chase Farm Hospitals NHS Trust (Barnet hospital), Barnet PCT and Finchley Memorial hospital
Barnet and Chase Farm Hospitals NHS Trust (Chase Farm hospital)
Barts and the London NHS Trust jointly with Tower Hamlets PCT
Bromley Hospitals NHS Trust
Ealing Hospital NHS Trust
Epsom and St. Helier University Hospitals NHS Trust (Epsom Hospital)
Epsom and St. Helier University Hospitals NHS Trust (St. Helier Hospital)
Hammersmith Hospitals NHS Trust
Hillingdon Hospital NHS Trust
Kingston Hospital NHS Trust
Lewisham Hospital NHS Trust
Mayday Healthcare NHS Trust
Newham University Hospital NHS Trust
North Middlesex University Hospital NHS Trust—Jointly with Haringey PCT
North West London Hospitals NHS Trust (Central Middlesex Hospital including Willesden Community hospital (Brent PCT))
North West London Hospitals NHS Trust (Northwick Park Hospital)
Queen Elizabeth Hospital NHS Trust
Queen Mary’s Sidcup NHS Trust
Royal Free Hampstead NHS Trust
St. George's Healthcare NHS Trust
St. Mary’s NHS Trust
West Middlesex University Hospital NHS Trust
Whipps Cross University Hospital NHS Trust
Whittington Hospital NHS Trust
NHS trusts in 2006, now foundation trusts:
King’s College Hospital NHS Foundation Trust
Foundation trusts in 2006
Chelsea and Westminster Hospital NHS Foundation Trust
Guy’s and St. Thomas Hospital NHS Foundation Trust
Homerton University Hospital NHS Foundation Trust
University College London Hospitals NHS Foundation Trust
This is a local issue. NHS London is working to improve stroke care in London, and this is one of the issues being dealt with by the long-term strategy for London being led by Professor Sir Ara Darzi. The Royal College’s National Stroke Guidelines are for a scan to be provided within 24 hours (and within three hours where a thrombolysis service is provided).
NHS London has advised that the majority of Sutton and Merton Primary Care Trust (PCT) patients are treated at St. George’s Hospital and St. Helier Hospital, which also provide services for other PCTs. St. Helier has one CT scanner, one MRI scanner and 10 radiologists. St. George’s has three CT scanners, and most of the reporting is carried out by five neuro-radiologists.
Information is not collected in the format requested. The following table shows the number of all diagnoses count of finished consultant episodes with Sutton and Merton PCT as primary care trusts of residence for strokes (which covers the Wimbledon area).
PCT description Finished consultant episodes (FCE) Sutton and Merton PCT 1,241 Notes: All Diagnoses count of episodes These figures represent a count of all FCEs where the diagnosis was mentioned in any of the 14 (7 prior to 2002-03) diagnosis fields in a HES record. FCE An FCE is defined as a period of admitted patient care under one consultant within one healthcare provider. Please note that the figures do not represent the number of patients, as a person may have more than one episode of care within the year. Ungrossed Data Figures have not been adjusted for shortfalls in data (i.e. the data are ungrossed). Source: Hospital Episode Statistics (HES), The Information Centre for health and social care