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Stroke Sufferers

Volume 483: debated on Tuesday 18 November 2008

Motion made, and Question proposed, That the sitting be now adjourned.—[Mark Tami.]

It is a great pleasure to serve under your chairmanship for the first time, Mr. Williams, in this important debate. A number of colleagues from both sides of the House are here this morning, some of whom have suffered strokes and some of whom have family members and close friends who have suffered strokes. I am sure that that applies to almost everyone in Westminster Hall this morning.

In my constituency last year, 72 people were killed by strokes. A stroke is a brain attack—the brain equivalent of a heart attack. It is caused by an interruption of the blood supply to the brain, and one in 10 of us will die as a result of a stroke. If we thought of a stroke as a heart attack needing the same emergency and specialist response, followed by sustained treatment, we could save thousands of lives and thousands of years of disability.

In my city, 700 people had a stroke last year. One third of strokes result in death, one third of sufferers recover and one third are left with a disability. Strokes are also the leading cause of severe adult disability. One in four long-term beds in the NHS are occupied by stroke patients. The disabilities resulting directly from strokes are more widespread than those resulting from any other cause, and can blight people’s lives for years and even decades.

For many years in the UK, stroke was the poor relation in the health service. The Stroke Association, the work of which I commend, as I am sure will other hon. Members, labelled the United Kingdom as having

“the unenviable reputation of having one of the worst outcomes for stroke patients in Western Europe.”

However, I congratulate the Government on what they have done to rid themselves and our country of that reputation, and the gap is slowly beginning to close.

I have 14 questions, and I have sent them with a copy of my speech to the Minister. If he cannot answer any, I shall be pleased if he will write to me and other hon. Members. First, will he tell us whether we are in fact closing the gap between the UK and western Europe on stroke outcomes, which is one of the strongest measures that we can look for? The Secretary of State has said:

“we know that if a stroke patient is treated quickly, and the simple things are done right, death rates can be halved and outcomes can be substantially improved.

So we have two clear aims in this strategy: to reduce the number of strokes experienced each year and to ensure that we provide effective acute and follow up care when strokes happen.”

The hon. Gentleman—my hon. Friend—has brought an important matter to the House, and I congratulate him on the way in which he started the debate. I declare an interest because my mother had a stroke about eight years ago and has not said a word since, although she is happy. My son is a consultant neurosurgeon, and deals with strokes.

Early intervention is the key to a decent quality of life after a stroke. If the Queen had a stroke, she would go from a paramedic to a specialist stroke-busting drug within three hours. That is for sure, but why cannot Mrs. Smith in Hadleigh have that same treatment? Will the hon. Gentleman’s questions to the Minister include asking him how we can get rid of the postcode lottery and ensure that everyone in this country receives the early treatment that makes all the difference to their lives afterwards?

It is always instructive when hon. Members, from whatever side of the House they come, bring personal experience to bear, and that applies to the hon. Gentleman’s comment. On the Government’s objectives, I will let the Minister explain how the Government have done so far, but if the hon. Gentleman allows me to make my case, he will hear that we now have a strategy, for the first time, on some aspects. I hope that we shall move towards implementation and action on those aspects.

There have been many improvements, even in the past two years. Next month will be the first anniversary of the launch of the national stroke strategy for England. At that time, the Secretary of State said:

“It has the potential to create a revolution in stroke care.”

What a marvellous comment for any Secretary of State to be able to make about any issue—that it will create a revolution if we do it right. He also said:

“The strategy is constructed around twenty ‘quality markers’ of a good stroke service covering four key areas”—

I shall cover those four areas this morning. They are:

“raising awareness and prevention; the importance of rapid assessment and treatment; provision of rehabilitation and care after stroke; and developing the workforce to meet these markers.”—[Official Report, 5 December 2007; Vol. 468, c. 70WS.]

Although we are only a year on from that publication, there are some good initial signs that stroke care is now being afforded a higher priority by health and social care providers. The most obvious example is that the existing cardiac networks throughout the UK have taken on the additional responsibility of stroke, so there are now 29 stroke and cardiac networks covering the whole of England. In addition, the operating framework for the NHS now identifies stroke as a national priority, and in addition to that, the requirements on primary care trusts are reinforced in the three-year operational plans that they must put forward, which are monitored and performance-managed by strategic health authorities. Implementation of the stroke strategy is a “must-do”. It is no longer a Cinderella; it is no longer marginalised; it is no longer on the periphery. It is now a “must-do” at the centre of the operational plans. I am sure that all hon. Members welcome that.

Monitoring will include two key indicators: the number of patients who spend at least 90 per cent. of their time on a stroke unit, and the percentage of patients with higher risk transient ischaemic attacks—mini-strokes—who are treated within 24 hours. When will the information on progress on those two indicators be published so that all of us—MPs, the Stroke Association, stroke patients and so on—will be able to measure progress?

I shall gladly give way to my hon. Friend. There are a number of hon. Members in Westminster Hall this morning, and I shall give way generously to any colleagues who wish to intervene.

I congratulate my hon. Friend on securing this one-and-a-half hour debate, during which 25 people in the country will have a stroke, 10 of whom will die. Many of them could be saved, but only one in 20 of those who could benefit from clot-busting drugs will receive them. Improving the provision of those drugs would drive those figures down.

My hon. Friend often plays the straight man to me, and he has again fed me the perfect line to take me on to raising awareness and prevention. I agree with the points that he made, and I will reinforce them in my next couple of paragraphs.

More than 40 per cent. of all strokes could be prevented if people kept their blood pressure under control, monitored cholesterol levels, ate healthily, stopped smoking, and took regular exercise. I am not yet on to awareness; I am talking about prevention. The Government have introduced a programme of vascular checks for 40 to 74-year-olds, which I would like to know a little more about. Will the Minister tell me when I, as a 55-year-old, and perhaps others here can expect to receive our personal invitation for a check under that important step forward? Is it possible to use similar techniques to identify and target those with a family history of or a propensity for strokes and give information on how to avoid them, and what they and their families should do at the outset? The first moments when someone detects that a person does not quite look how they did yesterday are crucial. What can we do to get information to the people in families with a propensity for stroke to enable them to see that action needs to be taken really early and quickly? Will the Minister consider the techniques of direct mail and the use of data tracking to ensure that we get to those people much earlier?

Both public and professional awareness of risk factors and symptoms of stroke are frighteningly low. The face, arms and speech test—FAST—relates to some of the key signs to act on early. Someone may notice that a person is not speaking as accurately as they did before, that they have trouble raising an arm or have a slight drooping or tingling of the face. The symptoms of stroke are often not as dramatic as those of a heart attack, in which people may clutch their chest and fall to the ground in agony. However, the symptoms of stroke are of equal importance. If we can act early, we will save thousands of lives and prevent years of unnecessary disability.

It is worrying that people do not know—I admit my own ignorance on this—that when a person has a stroke, they should dial 999 in the same way as when someone has a heart attack. That means that a person suffering a stroke can be treated quickly. I have one small quibble with the fantastic people—those in the voluntary sector and the professionals, who do an incredible job—who have provided some of the information for me on this subject. When we are trying to raise awareness, can we please not use acronyms and medical jargon? We should talk in a way that ordinary people understand, so that they can obtain treatment and help themselves and their families. When we talk about TIAs, coronary heart disease, aphasia, vascular, FASTs and so on, it is little wonder that people are confused. If we keep things simple, we will raise awareness throughout the UK in the same way as awareness has been raised of some of the key symptoms of heart attack.

The issue of professional awareness also needs to be examined. Some 20 per cent. of GPs admit to not referring one in five cases of mild and major strokes to hospital immediately. It is honest of them to say that, but we need to ensure that they are aware of the issue so that they can rectify the situation and save lives. Last year, the Stroke Association invested £500,000 in a press and radio advertising campaign to raise awareness of the fact that

“stroke is a brain attack”.

To implement the kind of sustained wide-ranging campaign that we need to make permanent improvements, the Government must play a role and take the lead, alongside the great work being done by the Stroke Association. I hope that when the Government do that, they will also consider the impact that raising awareness will have because there will obviously be an increased demand on services. I also hope that the Government will consider the impact on stakeholders, including those who offer advice and support to the public, as they may well have a steep increase in requests for their services.

I am pleased to say that my city is apparently doing well in relation to strokes. We are already responding to the national strategy and the Nottingham City primary care trust and Nottinghamshire Healthcare NHS Trust are holding a week-long campaign this week that will encourage people to become more aware of the symptoms of strokes and to change their lifestyle. Nottingham City PCT has commissioned community services, such as the new leaf stop smoking scheme, health trainers, exercise referral schemes and food and cooking schemes to support people at risk in the community and encourage them to be more active and eat more healthily. Lack of exercise and an unhealthy diet are important risk factors for stroke.

A locally enhanced service, which is basically the incentivisation of GPs, has been commissioned with all GP practices to identify and manage patients who are at high risk of cardiovascular disease. I am happy to say that it includes a partnership scheme with the pharmaceutical industry in Nottingham called “happy hearts”. That scheme is doing well. The “change makers” project also works with local community volunteers to improve awareness of stroke symptoms and risk factors. So, as a result of Government action and colleagues from all parties repeatedly raising the matter—including a debate that took place around 18 months ago on the Floor of the House—we have progressed from a big national strategy to real projects on the ground. What further plans are there to improve public and professional awareness of stroke symptoms and what people should do at the onset of a stroke? Equally important, what plans are there to make those campaigns sustainable? One-offs are really welcome, but it is also important to have a sustained campaign to change our view and the culture surrounding the treatment of stroke.

I now come to the point already made by my hon. Friend the. Member for North-West Leicestershire (David Taylor) about the need for rapid assessment and treatment. Time is of the essence when treating stroke. According to the Secretary of State, there is a window of only three hours in which stroke patients must be seen, scanned and treated. For each one-minute delay, 2 million neurons are lost from the brain, yet people who know this subject far better than me say that awareness of stroke is at the level of awareness of heart disease that existed 10 years ago. We still have a lot more to do, but that does not mean we need bags more money—of course, resources are always welcome—but the Royal College of Physicians has clearly stated:

“we do not necessarily need more resourses just better organisation of what we have already”.

I congratulate my hon. Friend on securing this important debate. May I give an example that reaffirms what he is talking about and perhaps touches on a point made earlier about treatment being not a postcode lottery but an organisational matter? I am aware of a couple whose experiences were very diverse. The wife suffered a severe stroke and was admitted to a specialist stroke unit. After six weeks, she was discharged having made almost a total recovery, apart from some speech impairment. She had no further episodes. A short time later, her husband was admitted via an accident and emergency department to a geriatric unit and died two weeks later from a second stroke. Does that not exemplify what we are talking about in terms of organisation: one couple and one place, but two pathways and two outcomes?

My hon. Friend has put it more eloquently than I can. I am not going to say that everyone will be as right as rain, but if we get to people early and give them the right treatment, they can go on to lead a full and productive life. In essence, during a stroke parts of the brain lose oxygen, which is the source of life for the brain. The longer the brain is left to suffocate, the greater the damage that will take place and the greater chance there is of irreparable damage. Early intervention is really important. My hon. Friend has clearly described the stark contrast between what happens if a stroke is dealt with quickly and what happens if it is not dealt with quite so expeditiously.

Nigel Mason of GE Healthcare goes further than the Royal College of Physicians and says

“reconfiguring staff and procedures for a daily two-hour immediate access clinic would save lives and generate £42 million savings as well”.

We all care about the individuals concerned, but even if we consider the matter purely in terms of a sensible way to manage resources, we can save immense amounts of money by getting it right. There are many other examples of that.

Stroke patients are around 25 per cent. more likely to survive, they make a better recovery and they spend six days less in hospital if they are admitted to a stroke unit, rapidly assessed and receive specialist care from a multi-disciplinary team. The national stroke strategy sets a clear standard to ensure that effective urgent care is in place, including transfer to an acute stroke centre that provides scans and thrombolysis—I hope I have got the pronunciation correct—where appropriate. The medical profession will shriek at this, but, for ordinary mortals, thrombolysis is basically souped-up aspirin. The national stroke strategy also refers to prompt admission to a specialist stroke unit. All those things in a line mean that we have done a great deal to reduce the number of deaths and disabilities arising from strokes. In addition, one of the hopes in the strategy is for more specialist stroke nurses to be available. We are only a year into the strategy, but perhaps the Minister will give an indication of when he hopes to have complete coverage, and when every hospital will have a stroke nurse.

With regard to thrombolysis, which is probably better known to people in the business as clot-buster drugs, the Secretary of State said last year:

“Right now, less than 1 per cent. of people who have a stroke are receiving thrombolysis. If we can get that number up to 10 per cent., 1,000 people a year would regain their independence, rather than die or be disabled for life. By following the guidelines set out in this strategy, 1,600 potential strokes can be averted through preventive work and a further 6,800 deaths and disabilities can be avoided.”

What a prize for something so simple and inexpensive; 6,800 deaths and disabilities could be avoided. Clot-busting, thrombolytic drugs can be the difference between someone leaving hospital on foot and beginning a lifetime in a wheelchair. In Ontario, 37 per cent. of patients get clot busters. Will the Minister bring us up to date on the level of use of clot-busting drugs in this country? The Secretary of State said more than a year ago that it was less than 1 per cent., but I am sure that that figure has improved. Perhaps the Minister will tell us how well we are doing and what the curve is. I do not expect the figure to leap to 37 per cent., but we would like to know what the curve is to ensure that people receive those very simple drugs at the moment when they need them most.

My hon. Friend has moved on to mobility, which is one of the problems that frequently follow a stroke, whether it is a transient ischemic attack or a severe stroke, but is there not a need to do more for those who have a communications disability? I am referring to disabilities relating to speaking, understanding, reading and writing. About 250,000 people have to grapple with such a disability for years and years. Will my hon. Friend commend, as I do, the Leicestershire County and Rutland primary care trust? It has a specialist stroke unit at Leicester general hospital, where stroke victims go, but then they are discharged via two rehabilitation units. One is in Coalville community hospital, which covers the northern part of the county, and the other is at Market Harborough. That type of initiative can help a great deal, can it not?

Again, my hon. Friend is absolutely right, and again he is at least five pages ahead of me in my argument. I will come on to some of the issues that he raises. I am very happy to commend the organisations to which he referred. I will speak about those issues later, but next I want to say a few words about scans.

I, too, congratulate the hon. Gentleman on securing this very important debate. If I may, I should like to follow up the intervention from the hon. Member for North-West Leicestershire (David Taylor) with regard to community care after a patient has been treated in hospital and is back at home. There seems to be great inconsistency across the country. There are some excellent examples of outreach services, particularly in the north-east, which I have seen myself, but that does not seem to be the case everywhere. I hope that the hon. Member for Nottingham, North (Mr. Allen) will come on to that issue.

I thank the hon. Gentleman for his comments. Yes, I will come on to those issues, and no doubt the Minister will respond on the patchy nature of provision. We need to look for the trend lines. Is something improving, and is it improving everywhere? Is there convergence in levels of provision? It would be unfair to say in a year’s time, “Has this problem been solved?” Of course it will not have been, but colleagues on both sides of the House will hope to see the trend lines going in the right direction.

Why do we do scans? I understand that the main reason is to exclude the other cause of strokes, which is a bleed in the brain. Clearly, we do not want to administer clot-busting drugs if the cause is a bleed, and a scan will immediately eliminate that possibility. The National Institute for Health and Clinical Excellence recommended in July 2008, just a few months ago, that a brain scan should take place within one hour of someone being admitted to hospital. The strategy emphasises the need to improve access to scans and stipulates that brain imaging should be performed in the next scan slot, or within 60 minutes of a request out-of-hours. In 2006, only one in 10 people were scanned within three hours. We need a tight target to make scans available 24/7. Any unit unable to deliver scans by a particular time should not be called a specialised stroke unit. I hope that the Minister will consider that. In Sweden, 100 per cent. of those who need a scan get one, and we should aspire to that in this country. Will the Minister tell us the percentage of scans in the UK and in my own city of Nottingham, and by what date we aspire to reach 100 per cent.?

The hon. Gentleman is being most generous in giving way. Does he agree that the ambulance service has a part to play, as it is not just a question of getting someone to a hospital—any hospital—as quickly as possible; it is a question of getting someone, even if it takes 15 minutes longer, to the right hospital for specialist treatment of their problem? If someone gets into a hospital and then has to be transferred to another hospital to have that work done, valuable time is often lost.

The only difficulty with the hon. Gentleman sitting immediately behind me is that clearly he is looking over my shoulder at what my next paragraph is about. He makes a very pertinent point, which runs on from the one about scans. We need to get people in the right place to have the scan. All local stroke networks should ensure that patients who could benefit from urgent care are transferred to an acute stroke centre that provides 24-hour access to scans and other specialist stroke care.

In Nottingham, ambulance staff all use FAST—the face, arms and speech test—to identify emergency stroke patients. The Secretary of State said last year:

“We are consulting about upgrading strokes from category B to category A events so that ambulances arrive within nine, rather than 18 minutes.”—[Official Report, 11 July 2007; Vol. 462, c. 1484.]

For the Department to consult on a nine-minute difference shows how important the Secretary of State and the Department consider the matter. Will the Minister tell us whether that review—that consultation—on changing the category from B to A has been completed and what the outcome is? Those minutes really can be the difference between life and death for many hundreds of people.

While I am talking about the way in which things are done in Nottingham, I will, if I am permitted, make a small boast. Nottingham university hospitals stroke services have been shortlisted for the forthcoming Health Service Journal awards in the “improving access” category for their work on TIA and hyper-acute services. There are four stroke units in Nottingham—one acute stroke unit and three rehabilitation units—and a system of virtual beds means that a bed is highly likely to be free for those patients who are FAST-positive. The stroke services are centralised in a 72-bed unit on the City hospital campus. There is direct access to the stroke unit through agreed protocols with the ambulance service. In other words, ambulance staff can drive by other medical facilities to go to the right place. That is not only permitted but encouraged. Thrombolysis—I keep getting my tongue twisted round that one—is available Monday to Friday from nine to five. That is excellent, but we need to be greedy. We need to say that it has to be available 24/7. Strokes happen at the most inconvenient time and they also happen at weekends. We have a daily one-stop clinic for high-risk minor strokes and acute care and rehabilitation were located in one unit in response to patient feedback.

I now come to a number of points raised by colleagues. The third part of my argument is about the provision of after-stroke rehabilitation care, which my hon. Friend the Member for North-West Leicestershire mentioned. As I discovered in a debate on incontinence last year in Westminster Hall—I think that you may have been present, Mr. Williams—when it comes to NHS matters, treatments and state of the art technologies are not the problem. The problem is that in soft skills and empathetic aftercare, medical culture requires serious transformation. That is the hardest thing to do, but it is at least as important as the medication, surgery and all those other things that we are so good at.

According to the Healthcare Commission, one year after leaving hospital, 80 per cent. of stroke patients think that they are not receiving adequate care. There is no magic wand and no one expects the Minister to pop up and suddenly deliver an answer to the problem. It needs lots of hard work, grinding organisation, staff training, supervision—all those things that are criticised under the general heading of bureaucracy. To make the health service work for an individual patient who has suffered something life changing, whether incontinence, a stroke or something else, we need the human interaction that, in many cases, makes life worth living. That must be examined and worked on over and over again.

Seven of the 20 new national stroke strategy quality markers are directly linked to the support and community services needed by those who have suffered a stroke and their carers. They include high-quality rehabilitation, information, advice and the practical and peer support that colleagues have mentioned. Such support should be provided throughout the care pathway and in line with individual need. There is no one-size-fits-all solution. For my next question, will the Minister tell us how we secure effective discharge planning that is built around the needs of the individual?

Can I insert subsection (a) to that question, unless it is down as the next question on my hon. Friend’s list? As part of rehabilitation after discharge from hospital, the stroke unit or a community hospital, does my hon. Friend agree that stroke clubs are important? People get a great deal from such clubs, which are often run by volunteers, stroke victims, families and carers on a shoestring. Such clubs play an important part in getting people back on to their feet with greater confidence. Many MPs visit stroke clubs. I have the good fortune to be the president of Ibstock stroke club, and I know how valuable the work done by it and similar stroke clubs is for the process of rehabilitation and recovery.

I know from reading up for this debate and from past debates, how committed my hon. Friend is to this topic, and the effort that he has put into it over many years. I agree with him, and I will come on to say a few words about stroke clubs and the difference between them and communication support groups, which are also very important.

As part of the stroke improvement programme, there is a central national team—I am pleased to say that it is based in the east midlands—which supports the development of the 29 local stroke care networks I mentioned. In Nottingham, a well-established partnership works across the local health and social care community through the stroke services strategy group with representation from the Stroke Association and an excellent relationship with @astroke, the local patients forum. There are also strong local research links with the university. Professor Marion Walker and Ossie Newell, a stroke survivor, were winners of a local media “reach out” award for their work in developing research and rehabilitation programmes for people who have had strokes.

My next question is about rehabilitation. NICE recommended 45 minutes of rehabilitation a day. Does the Minister know when that target is likely to be met? What steps are we taking towards it? As part of the national stroke strategy, the Department of Health published a local authority circular last May entitled, “Demonstrating how to deliver care for adults in the community.” It stated that councils with adult social services responsibilities in England receive funding to deliver long-term stroke care for adults in the community, and it encouraged more joint working between health and social care providers. That is important to enable stroke survivors to receive a seamless transfer of care from the hospital to the community, and to ensure that they receive the support they need for as long as necessary.

Does the Minister know specifically whether information about how that grant is spent by local authorities will be made public, so that we can see the implementation of the stroke strategy as it unrolls and overall monitoring can take place? The money is apparently ring-fenced, and we must ensure that it stays that way. The funding, however small, must be sustainable—I do not know how many debates in Westminster Hall I have attended where I have said that. Quick bursts of activity for one year or for three, are often worse than useless. I would prefer to have smaller amounts of money sustained over a longer period, so that people know where that central core of money is and can build around it.

Colleagues from all parties have mentioned community services. A particularly pleasing part of the new strategy are the references to the value of communication support groups for stroke survivors. The Stroke Association has pioneered work in that area with its “Lost without words” campaign. Communication difficulties include aphasia and speech impacts, which affect approximately one third of stroke survivors. Without support, survivors can experience problems including depression, isolation and an inability to return to work. Currently there are no communication support services in the Nottingham area. The group Aphasia Nottingham aims to help, but it is entirely voluntary and receives no statutory funding. However, there is a real need for that service in Nottingham.

At present only 12 per cent. of stroke survivors in England have access to communication support groups organised by the Stroke Association. That figure is even lower in my area, which I share with my hon. Friend the Member for North-West Leicestershire. Historically, there have been challenges to the discharge of stroke survivors back into the community, thereby creating bed blocking. Nationally, a community stroke team is in place, and from January next year, there will be a system of early supported discharge, which should help to address that problem. Nottingham City primary care trust is currently recruiting a team for that system.

Community care for stroke survivors is fragmented. The level of care that someone receives seems to depend on the area in which they live. In Nottingham, adult social services care for stroke survivors, and a 12-week programme called Stroke Ability is heavily exercise-based and has elements of prevention and awareness work. As my hon. Friend said, there are a number of stroke clubs in the area. From next year, a further family and carer support service in the south of the county will be funded by new local authority funding to help people with the transition from hospital to home. It is imperative that the Government encourage local authorities and PCTs to take account of the communication support needs of stroke survivors in their communities, and ensure that they keep that money ring-fenced for stroke-specific services.

Finally, the National Sentinel audit of stroke care by the Royal College of Physicians has proved an extremely useful tool for monitoring the implementation of standards and service improvements in the acute sector. However, there has not been a similar focus on monitoring community services. The Healthcare Commission’s patient survey 12 months after discharge from hospital was published in 2006, and gave an excellent snapshot of the standard of care and support for stroke survivors in the community. For my 13th question—there is just one more before I sit down—may I ask the Minister whether further surveys along those lines or an extension of the Royal College of Physicians auditing process into community care will be undertaken?

My final and briefest question is about the development of the work force to meet the markers that the Secretary of State mentioned when announcing the strategy. In Nottingham, we have a stroke training programme for all staff working for the stroke service, and we have one of the 10 Government-funded medical stroke specialist training posts. However, although the funding is welcome, again it is non-recurrent. We need specialist staff with stroke knowledge and skills, and Department of Health training for an agreed competency framework. When will that framework be ready and how will it be managed? Will units receive accreditation for providing different levels of specialist care? How much sustainable support are the Government providing to all levels of stroke care staffing?

I hope that I have been generous in accepting interventions to allow a large number of colleagues to contribute, and I apologise for taking up a lot of time. I believe that the Government are to be congratulated heartily on putting in place an excellent, although long overdue, stroke strategy. People who care about this subject, from all parties, inside and outside this House, campaigned for it for a long time. We must now put stroke awareness high on the agenda and ensure timely and urgent treatment to improve the quality of life of people suffering the after-effects of a stroke. I hope that this debate gives the Minister an opportunity to tell us what progress has been made since the national strategy was announced and what milestones he hopes can be achieved over the next year. The key message that I have received in putting together this debate is that it is not so much about money, but about organisation. As with so much public policy, if we choose to intervene early, the impacts will be cheaper, more effective and, in this instance, will save many lost and broken lives. I thank you, Mr. Williams, for allowing me to make my case at some length.

I wish to start the wind-up speeches at 10.30 am. I hope that hon. Members will bear that in mind, so that everyone can get in.

I congratulate the hon. Member for Nottingham, North (Mr. Allen) on securing this important debate. If others bring to it as much wisdom as he has, we will be tremendously privileged.

I am pleased to take part in this debate, particularly because almost two years ago I suffered a serious stroke. It is often said that every stroke is different, but still I would like to say a few words about my experience. When I first came round in hospital, I was in a pretty bad way. Two friends were there with my partner, Carole, and one leaned over me and said, “Don’t worry, your solicitor and your undertaker are here”. I am very glad to say that I did not need either of them professionally, but I did, in those first few weeks, have to learn, almost from scratch, how to function and communicate again.

I could not walk properly, so physiotherapists worked with me to restore my movement. My vision was affected. For a while, I could not judge distances, and I kept bumping into things. Over and over again, I had to use flash cards to help me to remember the words for dog, horse, cat, cow and so on. I have paid tribute before to the staff of St. Mary’s, my local hospital, and am pleased to do so again, for the excellent care that I received. I know I am very, very lucky. I have recovered from my stroke well and medical tests show that I am at no greater risk of another stroke than anyone else of my age—indeed, I am at less risk than many people.

I am sure that other hon. Members will make valuable contributions about the medical needs of stroke sufferers, but I shall raise a slightly different issue. I was in hospital for six weeks. After I was discharged, I needed no further medical treatment, although I did receive a fortnightly hour of speech therapy. In many areas, even that is not available owing to a lack of qualified therapists. That support was invaluable to me, but equally important was the experience of simply talking to lots of different people, and the mental stimulation that that brings.

As I said before, I was very lucky. My movement came back relatively quickly, and I could get out and about and meet people. It must have been trying for them, sometimes, because I could not always find the words I needed to get my ideas across. Almost one third of stroke sufferers are left with some kind of communication difficulty—it is called aphasia, and it is a hidden disability. I looked all right, my mind was functioning as it always had, my thoughts were in perfect order, and I was still the same person, but my brain sometimes let me down in getting the correct words out in the right order.

Aphasia has been likened to a filing cabinet falling over and all the files getting mixed up. The filing cabinet in my brain is now getting itself in order, but sometimes I still cannot find the exact word that I need when I need it. If that ever gets me down, I think of the blindness overcome by the right hon. Member for Sheffield, Brightside (Mr. Blunkett) or the silent world of Lord Ashley, who was so effective despite being completely deaf, and I remember that things are not that bad. Before my stroke, I could make a speech like this off the cuff, but these days I need to use notes—although, actually, I have found that having to think before opening one’s mouth is not necessarily a bad thing for an MP, and I commend it to colleagues in all parties.

I had the support of friends and family and was able to get out and about. As I am well known on the Isle of Wight and islanders are a friendly lot, I had plenty of people to talk to, but not all stroke sufferers are so blessed. Many are elderly and live alone. Aphasia makes them lose confidence, which makes it even harder to communicate. That is where the voluntary organisations come into their own. The Isle of Wight is home to just 130,000 people, but they have lots of voluntary support, including from the Stroke Association, the stroke club and Different Strokes, which do an amazing job. They provide the information that people need about every aspect of life following a stroke.

Such voluntary organisations arrange weekly exercise classes and events where people can meet others experiencing the same problems. They provide a forum where people can get the mental stimulation that they need from talking to other people without embarrassment. Quite simply, they make people realise that they are not alone, which is a great help. Such voluntary organisations gave me enormous support, and I thank everyone involved on the island. There are too many individuals to mention, but it is humbling that so many people willingly give up so much of their free time to help others.

Without the help and support of so many islanders, I simply would not be here today. I could have simply given up, but with so many people willing to help me to get well again, that was never really an option. However, the first time that I stood up to speak in the House after my stroke was a most terrifying experience.

My plea is for everyone to recognise and applaud the work that the charitable organisations do in helping people on the road to recovery. The support that they give can improve confidence and independence. It can overcome isolation and depression and improve communication skills. It is not the job of the national health service to provide someone to whom victims can talk. I know from experience how important talking is to recovery. The greatest help that can be given to many sufferers is the opportunity to communicate, and to practise talking so that they can build up their speech again. It is something that charities do very well, but it is also something simple that anyone can do.

I would never have chosen to have a stroke; however, I have learned a great deal from it. I hope that I can use that knowledge to bring an extra dimension to my life.

It is a particular pleasure to serve under your chairmanship, Mr. Williams. We are indebted to the hon. Member for Nottingham, North (Mr. Allen) for raising this very important debate. However, I am sure that he will understand when I say that tributes should be directed to the hon. Member for Isle of Wight (Mr. Turner) for his contribution. The test of time will show that he has been an inspiration to many thousands of people who have had the same experience.

I represent a Welsh constituency, so the responsibility for Government policy that affects my constituents is a matter for the Welsh National Assembly, and I am reminded by the Chair not to stray into devolved matters. Like the hon. Member for Isle of Wight, I want to spend a few minutes talking about the invaluable work of the voluntary sector and, in particular, of two or three organisations with which I have had the privilege of working over the past couple of years.

The hon. Gentleman said that we cannot build rehabilitation services without the voluntary sector. We have heard a lot about the Government’s laudable 10-year strategy and the contribution that social services departments make, but we must also acknowledge the work of the voluntary sector; without it, the lives of many thousands of people would be considerably worse. It has risen to meet the challenges mentioned earlier. For example, strokes are the third most common form of death in the United Kingdom, accounting for 9 per cent. of the deaths of men and 13 per cent. of women. The Aberystwyth and district stroke club in my constituency has 60 members, 40 of whom have had strokes. Many carers attend the meetings. We have not heard a huge amount about the carers and the unique advice and support that should be directed toward them.

The Aberystwyth and district stroke club was borne out of frustration with the lack of provision, yet, in its 20-year history, it has never received any public funding. A similar such point was alluded to by the hon. Member for North-West Leicestershire (David Taylor). The club has been reliant on the generosity of businesses and local residents to keep it going. It offers important confidence-building services, weekend breaks and help for people who may not have the chance or the resources to get away. It runs a bus, which is funded by the lottery’s “awards for all” scheme, which costs between £4,000 and £5,000 a year. However, more importantly, it enables stroke victims to meet other people in the same position as themselves—people who are some way along the path to rehabilitation, and who can offer the wisdom of their experience.

A central focus of the debate so far has been the need for immediate care and diagnosis. Everybody in this Chamber will agree with that goal, which has been raised by the Aberystwyth and district stroke club. Many of its members have had to wait 24 or 48 hours for a scan.

Like many others here, I represent a rural constituency. If we put into that context the misfortune of suffering a stroke and mix it with living in some of the most isolated and scattered communities in the country, it is a frightening experience. Ambulance times are already challenging. I ask the Minister to comment on the role of telemedicine throughout the country. The service has been pioneered in my constituency in Bronglais hospital, in Aberystwyth, and plays an invaluable role in assisting early diagnosis. It brings the expertise that may be available elsewhere into more scattered communities—a point made by Professor Boyle in his analysis.

We were disturbed to hear the story from the hon. Member for Pudsey (Mr. Truswell) about the couple in his constituency. We need to remind ourselves that recovery from stroke can be an incredibly long-term process; 25 per cent. of all long-term beds in hospital are occupied by stroke patients. We need to ensure that support is available in hospital and that the voluntary mechanisms are in place to enable people to have the moral support and encouragement to make the long journey to full health.

I applaud the Government for their announcement about the ring-fenced money, but I echo the views of the hon. Member for Nottingham, North about the need for us to monitor where that money is going and to ensure that our social services are delivering the services that we and the Government expect of them. For those who are able to live at home after suffering a stroke, the support provided by the voluntary sector is invaluable. I know that we are only a year into the strategy, but will the Minister tell us whether an early appraisal has been made of the adequacy of the ring-fenced funds?

Some voluntary groups have raised real concerns about the grants and funding made available to them. Positive Action for Stroke, which is based in my constituency, has had real difficulty obtaining funding. The Progressive Action Group in Aberystwyth faces similar concerns. I hope that the Minister will reflect on the importance of voluntary organisations in helping those who have had strokes, even if he cannot get into the nitty-gritty of the funding. Some public bodies have been reluctant to fund voluntary groups when lottery funding has not been available, and it has been a great challenge to find alternative sources of funds. If the Minister pointed the voluntary groups in the direction of funding, that would be very welcome.

I want to emphasise the importance of the services that voluntary groups offer. Progressive Action arranges what it calls “fun activities”, such as computing and arts and crafts. However, such activities also help stroke victims to return to the employment market. We have heard about the depression faced by many stroke victims. Again, in a rural constituency, that should be seen in the context of rural isolation, the feeling that one is not getting the services to which one is perhaps entitled, compounded by the health condition that has to be endured.

The ability to have organised breaks and activities allows people to be much more active than they might otherwise be. We are all aware that activity and dialogue, which the hon. Member for Isle of Wight mentioned, are integral to recovery. Such activity also ensures that victims can redevelop motor skills. The care is delivered as part of a care package, but once that time in hospital has ended, the recovery process can go on for many months and years. Having help and support outside the hospital environment is extremely valuable in aiding recovery. It is also very beneficial for people to be able to make new friends, and to meet those who have had similar experiences and been through the same process.

The hon. Member for Nottingham, North put his case very concisely. I, too, believe that part of the emphasis should be on the importance of raising awareness to prevent strokes. However, as the hon. Member for Isle of Wight said—my contribution is humble compared with his—it is important to recognise the work done by the voluntary sector in providing assistance to those affected by strokes.

I want to finish by praising the work of our health professionals. We have talked about developing skills and expertise in our hospitals. We have all had our family experiences in these matters; mine involved a dear aunt. I remember the fateful phone conversation when her husband told me that she had suffered a stroke and had lost the power of speech. She was a chatty, enthusiastic and vibrant individual who did a huge amount for her community: then—stop. Two years on, she has recovered her power of speech and is as active a member of the community as she used to be. That is no small tribute to her abilities and enthusiasm, but also to the health professionals who have helped her so much, and to the voluntary sector.

I congratulate the hon. Member for Nottingham, North (Mr. Allen) not only—nor most importantly—on securing the debate, but on the speech that he made, and the many points he put to the Minister. I pay tribute to his work and that of members of the all-party group, and I want to echo his comments, which were widely applauded around the Chamber, about the vital and wonderful work of the Stroke Association. The number of questions in the hon. Gentleman’s speech went up from 13 to 14 by the time he delivered it, so presumably he came up with another one overnight; he has helpfully shared his speech with us. I think that we all agree that if the Minister can answer the 14 questions, today and on a continuing basis, we shall be much closer to assessing our progress in the past year.

It is a pleasure to follow my hon. Friend the Member for Ceredigion (Mark Williams) and to hear something of his personal experience of the issue—something that has echoes around the Chamber, whether the experience is personal or whether it concerns constituents, as in the case raised by my neighbour, the hon. Member for Pudsey (Mr. Truswell).

I just want to correct a misconception. The case that I quoted did not concern constituents. To be honest, it was my mother and father.

That was my mistake. I thank the hon. Gentleman for that correction.

I want to echo the comments of my hon. Friend, and I pay tribute, too, to the hon. Member for Isle of Wight (Mr. Turner). It was incredibly humbling to hear of his personal experience, as well as enormously informative for us all. I think we all want to thank him for sharing it, and for his contribution to the debate. I reiterate what has been said about his being an inspiration to many people who have suffered strokes, in showing what people can do and how they can come back from a stroke. The way in which he has served his constituents is a tribute to him. The hon. Gentleman also made an interesting point when he mentioned the wisdom of thinking before we speak. Many hon. Members should remember that—and I certainly do not exempt myself from that group.

I had a vivid reminder about strokes a few weeks ago, when the mother of one of my best friends unfortunately suffered a severe stroke. She was in the highlands of Scotland and it was only thanks to the response of the air ambulance, and the wonderful medical care that I am delighted to say she received, that she is still with us. She is now recovering. It is a slow recovery but she is making good progress.

As we have heard, the effects of stroke can vary enormously. Stroke is the third biggest cause of death in the UK—there are about 50,000 such deaths every year—and the largest single cause of disability. Each year, 110,000 people in England alone suffer a stroke. Stroke affects more women than breast cancer. It is estimated that the overall costs of treatment for strokes and related and subsequent disabilities is a staggering £2.8 billion a year. As we have heard in eloquent speeches from the hon. Member for Nottingham, North and other hon. Members, the debate is important because we must ensure that care of the best quality, including consistent access to treatment, is available for those who suffer strokes, but also because of the need for prevention. That is why the Liberal Democrats warmly welcome the national stroke strategy, which was published in December. The chief executive of the Stroke Association, Jon Barrick, described it as

“a momentous opportunity to transform the outcomes and lives of stroke survivors.”

What the debate is about—as I am sure we would all agree and the Minister would acknowledge—is checking that we are taking that momentous opportunity, and seeing whether people are receiving better care than they were 10 months ago.

The initial signs are that some progress is being made. Even before the strategy was announced, 97 per cent. of hospitals had a stroke unit, and more than 90 per cent. of stroke units providing acute care had access to brain imaging within 24 hours of admission. That is a big increase—82 per cent.—since 2004, and is to be commended. However, there are certain points that we need to examine, and the audit this year by the Royal College of Physicians found that only 45 per cent. of hospitals could meet the recommendation made in the strategy that high-risk patients who had a transient ischemic attack or mini-stroke—and I share the wish of the hon. Member for Nottingham, North to use ordinary phrases that mean something to people—should be examined and treated within 48 hours. Given that the Stroke Association has pointed out that meeting that one target could result in an 80 per cent. reduction in the number of people going on to have a full stroke, the standard is one that needs real focus both now and as the strategy progresses.

A requirement has been placed on primary care trusts to set out their plans for improving stroke services for 2008-09. The House should welcome that, and monitor it. However, the Stroke Association has voiced concern that an absence of national targets and time scales for those targets in the strategy may affect progress. It is important to say that some strategic health authorities have gone further than the strategy specifies, and have included a timetable for the implementation of selected recommendations, but serious consideration should be given to setting a timetable across the board for implementation of the targets, so that we can achieve the speed of change that we need, and be confident that people are getting consistent access to services in all areas. Good progress has been made, which is enormously encouraging, and we all welcome that. I want to ask the Minister whether we can examine progress annually. Today’s debate is useful, but we should continue to monitor what happens.

Most of the debate today has rightly focused on issues such as prevention and acute hospital treatment and care, but the speech of the hon. Member for Isle of Wight in particular dealt with the huge importance of long-term care and community support following a stroke. The importance of effective long-term care and the need for stroke sufferers to be active participants in their treatment has been well documented. According to the Stroke Association, only about half the individuals who have experienced a stroke receive the rehabilitation that they need in the first six months following their discharge from hospital. In the next six months only one in five receive the help, support and treatment they are deemed to need. That is something on which the strategy should focus, and I hope that the Minister will agree.

One of the most important issues in the debate is embodied in one of the figures that has been quoted: 40 per cent. of strokes can be prevented. The importance of awareness of strokes cannot be overestimated. One concern is that polling by the Stroke Association found that one in five GPs do not refer about 20 per cent. of cases of mini-stroke. Just over half of GPs said that they would refer someone with a suspected stroke immediately. A concentrated effort must be made to ensure that strokes are regarded as nothing short of a medical emergency, in which time is of the essence, and that all treatment is recommended with that in mind. I am aware that NICE and the Royal College of Physicians recently published guidelines, and I hope that there will be a concerted effort across the board.

I pay tribute to the Government for the £12 million that is to be invested in the next few years in awareness activity. That is a common-sense thing to do, considering the enormous cost of £2.8 billion that I have already mentioned. I should like an assurance from the Minister that any public awareness campaign will take account of the needs of some ethnic minority groups that are at greater risk of strokes, and of the possibility that it may be more difficult to reach those groups. Finally, there is a need for more research. The Stroke Association funds £2.5 million of research, and we must always look for ways to improve what is done.

To conclude, this has been an excellent debate. It could not have been more timely and I do not think that it could have been more informative or constructive for all of us. I simply urge the Minister to allow us all to continue to contribute to monitoring the progress of this very important and very welcome strategy, and I look forward to hearing his response to the debate.

I am pleased, Mr. Williams, to see you in the Chair.

I want to reiterate the comments of other hon. Members in congratulating the hon. Member for Nottingham, North (Mr. Allen) on securing this important debate. I also want to congratulate him on the very comprehensive and detailed way in which he introduced this significant topic. He set out very clearly the importance of ensuring that the Government maintain the momentum that has been generated recently, first by the National Audit Office report, then by the Public Accounts Committee report and finally by the stroke strategy, which was released roughly a year ago. I thought that he made his points in a very constructive and thoughtful manner, and hopefully the Minister will respond in a similar vein.

The hon. Gentleman was right to congratulate the Stroke Association, which does fantastic work in this area. I will not repeat them, but he was also right to highlight the four key markers that the Government set down. He was also correct to summarise the four distinct areas—the patient pathway—of awareness, diagnosis, treatment and subsequently community care and rehabilitation. If all those areas are addressed, that will make a significant difference to patient outcomes. The Minister will probably not have time to answer in detail all of the 14 questions that the hon. Gentleman put to him today, but I am sure that he will respond in writing to the hon. Members who are here with answers to all of those excellent questions.

I also must say to my hon. Friend the Member for Isle of Wight (Mr. Turner) that his contribution today was exceptional and inspirational, and I am delighted to see that he has clearly made a full recovery and is back on full form, both in articulation and humour, which is very good to see. He was absolutely correct to highlight the important contribution of the charitable and voluntary organisations, particularly in rehabilitation and community support. He was also right to ask all of us, irrespective of our party political persuasions, to thank and congratulate the people involved in those organisations. As an additional question, it would be helpful if the Minister would address the point made both by my hon. Friend and by the hon. Member for North-West Leicestershire (David Taylor) about the potential to fund or assist charitable and voluntary organisations in the community and rehabilitation aspects of their work.

We heard, too, from the hon. Member for Ceredigion (Mark Williams), who raised the important issue of the contributions of the voluntary and charitable sector. Furthermore, he stressed the overriding importance of people who have experienced strokes meeting others who have gone through a similar experience, if only to ensure that those people understand that they are not alone and that they are not unique in their experience of stroke. The hon. Gentleman was right to highlight the problems that are exacerbated in large rural constituencies. I, too, represent a rural constituency—the Lincolnshire constituency of Boston and Skegness—and I suspect that we have problems that are similar to those that he faces in north Wales. I sometimes think that the Government do not necessarily address the needs of those who represent physically great but sparsely populated rural areas and provide the requisite funding, although that is not the specific issue that we are debating today. The hon. Gentleman was also right to praise health professionals who are involved in stroke care.

Of course, there is cross-party support for the enhancement of stroke services, particularly those that improve patient outcomes and survival rates, although it must also be said that, despite the stroke strategy, we still have fairly low survival rates in the UK in comparison with some other EU countries. Nevertheless, we recognise and welcome the progress that has been made since the publication of the stroke strategy, particularly in the development of stroke networks. However, it was a shame that it took the Government so long to produce that strategy, and I suspect that they did so only in response to the highly critical reports from the NAO and the Public Accounts Committee.

Despite all the evidence that care in a specialist stroke unit increases a patient’s chance of survival and recovery by 25 per cent. and reduces their stay in hospital by six days, in 2006 just 15 per cent. of stroke patients were admitted to stroke units on the day of admission. I accept and acknowledge that that is a slightly historic statistic. However, it would be helpful if the Minister could update it, either today or subsequently, particularly in the context of the overriding importance that is now correctly attributed to stroke and stroke care, both in the operating framework, which identifies stroke as a national priority, and in the primary care trusts’ operational requirements, which was a point quite rightly made by the hon. Member for Nottingham, North.

There are some background statistics that I briefly want to put on the record, because some of them are worrying. The national audit by the Royal College of Physicians this year showed that only 45 per cent. of hospitals were able to meet the target in the stroke strategy of investigating and treating high-risk patients with transient ischemic attack, or TIA, within 24 hours, and yet that is clearly one of the key methods of identifying patients at risk of stroke and preventing patients from going on to have a full stroke.

Fast access to stroke units and fast treatment is a key to a patient’s survival, whether that treatment is the CT scans that were mentioned earlier or the three-hour time limit for thrombolysis. These two methods of treatment must be linked, as the hon. Gentleman pointed out, so that the thrombolysis is not administered to patients who would not benefit from it or to patients to whose health it would be detrimental. One statistic that has already been given is from Sweden, and it is absolutely startling compared with our own performance here in the UK; in Sweden, 100 per cent. of stroke patients have access to a CT scan within 24 hours.

A quarter of British hospitals have no specialist stroke nurse and only 22 per cent. of hospitals have an early supported discharge team. Specialist teams working in a multidisciplinary framework are best placed to improve outcomes and reduce mortality. Last year, I visited the North Tyneside general hospital near Newcastle, which has a fantastic specialist stroke team. That team not only works in the hospital but goes into the community, with outreach workers and specialist nurses. I very much hope that that the Minister will ensure that that model is rolled out across the UK.

One of the disparities that seems to exist between statements made by the hon. Gentleman and the previous Government announcements relates to the population screening that the Prime Minister announced in January. It was clear from the Prime Minister’s announcement that the screening would be whole-population screening with cardiovascular checks, which would also include looking for tell-tale signs of a stroke. It would be interesting if the Minister could say, first, whether or not the funding has been provided to support that whole-population screening and also whether or not the clinical evidence supports that type of screening, or is the hon. Gentleman correct that screening should be limited to those between the ages of 40 and 74?

We also support the “hub and spoke” strategy for specialist stroke centres. Clearly, there is a direct correlation between specialist stroke centres and better patient outcomes and survival rates; in those centres, patients are scanned and given thrombolysis if appropriate and necessary. However, that does not necessarily mean that there should be closures of small stroke wards in local hospitals. Indeed, Manchester is perhaps the best example of a good system; in the local service plan for Manchester, a hyper-acute unit has been proposed, where all stroke patients would be taken for the initial scan and treatment, before they are referred back to their district general hospitals for treatment to be continued and for subsequent treatment in the community.

In the remaining few minutes, I have just a couple of additional questions for the Minister. Again, if he does not have time today—I clearly understand that this is the hon. Gentleman’s debate—it would be helpful if he could write to me. For example, how much of the funding pledged for the stroke strategy has been delivered? How many of the stroke centres to date have achieved all 20 quality markers for a good stroke strategy? I assume that not all of them have achieved that target and, if so, what is the time scale for enabling all stroke centres to achieve it? Would the Minister also say a little about the awareness campaign that will begin next year? Has thought been given to the fact that it may stimulate additional demand, and does the NHS have the facilities and sufficient capacity to deal with such additional demand? Furthermore, what are the Government doing to support the communication needs of people who have suffered a stroke? That point was quite rightly made by other hon. Members.

I also want to reiterate two key points made by other hon. Members; again, if the Minister does not have time to address them today, he and his team at least need to think about them. The first point is about awareness, including public awareness of stroke. A recent NOP poll demonstrated that there is both confusion and ignorance about the signs of stroke. Promoting awareness also includes the important factor of GPs. I was very concerned, as other hon. Members were, when I saw the statistic that about 20 per cent. of patients who go to GPs with a TIA are not referred on. The second key issue that hon. Members have raised, which the Minister will want to address, is the concern about ring-fenced money going to local authorities. That money has clearly been used, in some instances, for purposes for which it was not intended. That issue needs to be looked at, because it could have a detrimental impact on stroke care.

In conclusion, we spend more on stroke services, as a nation, and there is rightly an increased focus on them, but we still have worse outcomes than comparable European nations. We should adopt more of the recommendations of the National Audit Office and the Select Committee on Public Accounts to enable our dedicated and hard-working stroke physicians, nurses and associated health care professionals to improve the quality of stroke care in the shortest possible time.

First, I congratulate my hon. Friend the Member for Nottingham, North (Mr. Allen) on securing the debate on this important subject. Secondly, I apologise that the Under-Secretary of State for Health, my hon. Friend the Member for Brentford and Isleworth (Ann Keen), who leads on stroke policy, could not be with us this morning due to two long-standing ministerial engagements.

I calculate that to answer 14 questions in nine minutes I will have to spend only about 35 seconds on each of them, so I shall throw aside the usual niceties of going through the history of the issue, as other hon. Members have done that. I shall not go into why we have a new stroke strategy or the importance of stroke, because those issues have been discussed so eloquently, not least by the hon. Member for Isle of Wight (Mr. Turner) in his moving and effective testimony.

I shall move straight to answering the questions that have been asked. On awareness, my hon. Friend the Member for Nottingham, North will know that a major awareness campaign is planned for the spring. It will include the face, arms, speech approach that he advocates, as well as stressing the importance of dialling 999. It will be along the lines of the successful British Heart Foundation campaign that many people will remember from the past year or so, which used posters and advertising of great impact on our streets and buses.

On prevention, my hon. Friend will be aware that we have asked primary care trusts to begin rolling out, from April 2009, vascular checks for the whole population aged between 40 and 74. As for when he can expect his check, in his local area, we expect the full system to be up and running by 2012-13. He has said that his area already has good practice and a good model, so he might get his check a little earlier. It is not only people’s risk of heart disease, stroke and kidney problems that will be assessed. The system will also work on the preventive messages on lifestyle and public health that he has rightly identified as being important. Those issues are the same as those for heart disease, and include smoking, obesity and physical exercise. Where necessary, people will be recommended courses on weight management and even cookery, assistance with smoking cessation, exercise classes and walking clubs. My hon. Friend is right to say that prevention is very important.

My hon. Friend is also right to stress the importance of rapid response, including the use of thrombolysis. That is recognised in the strategy, which is clear about the importance of acting quickly in the event of a stroke. It recommends the immediate referral for assessment of all patients with recent transient ischaemic attack—I, too, hate the acronym—or minor stroke. Those with a higher risk of subsequent major stroke will be assessed within 24 hours. For those with major stroke, the strategy suggests immediate transfer to a centre that provides hyper-acute services.

On clot-busting drugs, my hon. Friend asked where we were on the roll-out of thrombolysis. The National Sentinel stroke audit of 2008 states that thrombolysis services are increasing rapidly, albeit from a low base. We should, as he said, be aiming for at least 10 per cent. of stroke admissions being thrombolysed. Services are being reorganised to achieve that, and we are funding specialist stroke training, but it is important that thrombolysis is given in a safe and appropriate setting.

On scanning, I am informed that all hospitals now provide CT scanning, and that the great majority also offer MRI and carotid doppler scanning. However, access to imaging continues to present a major barrier to delivering high-quality care to all stroke patients, and the new strategy aims to address that problem.

The ambulance review has been completed. Of the 70 recommendations that have been made, some have been introduced and the rest will be completed by 2010. I understand that recategorisation as category A has been recommended, and provisions to ensure that that is implemented are being put in place.

On rehabilitation immediately after stroke, my hon. Friend has mentioned that operating across the seven-day week can limit disability and improve recovery. The strategy recommends that specialist rehabilitation should continue across the transition to home, or care home, to ensure that health, social care and voluntary services are joined up to provide the long-term care that people need. We have, as he has acknowledged, provided local authorities with £45 million—£15 million a year for three years—to develop improved models for delivering that joined-up care. As for whether information will be made public and how it will be monitored, we expect the evaluation of the strategy’s implementation to provide details on spending and information on its effect.

My hon. Friend asked whether the NICE-recommended target of 45 minutes of rehabilitation a day would be met and, if so, when. The strategy is a 10-year strategy, and we cannot comment on when any particular measure will be successfully implemented, but we expect all service providers to be making progress now. We intend to begin the evaluation of the strategy’s implementation soon, and that will give us detailed information about what is happening locally.

My hon. Friend stressed the importance of communication and helping people with speech. The strategy lists communication as a component of the joined-up rehabilitation approach, and will rely on a multidisciplinary approach being taken locally to ensure that patients receive the right support both in hospital and when they are discharged into the community. He rightly points to the recent problems that he has highlighted in a letter to my hon. Friend the Under-Secretary of State about speech therapy services in his local area. I am pleased to say that the PCT is now addressing those problems.

My hon. Friend is absolutely right that the work force in both health and social care is important to the strategy’s delivery. We have allocated £16 million of central funding to enable the training of new stroke-specialist physicians, thus allowing services to expand their stroke work forces appropriately. We have also established a national training forum to develop a stroke educational framework, and we are supporting leadership programmes to improve skills and provide champions for stroke services at a local level. He asked particularly about the competency framework, which is under development. It includes looking for suitable institutions to provide accreditation. We hope to put the framework out for consultation in the spring, and there will be funding to support work force development, but exact details of spending levels cannot be agreed until the framework is in place.

On whether we are closing the gap between the UK and comparable western European countries, there have not been any international comparisons since the 2005 NAO report. However, the strategy is seen as a model by others. Professor Roger Boyle has been invited to Australia to give a presentation on how the strategy has been drawn up and how it will be implemented. A year into its implementation, we are confident that good progress is being made.

Hon. Members have mentioned the importance of the operating framework, and I should like to reassure them that the data that are included in the indicators will be published. The performance of PCTs and acute trusts will be measured against that publication. The inclusion of stroke in the vital signs means that PCTs will have to take performance seriously. They and acute providers know that they will be closely watched and judged on their performance. Furthermore, Lord Darzi’s report, “High Quality Care for All”, has offered welcome reinforcement of the key themes of the stroke strategy. The independent health watchdog, the Healthcare Commission provides indicators that will help to measure progress on the stroke strategy.

None that will add to what I was going to say, but I thank my hon. Friend for his helpful intervention.

There have already been encouraging signs of early progress. The 2008 National Sentinel audit of stroke states that almost every hospital now has an acute stroke unit, and that, between 2006 and 2008, there were substantial improvements in organisational scores on the provision of and access to minor stroke services. We expect that the strategy’s implementation could prevent 6,800 deaths or cases of disability. A further 1,600 strokes could be averted through preventive work. I shall finish with a quote from Jon Barrick, the chief executive of the Stroke Association. He has said of the strategy that this is a “historic time for stroke” and a

“momentous opportunity to transform the outcomes and lives of stroke survivors in this country.”