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Stroke Services (Ealing and Southall)

Volume 493: debated on Wednesday 3 June 2009

I am grateful for the opportunity to raise the important issue of stroke services in my constituency in Ealing and Southall. I will come quickly to the point and say that my concerns centre on the recent Healthcare for London proposals for stroke services in London. If proceeded with, those proposals will result in the closure of Ealing hospital’s stroke unit. I hope today’s debate will give the Minister good reason to get Healthcare for London to think again about those proposals, and designate Ealing hospital as a local stroke unit for patients to return to after treatment at a hyper-acute stroke unit.

During the consultation on Healthcare for London’s proposals that ended in early May this year, it became clear that there was significant local opposition to the closure of the unit. Many constituents, local health practitioners, local councillors, clinicians and the hospital management contacted me with serious concerns about the impact of such a closure on the local community. Of particular concern were the extra journey times that my constituents would face both as patients and as visiting relatives. That was because under the new proposals, patients would be treated in the first instance at either Northwick Park or Charing Cross hyper-acute stroke units, or subsequently at Hillingdon or West Middlesex stroke unit, which I understand is in the Minister’s constituency.

The recent early-day motion that I sponsored highlighted the fact that 170 people died from strokes in Ealing in 2006-07. In the same year there were approximately 1,600 admissions to hospital for stroke-related conditions, with admissions from wards in Southall running at twice the national level. There are 4,000 people in Ealing who have had a stroke at some time.

It is well known that people of south Asian and Afro-Caribbean origin have a higher incidence of stroke, and both those groups are well represented among my constituents. The figures also show that the correlation between age, ethnicity and the incidence of stroke is disproportionately high among south Asian, Afro-Caribbean and other non-white ethnic groups, regarding people who have a stroke before the age of 60. Given those figures and trends, it seems unwise not to have a stroke unit at Ealing hospital, which is geographically positioned in the middle of my constituency. Stroke is a major killer in this country, disproportionately so among my constituents. Major improvements in the treatment of strokes have been made in recent years, and Ealing hospital has invested in better facilities to treat stroke patients. The latest independent assessments of stroke services at Ealing hospital show that in the main categories of stroke treatment, it is in the top 25 per cent. of the country. The hospital also stands ready to work with Healthcare for London to ensure that it can reach the highest standards that a designated stroke unit would need to attain by 2011.

If there is no stroke unit at Ealing, residents from Ealing and Southall will be sent from the hyper-acute stroke unit to Hillingdon or West Middlesex hospitals for stroke unit care, even if they have had no previous contact with those hospitals. The proposed HASUs at Charing Cross and Northwick Park have already expressed concerns about their ability to repatriate Ealing residents in a timely fashion if there is no stroke unit at Ealing hospital. If patients cannot be moved from the HASUs efficiently, the hospitals might have to close to new admissions and the London ambulance service would have to take patients to HASUs in other parts of London.

The Healthcare for London consultation document states that the patient capacity supplied by Ealing hospital is “not required”. Healthcare for London has indicated at recent meetings that final decisions on capacity have not yet been made, and that designated stroke units will be asked to provide information on how many beds they will provide. I am concerned that the current plans will not have the capacity to deal with Ealing’s stroke patients.

If there is no stroke unit at Ealing, that will have serious implications for the running of other local services in the hospital and in the community. There are specialist acute services and procedures available at Ealing hospital trust that will be under threat if the stroke unit is removed. Those include acute surgery and coronary angiography. Patients undergoing those procedures have an increased risk of stroke, and the removal of an on-site stroke unit means that if they suffer a stroke as a complication of their treatment, optimal subsequent management might be compromised. If a patient has a stroke while in hospital, they will be unable to access immediate stroke care, which would significantly worsen the outcome. They would have to be transferred away from Ealing for further management. Access to key therapists, such as speech and language therapists, physiotherapists and occupational therapists will also be impaired, as they will not be available on site.

I and many of my constituents are deeply concerned about the proposal to close the stroke unit at Ealing hospital. I ask the Minister to work with Healthcare for London to find a way to provide those services for my constituents at their local hospital. The preferred option, which I believe is viable, would be to keep the stroke unit open under the management of Ealing hospital. If that is not possible, it is essential that a stroke unit is on the Ealing site under the management of one of the other designated stroke service providers.

I am sure that there is a positive way forward on this vital issue for the health of my constituents and I ask the Minister to do all she can to help to find a solution. I thank her for coming today and look forward to her reply.

I congratulate my dear friend the hon. Member for Ealing, Southall (Mr. Sharma) on securing this debate. It is also a particular pleasure to serve under your chairmanship this morning, Mr. Bayley.

I know that for many years, even prior to his well-earned election to Parliament, my hon. Friend has shown a great interest in the welfare of his local health services and the future of stroke services at Ealing hospital. I commend the dedication with which he serves the needs of his constituents.

On average, someone suffers from a stroke every five minutes in England. There may be people in this room who have been touched by a stroke that affected either them or members of their family. Behind that unfortunate statistic, however, lies a terrific cost for the NHS. At any one time, a quarter of all long-term beds are occupied by stroke patients. As those who care for their loved ones will testify, stroke survivors need long-term care and attention. In my many years as a nurse, I worked with stroke survivors and know the importance of dedication and continual rehabilitation, with staff trying so hard to bring quality back to once active lives. When sudden emergency hits, it is quite devastating—and it affects not only the stroke sufferer but of course the family.

To universal acclaim, the need for long-term care was recognised in the Department of Health’s 2007 national stroke strategy. The strategy underlined the impossibility of furnishing every accident and emergency department with a 24-hour stroke consultant service and open access to that all-important CT scanner. There simply are not enough people with the right skills to do it safely. The Royal College of Physicians and the National Institute for Health and Clinical Excellence both agree.

A and E is not the best place to treat stroke, and getting stroke patients directly to specialist units will put us in a position where more lives can be saved, which is what we want. Having worked in accident and emergency, I know that it is exactly what it says; to have people arriving after road accidents or particular traumas at the same time as someone who is suspected of having had a stroke can result in neglect to the stroke patient. Furthermore, the 2007 strategy document recommends that stroke services are co-ordinated into networks, supporting highly specialised centres of excellence. Networks have proven to be highly effective in treating cancer and heart disease, and we want to transfer and adapt that knowledge into the stroke strategy.

I am sure my hon. Friend is aware that the NHS responds to the national stroke strategy locally. NHS London is responsible for bringing stroke care for its population into the 21st century. At the moment, treatment throughout London varies radically. Each year about 11,500 stroke victims are admitted to hospital in London, 16 per cent. of whom die as a result of their stroke. There are outstanding examples of good practice, but we want to see them become the norm.

Consistent with national policy, the stroke strategy for London, published in November 2008, recommended that patients should be treated within three hours of having a stroke. To that end, stroke networks should comprise three vital elements. On the front line, the hyper-acute stroke units—HASUs—will provide an immediate response, with a CT scan and the appropriate drugs. Supporting stroke units will provide ongoing care and rehabilitation. Services for the mini-stroke—the transient ischaemic attack—will also provide rapid access to a specialist.

A consultation on the location of these services ran from 30 January to 8 May this year, and a remarkable 8,600 people responded. Taking account of those responses, a joint committee of primary care trusts will make a decision on 20 July about the location of stroke units across the whole of the capital.

I am aware that consultation took place between January and the first week of May, but does the Minister have the figures? How many from Ealing and Southall responded to the consultation?

I do not have the exact figures for that area to hand, but if statistics are available I will certainly let my hon. Friend have them.

As I said, a joint committee of PCTs will make a decision on 20 July about the location of stroke units. Under the PCTs’ preferred proposals, residents of Ealing and Southall suffering strokes will be taken to Charing Cross or Northwick Park hospitals for improved care. I am told that that is the local PCT’s preferred choice. The proposed locations of the HASUs will ensure that every Londoner is within 30 minutes of getting the treatment that they need. The PCTs anticipate that both Charing Cross and Northwick Park hospitals will also have stroke units. Depending on where they live, my hon. Friend’s constituents will either remain at those hospitals for ongoing care or be transferred to Hillingdon or West Middlesex university hospitals.

I must tell my hon. Friend that Ealing hospital did not bid to offer hyper-acute stroke care. The trust instead submitted an application to offer secondary and mini-stroke care. Bids were assessed by an independent panel of stroke experts from outside London. The panel assessed each bid on its merits. Influenced directly by the independent panel, the consultation proposals state that Ealing hospital should no longer provide acute stroke services.

I know that it is important to my hon. Friend, so I repeat that no decision has been taken to stop the commissioning of stroke services from Ealing hospital. The recommendation was proposed in the consultation. We must wait for the PCTs’ decision in July, so it remains a possibility that Ealing hospital could continue to provide stroke services. Indeed, as we speak, the trust and the local PCT are developing a proposal for delivering an effective, high-quality stroke service at Ealing hospital. The service would be part of the wider pan-London network. If that goal is achieved, the unit would have to meet the stringent Healthcare for London quality standards. The proposal is to inform the decision of the joint committee of PCTs in July.

I thank the Minister for giving way again. I accept that further reports and proposals will be coming from the PCT. How many locally based voluntary sector health organisations—what we call the third sector—have been consulted? How many local GPs have been consulted, and how many other patients’ groups have been consulted on proposals for the future and the vision for the local PCT and the health area in my constituency?

That point was very well made. I am sure that the PCT and the chief executive will be able to furnish my hon. Friend with answers. I am aware that he has a good relationship with them and meets them regularly when working in his constituency. I feel confident that they will be able to inform him.

Thanks to the standards being applied in London, and regardless of the outcome of the joint committee’s decision, Ealing’s residents can expect to receive world-class care if they have the misfortune to be affected by stroke. On 1 April, PCTs began the phased implementation of the NHS health check. The programme will cover everyone between the ages of 40 and 74, and it will asses the risk of stroke, heart disease, kidney disease and diabetes. Everyone will receive a personal assessment, setting out their level of risk and saying exactly what they can do to reduce it.

Members of the south Asian population in my hon. Friend’s constituency suffer strokes at a younger than average age, and many still of working age. The statistics are alarming. I know this from experience in my constituency, which is close to my hon. Friend’s. I understand how important it is to get stroke victims out of hospital and back to work and back to their families. It is imperative that people in that age group have the highest quality care, should they have the misfortune to suffer a stroke, so that we do not waste working lives. For the family, the emotional and financial consequences are high. Every one of my hon. Friend’s constituents will be within 30 minutes of that all-important hyper-acute stroke care. That speedy response will mean fewer people having their working life and their retirement marred by stroke.

The consultation does not propose the closure of any A and E departments or any loss of staff. Ealing hospital will continue to offer an extensive range of exceptional facilities for local residents. I realise that the first priority for all Londoners is to ensure that they have access to high quality care, and NHS London is working closely with the PCTs and other trusts involved to ensure enough beds and capacity for everyone.

My hon. Friend raised the secondary, but still important, concern about the time it takes for visitors to travel to the hospital. Although the new proposals will inevitably mean more travel for some, analysis has shown that average travel times will only increase from 31 to 42 minutes when travelling by public transport, and by three minutes when driving. I am not sure how those statistics were formulated, but I am sure he has as much faith in them as I do.

I live in the area. In my earlier days, I worked as a bus conductor there. I travel by public transport daily. I am familiar, therefore, with travelling times from the Southall area to Ealing hospital as well as to Charing Cross and Northwick Park hospitals, which are miles away from Southall. Traffic congestion is a major problem in the area, and the reliability of public transport causes concern among my constituents. They feel that the times will be longer than was expected and quoted in the consultation.

My hon. Friend raises an interesting point about an area that I know very well too. Depending on what celebrations are taking place in Southall at the time, travelling through the area can take some considerable time, so I share some of his concerns. However, we must focus on the safety of patients when they arrive at hospital having had the misfortune to suffer a stroke. They need the best expert care. I would like to continue my reply in that fashion, and perhaps later we can have a conversation outside the Chamber about transport in Southall.

The development of a high quality stroke service is a work in progress. Each stroke unit will be expected to achieve standards of excellence that London has not yet experienced. We hope that the proposed improvements to stroke services will save as many as 400 lives a year and save thousands more from serious disability. We should concentrate on those statistics. I saw them in practice over many years as a health worker. The service throughout London will be greatly improved, which will benefit my hon. Friend’s constituents.

The plans that I have outlined today are built on an outstanding dedication to the principle of patient and public involvement. More than 13,000 people visited 46 health fairs held in the capital throughout the consultation, and clinicians have been on hand to offer expert advice every step of the way. My hon. Friend’s local hospital, council and residents have all participated fully in the consultation—a consultation that demonstrated widespread support for the general principles of change. As I said earlier, I shall try to provide him with the exact figures later.

A stroke is a medical emergency. The signs and symptoms of a heart attack are now very familiar to us all, but stroke is an attack on the brain and its treatment also requires expert advice, support and help as soon as possible. A swell of good work has already begun to roll out across the country. The number of under-75s dying from stroke has fallen by a third in the past 10 years, and although far from perfect, it is clear that a heroic effort has been made already by health professionals to save, and improve the quality of lives.

In addition to extra funding to PCTs, the Department of Health has guaranteed £105 million over the next three years to train more staff and raise awareness. I am sure my hon. Friend will have seen the hard-hitting and successful FAST—face, arms, speech and time—campaign launched this spring throughout the media. The campaign highlights the need to check the person’s face immediately, to check whether they can raise their arms and whether their speech is affected and then, most vitally, to call 999. When that call is made to the ambulance service, the paramedics will then get that person to the appropriate unit as safely and as quickly as possible to save their life and enhance the quality of life afterwards. FAST will help public and professionals alike remember the symptoms and urgency of stroke.

Stroke is the third biggest killer in this country, and the largest single cause of severe disability. Men of south Asian origin and Bangladeshi and Pakistani women have a disproportionately high chance of suffering from a stroke, which is why stroke will remain at the top of the agenda for some time to come. I am sure that my hon. Friend will continue to champion and support health services, and in particular, stroke services within his constituency. I know that he recently had a very positive meeting with the chief executive of Ealing PCT, whose work, and that of his PCT team, I also acknowledge.

I would like to take the opportunity to thank Ealing PCT for campaigning on this issue. There are sometimes differences of view, but generally I am very pleased with the services that it offers, so I am grateful for the Minister’s comments.

I thank my hon. Friend for that intervention.

I urge my hon. Friend, however, not to be negative in some of his remarks or to raise unnecessary fears about the rest of the hospital and its staff, who are striving to achieve excellence, as he recognised. I encourage him to continue to engage with Ealing PCT and to fight for his constituents, as he does so well. We must all continue to improve stroke services for the benefit of his constituents and everyone else in the country.

Sitting suspended.