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Strokes: Health Services

Volume 506: debated on Monday 22 February 2010

To ask the Secretary of State for Health what steps his Department is taking to improve the provision of needs-based services to support stroke survivors and their carers in the long-term; and if he will make a statement. (317926)

The National Stroke Strategy recommends that local action is needed to ensure that stroke features in local joint health needs assessments so that primary care trusts and local authorities can shape their local commissioning priorities accordingly. The Stroke Improvement Programme and the stroke networks are disseminating across the service good practice for needs-based services that has already been developed in some areas. In addition, local authorities are benefiting from £45 million over three years in ring-fenced grants to improve support services to adult stroke survivors and their carers in the community.

To ask the Secretary of State for Health what steps his Department is taking to require the provision of appropriate stroke-specific training for care home staff. (317927)

It is the responsibility of individual social care employers to ensure that their staff are adequately trained for the role that they perform. However, we recognise that stroke survivors in care homes have particular needs and are currently considering what steps we can take to improve stroke specific training for care home staff.

To ask the Secretary of State for Health what steps his Department is taking to raise (a) public and (b) professional awareness of (i) risk factors for stroke and (ii) effective primary prevention measures at individual, family, community and societal levels; and if he will make a statement. (317930)

The Department has run a series of campaigns to raise both public and professional awareness of the importance of a healthy lifestyle in reducing the risk of a number of diseases, including stroke. These include Change 4 Life, which is aimed at reducing obesity, Smokefree marketing to motivate people to stop smoking and direct them to national health service information and support and a jointly branded campaign with our stakeholders, including the Stroke Association, about the unseen damage that drinking can cause to long-term health. The link between alcohol and stroke was one of the key messages.

To ask the Secretary of State for Health how much his Department has spent on public health measures to reduce exposure to risk factors for stroke in each of the last 12 months; and if he will make a statement. (317931)

This information is not available. The Department invests in a number of primary prevention measures to help people across different socio-economic groups address risk factors that are commonly associated with a number of diseases, including stroke. These help people to stop smoking, maintain a healthy weight, moderate their alcohol consumption and participate in more physical activity. For example, we are working across Government to make two million adults more physically active by 2012 and phasing in the implementation of the NHS Health Check programme that is designed to reduce an individual’s risk of a number of vascular diseases including stroke.

To ask the Secretary of State for Health what steps he is taking to develop community-based stroke prevention services with the voluntary sector, the NHS and local authorities; and if he will make a statement. (317932)

The National Stroke Strategy recognises the importance of educating people about the risk of stroke and associated prevention measures. It asks that local assessments should be made of how effectively areas are supporting healthier lifestyles and taking action to tackle vascular risk including hypertension, atrial fibrillation and high cholesterol.

Phased implementation of the NHS Health Check programme began in April 2009. This programme is designed to reduce an individual's risk of a number of vascular diseases including stroke. Primary care trusts (PCTs) are responsible for commissioning. The programme has been designed so that it can be delivered from a variety of settings and by different providers where they have undergone appropriate training. PCTs may, therefore, use a range of providers, including the third sector, to deliver the programme.

To ask the Secretary of State for Health when his Department plans to implement the National Institute for Health and Clinical Excellence guidelines for diagnosis and treatment of transient ischaemic attack and minor stroke; and if he will make a statement. (317933)

Implementation of the ‘Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA)’ guidance is the responsibility of local commissioners and providers. It is the responsibility of commissioners in consultation with their providers to procure the stroke services for their populations.

To ask the Secretary of State for Health if his Department will issue guidance to ambulance services on the agreement of stroke protocols with hospitals with acute and hyper-acute stroke units. (317938)

We are not planning to issue such guidance. The Royal College of Physicians' Stroke Sentinel Audit of 2008 showed that there has been a striking improvement in the number of protocols ambulance services have for the management of stroke patients. It shows that between 2006 and 2008 the percentage of primary care trusts having arrangements with their local ambulance service for emergency/rapid transfer to hospital for specialist acute stroke care services has risen from 12 per cent. to 49 per cent. It is the responsibility of the NHS locally to develop these arrangements.

To ask the Secretary of State for Health if his Department will issue guidance on the treatment of stroke as an emergency, with particular reference to appropriate access to brain scanning and thrombolysis and immediate admission to an acute stroke unit. (317939)

The National Stroke Strategy recommends that everyone who can benefit from urgent stroke care should be transferred to an acute stroke centre that provides 24-hour access to scans and care in a specialist stroke unit.

The 2009 National Sentinel Audit of stroke undertaken by the Royal College of Physicians shows that the number of stroke units providing thrombolysis is increasing and that the provision of these services out of hours remains a challenge. Local stroke care networks have been established to assist in improving the delivery of stroke services. This includes working with health care professionals to ensure urgent admission to an acute stroke unit, timely access to scanning and the provision of thrombolysis where appropriate. All hospitals provide CT scanning and most provide MRI and carotid doppler and the Department published an imaging guide in 2008, to help ensure that imaging services develop in line with the quality markers in the National Stroke Strategy.

To further encourage improvements in stroke care, in April 2010 we will introduce a Best Practice Tariff for stroke which incentivises direct admission to a stroke unit and timely brain imaging. We will continue to improve care for stroke patients by ensuring that more patients, for whom there is potential benefit, have a brain scan within one hour of their admission. However, thrombolysis can only be delivered safely by experienced teams. Hospitals should not aim to provide thrombolysis before the associated components of the service are functioning well and are of high quality. It is not appropriate, therefore, for every hospital to deliver a thrombolysis service.

To ask the Secretary of State for Health if he will make it his policy to provide for every patient with stroke to be treated in a high quality stroke unit for the duration of their hospital treatment. (317940)

The National Stroke Strategy recognises that stroke unit care is the single biggest factor that can improve a person’s outcome following a stroke. We have, therefore, made this a top priority for the national health service. The tier 1 vital sign in the NHS Operating Framework aims to ensure that, by March 2011, 80 per cent. of patients with stroke spend at least 90 per cent. of their time in hospital on a stroke unit. This recognises that there are times when a patient, for clinical reasons, might need to spend time in the care of others outside a stroke unit.

To ask the Secretary of State for Health if he will make it his policy to require all stroke units to meet the criteria set out in clinical stroke guidelines and by the British Association of Stroke Physicians. (317941)

The National Stroke Strategy sets out twenty quality markers outlining the features of a good stroke service. In developing the strategy, we consulted experts in the field and used the most up-to-date clinical guidelines, including those from the National Institute for Health and Clinical Excellence and the nine key indicators used in the Royal College of Physicians’ National Sentinel Stroke Audit.

To ask the Secretary of State for Health if his Department will issue guidance on the (a) appropriate knowledge and skills relating to stroke and (b) appropriate training in stroke for all NHS staff working in emergency and acute care. (317942)

Standard setting for the knowledge and skills required of those working with stroke patients is for the relevant professional bodies. It is for local areas to review, plan for and develop a stroke-skilled work force. Standard setting also guides commissioners on the criteria against which to judge services that they will commission.

The Department set up the UK Forum for Stroke Training through which the Stroke Specific Education Framework has been developed. This framework reflects the elements of the stroke care pathway from prevention through to long-term care which will facilitate links between training, education, work force competences and professional development. It aims to build on the generic skills that health, social, voluntary and independent care staff already possess through the clear identification of additional stroke-specific knowledge and skills. Its purpose is to ensure quality in stroke care by supporting stroke specialist and stroke relevant career pathways and course design and promoting recognised and transferable training and qualifications.

To ask the Secretary of State for Health how much funding has been allocated under the National Stroke Strategy to each local authority in Tyne and Wear; and in which years those allocations were (a) made and (b) spent on each (i) project and (ii) service. (318007)

Ring-fenced grants are being provided to all 152 local authorities in England over the three years 2008-09 to 2010-11 for the provision of support services to adult stroke survivors and their carers in the community. The ring-fenced grants total £45 million over the three years which means that each local authority receives an average of £100,000 a year. A local authority circular has been issued that sets out the kind of services that these grants might be used to fund. Annex B of the circular also lists the funding allocated to local authorities. The local authority circular can be found at the following web address:

www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/LocalAuthorityCirculars/AllLocalAuthority/DH_098601

The Department does not collect information on how local authorities spend these grants.