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Stroke Services (North Yorkshire)

Volume 507: debated on Monday 15 March 2010

Motion made, and Question proposed, That this House do now adjourn.—(Kerry McCarthy.)

May I, with your indulgence, Mr. Deputy Speaker, say how sad I was to hear of the death of Ashok Kumar, the Member for Middlesbrough, South and East Cleveland? He was a man whom the whole House respected enormously for his knowledge of science and for the support that he gave to an area that I know well. My first school as a head teacher was in his constituency, and I have many friends in the area who think of him as a very special Member of Parliament. He combined his duties as a constituency MP with his role in the House, particularly his chairing of the Parliamentary Office of Science and Technology. He held together a disparate group of people in POST and produced some remarkable pieces of work, which Members of this House and the public at large have found incredibly useful in trying to understand some of the big science issues. He will be greatly missed as somebody who graced this House with dignity, and we will hold him in great affection.

I suspect that this is the last time that I will have the opportunity, before I retire, to make a speech in the House. It is therefore with a little sadness that I speak tonight, but it is pleasing that Back-Bench MPs can raise on behalf of their constituents issues that have a broader appeal than some of the more parochial issues that dominate the House. It is therefore important that I can raise with the Minister this evening the subject of services for stroke victims.

As someone who was fortunate enough to recover from a small stroke in 2007, this debate is important to me personally. However, it is also important to the estimated 6 million people in the United Kingdom who are coping with the after-effects of strokes. This is a major, massive issue: in the course of this short debate of half an hour or so, six people in the United Kingdom will have a stroke, which will add six to the 150,000 people nationwide every year who suffer from a stroke or mini-stroke. In a year’s time, 40 to 50 per cent. of those who have had a stroke this year will be reliant on somebody else for their day-to-day activities, and nearly one in three will be clinically depressed.

Many stroke victims suffer ongoing physical, psychological, sensory and social complications, often for the rest of their lives. I suspect that Members in all parts of the House know people—members of their families or communities—whose lives have been devastated in this way. Stroke destroys lives. Not only is it a major killer; it is currently estimated that 900,000 people in the United Kingdom are living with its after-effects—not to mention their families, friends and carers, who are also profoundly affected.

Without the remarkable efforts of the Stroke Association, many people and their families would struggle to cope, let alone begin to recover. I want to record my thanks to all who work for, raise resources for and support the association. Its excellent manifesto for 2010-2015 contains clear, lucid and achievable proposals of ways in which a Government of any persuasion can continue to improve stroke care in the future. I hope the Minister will tell us whether she has received that document and whether the Government will adopt any of its key proposals, which are very much in line with their own stroke policy documents.

The Stroke Association depends on inspirational individuals who deliver support to victims and their families—people like Jenny Jones, in my constituency. Jenny pioneered and runs the association’s family and carer support service in Harrogate and Craven. So far, the service has helped more than 350 stroke survivors and their families since its inception in 2008. Jenny Jones has personally been responsible for improving the lives of hundreds of people, and—for her and many like her—I want to register my deepest thanks on behalf of all whom she has supported.

To be fair, the Government also deserve recognition for the progress made recently in the delivery of stroke services. As the Minister will know, in 2005 the National Audit Office published a ground-breaking report exposing the lack of priority given to stroke services in the United Kingdom, and the unnecessary suffering that it was causing to stroke survivors throughout the country. As a result, the 2007 national stroke strategy for England was produced, and was widely welcomed by both survivors and those working in the sector.

The fact that the national stroke strategy came with an additional £105 million from central Government, to be funded over three years, was particularly positive. Strategies without resources are pretty useless. I know that those funds have made an enormous difference to the lives of stroke survivors throughout the United Kingdom. I thank the Minister—and her predecessor, who did a great deal of work in this regard—for making it happen.

One thing was particularly rewarding. All too often money is spent on initiatives that do not make any difference, but, as the Minister knows, when the NAO revisited the issue it concluded that a considerable amount of progress had been made, and that has been endorsed by the Stroke Association in particular. It has been argued, however, that improvements in the acute care delivered in the immediate aftermath of a stroke have not been matched by provisions for long-term community care.

The National Audit Office was right: there has been an improvement in the recognition of stroke. It has been helped by the excellent media campaign that has been running over the past year. Posters have been put up in appropriate places, particularly near sports grounds. We know that people may have strokes when they become excited. Access to specialist stroke services in our hospitals and hugely effective physiotherapy services have also made a real difference. All the evidence suggests that if people who have had strokes are taken into most general hospitals very quickly, they are likely to receive pretty good attention.

Long-term community care, however, remains problematic. I want to concentrate on that problem this evening, and to highlight the challenges in my part of the country. In 2008, North Yorkshire county council allocated funding for the Stroke Association’s family and carer support service in Harrogate and Craven. This was the first provision of any kind in North Yorkshire, and the county council should be congratulated on its foresight in creating such a service. I have put that on the record. When the national stroke service funding was allocated in 2008, the pioneering work that occurred in Harrogate was replicated across North Yorkshire using the Harrogate model, providing invaluable care and support for thousands more people. That is laudable. However, as Harrogate and Craven already had a service, it was not allocated any national stroke strategy support. Last year North Yorkshire county council announced that it would not be renewing the funding for the Harrogate service when its initial contract runs out this month, presenting a real threat that the pioneering service in the county would close.

I raised this issue with the Prime Minister last month at Prime Minister’s questions. I did not receive a very constructive response, but the local support for the campaign to keep the community service open has been absolutely phenomenal. As an example, I launched a Facebook group on this subject last week ahead of this debate, and 365 members have joined the group in a week. These are real issues affecting real people. It would be useful to reiterate a few of the messages that I have received since starting the campaign; these are from the last week.

One constituent messaged me this morning to say:

“My mother had a very serious stroke on May 2008. The help she received from the Stroke Association was fantastic and the support we got as a family from Jenny Jones and the rest of her team in Harrogate is something I will never forget.”

A local nurse wrote to say:

“As a staff nurse and then a ward sister I worked with patients who have suffered a stroke and the involvement of the Stroke Association in Harrogate made a significant difference to the lives of patients and their relatives.”

Finally, we received a heartbreaking letter in my office two weeks ago from a young woman who explained:

“In May 2008 my grandfather suffered a severe stroke. The thought of another family having to face the devastation a stroke causes without the support of someone like Jenny honestly moves me to tears.”

Let me be clear; there is no doubt about the value of this service to my local community. Thanks to our campaign—particularly the work of Claire Kelley, my assistant in Harrogate—and to the strength of local stroke survivors and their families and carers who have joined us in this, North Yorkshire county council is now back at the negotiating table with the Stroke Association to discuss the short-term extension of the funding for this service. Again, to be fair, I would like to register my thanks to the officers of the county council for their willingness to reconsider their decision, but my ongoing concern remains that the long-term future of the Harrogate stroke service remains in jeopardy.

These are difficult times for all councils across the country but when one considers that the cost of this provision is just £35,000 a year, compared with £400,000 spent on the county council’s self-serving local authority newspaper, it is hard to believe that even in these hard times, funds cannot be found for something that makes such a huge difference to the lives of so many people. Vulnerable stroke survivors, their families and carers should not have to launch a large-scale campaign to preserve a basic standard of provision that, on my understanding, was promised under the national stroke strategy and is being largely funded by the Government. Indeed, the Government’s own strategy published in 2007 stated:

“People affected by stroke and their carers should have immediate access to high quality rehabilitation and support from stroke-skilled services in hospital immediately after transfer from hospital and for as long as they need it.”

It goes on to say that

“a range of services need to be available locally, to support the long-term individual needs of people who have had a stroke and their carers. This includes communication, psychological, occupational health and physiotherapy services”.

That is the Government’s own strategy, so that is what should be happening. The strategy does not say that these services will be available only after vulnerable people kick up a fuss and get their MP involved, questions are asked of the Prime Minister, and a debate is held in the House of Commons. It says that these services should be available immediately to all who need them for as long as they need them.

Sadly, this problem is not confined to Harrogate. In fact, the biggest concern I have is that the Harrogate example may be an omen of the state of things to come. The national stroke strategy funding is due to come to an end in a year’s time, at the end of March 2011. What will happen to these services once the funding dries up? The Government do not seem to be actively seeking reassurance from local authorities that they intend to continue these services beyond March 2010, despite the fact that the 2010 National Audit Office report recommended that they do so.

In fact, when pressed on this in the recent Public Accounts Committee hearing on stroke on 24 February, the NHS chief executive, Sir David Nicholson, said that there would be no extension of the ring-fenced funding for local authorities, commenting:

“Our expectation is that the local authorities will continue to fund it after the period ends”—

that is, after the period of funding ends.

Frankly, an “expectation” or assumption is not good enough. As the example of Harrogate and Craven shows, not all local authorities understand the need for community stroke services, and not all of them will decide to continue to fund these provisions once the additional funds dry up. The Stroke Association estimates that 50 to 60 such services across the country may be under threat of closure by this time next year unless something is done.

I therefore have four questions for the Minister, and I would be grateful if she would do her best to answer them as fully as possible, to provide some peace of mind for the survivors of strokes who rely on these services. First, what assurances can the Minister give that stroke support services, developed by local authorities in response to the Government national stroke strategy, will be sustained beyond 2010-11, and what action do the Government plan to take to ensure that these services are sustained? That is fundamental.

Secondly, what plans do the Government have to monitor and evaluate the use of ring-fenced funds by local authorities, to ensure that they have been effectively allocated to stroke-specific services, and not diverted elsewhere? Thirdly, will the Government consider extending the period of the ring-fenced funding for local authorities from three to five years, to allow for sufficient development and continuation of community stroke support services? Finally, will the Department of Health take action to improve the research-based evidence and guidance on the costs and benefits of clinical and other support for long-term stroke care? That is a fundamental issue too, because if we do not support stroke victims in the community and get them reasonably or fully rehabilitated, the costs to the NHS and the nation are extensive—yet we have no real evidence to support that assertion.

It is clear to me that the Government have done some very positive work in improving both acute and community stroke provision throughout the country, and many local authorities have responded positively; some, like North Yorkshire, have responded proactively. However, the Government have been naive as well, by assuming that local authorities, such as Conservative-controlled North Yorkshire, will not only recognise this work but use their overstretched budgets to continue to fund it. They are in a bind—I recognise that—but we should not take community stroke services for granted. They are absolutely essential for stroke victims and their families.

I despair that an incoming Government, desperate to slash public spending, will not recognise the importance of these community-based services. I therefore hope that the Minister will put down a marker tonight that, in the event of a Labour Government being returned to office after the general election, this matter will continue to be a high priority, so that these vulnerable people will continue to get the support that they need.

I congratulate the hon. Member for Harrogate and Knaresborough (Mr. Willis) on securing this debate. As always, he shows an acute interest in the welfare of his local health service, and I commend the dedication with which he serves the needs of his constituents.

I should also like to pay tribute to my colleague and good friend, Ashok Kumar, the former Member for Middlesbrough, South and East Cleveland, who passed away today. He was a very good friend to me, and he was known for his quiet work in the House. I also want to pass on my condolences to his family and close friends, some of whom I know well.

The hon. Member for Harrogate and Knaresborough referred to his constituent, Jenny Jones, and I hope to make further reference to her during my speech. Time constraints mean that I cannot answer all his questions in full tonight, but I will of course write to him with a more detailed response. In December 2007, we launched the national stroke strategy, which sets out a radical and challenging agenda across the pathway from awareness and prevention to long-term care in the community for what is one of the major health conditions. The strategy defines a series of key quality markers for action and associated progress measures.

Stroke is a devastating condition for those who have a stroke and for their families and friends. Some 110,000 people in England have a stroke every year, and 900,000 people live with the consequences of stroke. For some 28 years, I worked as a nurse, and I was aware of the neglect of this serious condition. It involves a brain attack, and is a real medical emergency. I am pleased to be part of a team of people who have brought about the awareness of the condition that we now have. It is the biggest single cause of adult disability, with some 300,000 people being moderately to severely disabled as a result of a stroke. The aim of the strategy is to modernise care and deliver the most appropriate treatment for each stroke. Our goal is a real revolution in NHS stroke services.

The hon. Gentleman asked whether I had read the important document produced by the Stroke Association. I have read it; I have always taken a great interest in the association’s work, and in the work of the all-party stroke group, which also does excellent work. I certainly want to see the Stroke Association’s proposals brought to the forefront and continued, because I have a personal knowledge of the situation from my nursing background as well as a commitment, through the post I am privileged to hold, to ensuring that everything possible is done to achieve the necessary awareness and to fulfil the proposals in the association’s manifesto.

The national stroke strategy has been universally welcomed and, although it presents a 10-year plan and we still have a long way to go, we are making significant progress. The recent report from the National Audit Office, “Progress in improving stroke care”, found that

“early indications are that implementation of the strategy is…starting to deliver improved levels of service and improved outcomes”.

The strategy sets out a clear agenda for modernising and delivering the best stroke services, and we have done much to support its implementation, as the hon. Gentleman has acknowledged. The stroke improvement programme, which has been created in collaboration with NHS Improvement, has helped to establish stroke care networks to implement the strategy and assist in delivering improved services for patients and their families. There are now 28 stroke networks across the country that look at service improvement and development according to local needs.

Long-term care and support are an essential part of the stroke care pathway. In addition, choice and personalisation for people living with long-term conditions was a major theme running through the NHS next stage review’s final report. Furthermore, the training of new stroke specialist physicians is being funded centrally, allowing deaneries to expand their stroke work force appropriately.

In addition to the allocations made to primary care trusts this year, we have also allocated central funding over three years to support the development of stroke services. The hon. Gentleman asked what assurances I could give that stroke support services developed by local authorities will continue beyond 2010-11. As far as tonight’s debate is concerned, I can say that the ring-fenced grant was made in recognition of the particular importance of social care for stroke survivors. We have always made it clear that the funding for local authorities was for three years to pump-prime services that local authorities would continue to fund in the longer term, if they proved cost-effective and beneficial for stroke survivors.

When local authorities have invested in such services, they should be making plans now, in 2010-11—the last year of the ring-fenced funding—to mainstream them so that they are covered by existing resources. The ring-fenced funding will have alerted local authorities to the need to cater for stroke survivors in their service delivery plans when commissioning, which is key to the future commissioning of services for people with disabilities.

As part of the central funding that we have provided to support the early implementation of the stroke strategy, £45 million has been ring-fenced and given to 152 local authorities. That funding is to help local authorities to understand the needs of adult stroke survivors and their carers and to provide support services for them. It is particularly essential that we should include carers in our family of NHS support people. We need to understand the need for aftercare—I believe that, in the past, it has not been fully understood—so that people can survive this medical emergency. It is needed to get the family back into work and to get the survivor back into work. Only such aftercare can bring back the quality of life that only they, as part of that family, and those who visited that family would know to be absent. I am sure that people such as Jenny Jones are essential to those families—the hon. Gentleman read out such cases from the responses to his Facebook group.

I should emphasise that it is for individual local authorities to decide, based on local needs and the priorities of people with stroke, how best to spend the ring-fenced funding. That devolved authority can be frustrating, at times, for us all.

The funding averages approximately £100,000 a year to each of the 152 local authorities, including North Yorkshire. I understand that prior to the allocation of that national funding, the Harrogate Stroke Association was already in receipt of core funding from both North Yorkshire county council and the North Yorkshire and York primary care trust to support its drop-in service and support group. The core funding continues to be provided to the Craven and Harrogate area and has not been cut.

I understand that in 2008, an arrangement for additional one-off moneys was made between the council and the Harrogate Stroke Association that was intended to last for one year and to fund two co-ordinator posts. In actuality, it lasted for two years as only one co-ordinator could be recruited. A further £12,000 was allocated to allow the post to continue for two years. However, there was an understanding at the time between the council and the Stroke Association that the additional money was for 12 months only and an agreement was signed to that effect. It is that contract that is coming to an end, as planned, by the end of March 2010. It is for local authorities to act to ensure that the local needs and priorities they have identified for stroke survivors and their carers continue to be met. The council is still in contract with the Stroke Association for it to provide an equitable service across the whole North Yorkshire county.

Motion lapsed (Standing Order No. 9(3)).

Motion made, and Question proposed, That this House do now adjourn.—(Kerry McCarthy.)

The funding is allocated across the county and I understand that the regional Stroke Association does that in partnership with local branches. We have always made it clear that the funding to local authorities is for three years to pump-prime services that they will continue to fund in the longer term. I urge the hon. Gentleman to continue to raise his concerns with the council, which I am sure will take great interest in this debate and might read that I urge that to happen.

On the wider provision of stroke services in North Yorkshire, the hon. Gentleman will know that its local authorities are working hard to develop services according to local needs and priorities. Indeed, that is the case throughout the country. Local authorities are the pivotal access point to a range of services that can benefit people who have had a stroke and who want to live independently at home. Local authorities are working with their NHS partners locally and with stroke networks and the voluntary sector to help individuals and carers at an early point to reduce the likelihood of increased dependence at a later stage.

The hon. Gentleman might know that the North Yorkshire and York primary care trust is working with North Yorkshire county council’s scrutiny of health committee to raise awareness of stroke and to promote wider understanding of stroke care across the county. I understand that the PCT is also developing plans for early supported discharge and community rehabilitation services for stroke patients in each locality.

On a regional level, much work is being done to improve services further and to respond to the national stroke strategy. In the Yorkshire and the Humber strategic health authority’s response to the next stage review, the improvement of stroke care is identified as a priority, and the pledge to

“save 600 premature deaths every year with better stroke care”

is key. Clinicians from across Yorkshire and the Humber have been involved in establishing and agreeing a stroke assurance framework that describes the stroke care standards, both core and developmental, that the SHA expects all primary care trusts to provide. Each PCT has submitted to the SHA a plan for working with local providers to meet the standards. Those plans are being assured by the SHA with expert advice from the stroke networks.

In addition, a review of vascular services across the region is currently being conducted by the Yorkshire and the Humber specialised commissioning group. Provisional service standards to improve outcomes for all vascular patients have been agreed, and work is under way to identify the most appropriate configuration of services needed to meet those standards. It is expected that that work will be completed by late summer 2010.

The hon. Gentleman has raised some important points tonight—some, but not all, of which I have been able to address. His point about research-based evidence is one of the most critical issues that he has raised. He talked about the cost-benefits of providing proper stroke support, and I agree wholeheartedly with him. To do anything else would be a false economy, and would have an impact on the livelihoods and lives of those affected and their families.

We now know about prevention, but even with our commitment—the advertising campaign, the speedy results, the expert clinical care and the imaging of those brain attacks—we know that we also need to look at the serious aspects of aftercare. The difficulty of measuring the quality and effectiveness of post-hospital care is recognised across all long-term conditions. It is an area the Department continues to work on, with health and social care services. The stroke improvement programme has been developing a minimum dataset of key performance indicators for the entire stroke pathway. I hope that will go some way to reassuring the hon. Gentleman.

Provisional service standards have been agreed that seek to improve outcomes for all vascular patients. Work is under way to identify the most appropriate configuration of those services. When implemented they should have a positive impact on outcomes and patient experience for stroke and other vascular conditions.

It is important to acknowledge the good work the voluntary sector is doing to help implementation of the strategy. I pay tribute to the support it has provided for stroke survivors over many years. Third sector organisations, including Connect, the Stroke Association, Different Strokes and Speakability, provide valuable services to survivors and their carers. They bring expertise and skills that support improvements in the quality of people’s lives—their independence, well-being and choices.

I know that the hon. Gentleman is much impressed with the stroke support services available across North Yorkshire that the council and the Stroke Association have worked together to provide. I, too, commend those efforts. Much is also being done in the NHS locally to respond to the challenges set by the national stroke strategy, and I hope he will join me in commending the NHS in North Yorkshire for striving to provide a first-class stroke patient service.

I hope that the despair the hon. Gentleman referred to will not arise. I hope a Labour Government are re-elected so that we can continue our good work. I also hope to see the council and the local NHS continue to work together to ensure that patients are supported, not just at a critical time in their illness but to help them achieve a comfortable and independent life for as long as possible.

I wish the hon. Gentleman well in his retirement. I hope he stays in very good health and continues to work as hard as he has done as a Member of the House. I put on the record again my thanks to Jenny Jones and her team for their valuable work.

Question put and agreed to.

House adjourned.