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Health: Stroke Care

Volume 707: debated on Monday 2 February 2009


Asked By

To ask Her Majesty’s Government what progress has been made in improving stroke care since the launch of the Government’s National Stroke Strategy.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare an interest as a member of the Stroke Association.

My Lords, the Government launched the stroke strategy in December 2007 and have made stroke care a priority for the NHS. We aim over the next few years to effect a revolution in stroke care by, among other things, creating stroke networks, by providing extra funding of £150 million for equipment and staff and by a public awareness campaign, which is soon to be launched.

My Lords, I thank my noble friend for her Answer. Does she agree that at present the public are insufficiently prepared to recognise the signs of stroke? Most particularly, they are unaware of the importance of the time factor—that a stroke patient or potential stroke patient should be got to a stroke unit within three hours. Is she aware of the stem cell therapy that is currently being trialled—it involves human trials—with the aim of repairing stroke damage and disability? Does she feel that the Government would approve and support those trials?

My Lords, since December 2007 we have been establishing the stroke networks, which are modelled very much on the cancer and heart networks which have proved so successful. Next Monday, on 9 February, we are launching what we call the FAST campaign, which aims to make the general public and relevant healthcare professionals more aware of how to identify stroke and the necessity of speedy emergency action. FAST stands for: “Face—is there facial weakness?”; “Arm—can the person lift both arms and hold them there?”; “Speech—can the person speak and are their words slurred?”; and “Time—is it time to dial 999 for an ambulance if you see any of these signs?”. On my noble friend’s second point, I am aware that at least one proposal being considered for clinical trials is directed specifically at stroke. As we are all aware, stem cell research offers enormous potential to deliver new treatments for disease. The Government, in support, have tripled their investment in this area in the past three years from £13 million to £42 million.

My Lords, the crucial issue in the management of stroke is that the patient should be admitted preferably within three to four hours at the most, and have a scan so that the suitable cases can be treated with appropriate therapy. Following the noble Baroness’s point, is the Minister aware that in Glasgow, based upon experimental research which has been very encouraging, it is proposed that 12 patients should be treated in the very near future by the injection of neuronal stem cells derived from foetal material in the hope of promoting repair of the damaged brain tissue?

Yes, my Lords, I am aware of the noble Lord’s second point. Like him, I hope that it proves as successful as it looks like it might well be. The noble Lord is completely correct to say that speed is of the essence with stroke; three hours can make the difference between complete recovery and someone having a disability for rest of their life or, indeed, losing their life. That is why we want the whole NHS to follow the example of the best of the NHS, which is to create the right kind of acute centres to provide scanning immediately when someone is admitted to hospital and then to provide the necessary treatment within that three-hour period.

My Lords, I am sure that we all welcome the Government’s plans for stroke centres—they are indeed long overdue. But what plans does the Department of Health have to ensure that pre-hospital care is available by doctor-led teams who can assess, intubate and ventilate patients, if necessary, on their way to the stroke centre so that they arrive alive?

My Lords, one of the reasons that we are promoting the new public awareness programme not just for the public but also for health professionals is so that ambulance drivers and paramedics—who are often the very first people to deal with this—know that they need to take the patient straight to one of the centres where they will receive treatment at speed.

My Lords, while I am delighted to hear that the education is widening, there is a major problem in that even when someone with a stroke presents at the hospital accident and emergency department, it can still be many hours before a brain scan is done, as the noble Baroness, Lady Rendell, pointed out. That is what happened to my husband, who spent four or five hours in accident and emergency. What attention is being paid to transient ischaemic attacks, known as TIAs, which are minor strokes? All stroke experts believe that each case should be followed up because very often they are followed by major strokes.

My Lords, the noble Baroness is completely correct. That is why access to scanning and treatment is absolutely vital and needs to be very quick. The national audit of the Royal College of Physicians shows that all hospitals should now provide CT scanning, but the problem is that they do not all provide it 24/7. We need to put more investment into training doctors, specialists and physicians to ensure that the cover is as comprehensive as it needs to be.

My Lords, can the Minister reassure us about the transition from hospital care back into the community? Is progress being made on this? Is a postcode lottery still in existence? I think that so far only about half of patients have received the care that they should have done.

My Lords, there is no question but that for too long strokes have been the poor relation in the NHS, so I shall not pretend that everything is satisfactory. The noble Baroness is completely right about rehabilitation. Our strategy sets out the care and support that is needed following a stroke, but we are not pretending that this does not present a major challenge for the whole of the NHS and social care services. We know that it can be achieved because it is happening in some areas of excellence where world-class services are provided. We need both to become the norm.