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Health: Stroke Care

Volume 729: debated on Monday 4 July 2011


Asked By

To ask Her Majesty’s Government what actions they will take to address geographic variations in stroke care identified by the Royal College of Physicians and detailed in the National Stroke Audit Report 2010.

My Lords, the 2010 audit shows ongoing improvements in stroke care in England. To achieve the high-quality care described in the national stroke strategy and the NICE quality standard, the NHS is continuing to implement the accelerating stroke improvement programme. This aims to go further and faster in delivering improvements in stroke care across England.

I thank the Minister for his response and his recognition of the tremendous progress that has been made in the past three years with the national stroke strategy. I am sure that he agrees that progress has been most marked where strategic health authorities have provided strong leadership to drive forward strategy. With their abolition, how will the new system, through the subnational elements of the NHS commissioning board—the clinical senates—help facilitate the necessary improvements, and where will accountability lie? Also, I am concerned that the future of the stroke strategy team at the Department of Health seems to be uncertain. I have heard that the national clinical director for strokes will shortly stand down. Will the Minister confirm this and explain, if that is so, who will be responsible for providing strong leadership on stroke improvements at national level both in the short term and under the proposed new system?

My Lords, clinical leadership is at the heart of our reform plans for the NHS, both at local and national levels. As regards the national director, our officials are currently considering how best to reflect that leadership at national level as part of the work being done to develop the new NHS commissioning board. I say to the noble Baroness that I see the NHS reforms as presenting an opportunity for much stronger partnership working between primary care commissioners and secondary care specialists. The NHS outcomes framework will enable us to track the overall progress of the NHS in delivering improved outcomes, and commissioners and providers will be supported by advice from the stroke networks under the auspices of the board. Therefore, we will have the opportunity in future to drive consistency and quality throughout stroke care in England.

My Lords, does the Minister accept that, in addition to the availability of facilities in all geographical areas, the other essential ingredient in getting a successful outcome is the level of knowledge that individuals have of the symptoms that might indicate that a stroke is about to happen? What initiatives have the Government in mind to improve public understanding and education in that matter?

The noble Lord is absolutely right. I am sure that he will know of the FAST campaign, which stands for face, arm, speech and time to call 999, as the noble Baroness, Lady Thornton, used to tell us. We conducted a renewal of that campaign in March. We believe that it is an extremely important way of raising public awareness of the urgency of the situation. We will keep that programme firmly under our eye and renew it as we feel necessary.

My Lords, it is well reported that the incidence of stroke and TIA in the north-west is higher than the national average. It is sad to note that, in my diocese of Blackburn, none of the hospitals in Lancashire manages to come into the best 25 per cent. I am very satisfied with the noble Earl’s Answer about the improvement that has taken place, but can he ensure that there are suitable specialists in place to provide a comprehensive stroke service throughout the country?

The right reverend Prelate is quite correct to point out that there is variation in the country, as one would expect, not least in the area of rehabilitation after a stroke. The most encouraging progress we have seen throughout the country has been on acute stroke care, but we now have work to do on the rehabilitation side. As it happens, I was in the north-west some weeks ago and saw some encouraging work going on in the area of telecare, whereby stroke physicians can assess and diagnose a patient remotely, sometimes from their own living room. This will make an enormous difference, particularly where there are distances to travel for stroke specialists. I believe we should encourage those initiatives where we can.

My Lords, with regard to stroke in young people, what specific policies is the Minister’s department pursuing, particularly bearing in mind that most strokes in young people are caused by sickle cell disease?

My noble friend makes an extremely important point about strokes in young people. It is of course true that, thankfully, fewer young people suffer these strokes, but he is right that sickle cell presents a warning sign. There are clear guidelines for ambulance crews and doctors more generally relating to those who have sickle cell disease. We had a debate a while ago on this topic in which the noble Baroness, Lady Benjamin, made some extremely important points which we continue to bear in mind.

My Lords, various reports show that the mortality for stroke can be as high as 30 per cent. Sadly, in the United Kingdom mortality is higher than almost anywhere else in Europe, although there is great geographical variation all over the world. One of the issues that Professor Peter Rothwell, of the University of Oxford, has pointed out is that speed is the essence of success. Therefore, it is not merely a question of informing patients, but of making certain that the right availability is present in our hospitals. If we do that we can reduce the risk of a further stroke by 80 per cent and probably, as he says, reduce the cost to the National Health Service in primary care by somewhere between £100 million and £200 million annually. Would the Minister be kind enough to explain how that will work in the future of the health service?

My Lords, the noble Lord is quite right in all that he says. I would just point out that the official statistics are rather historic and it is important that we take stock when the revised figures are before us in some months’ time. As regards how best practice will be driven when the health service reforms are in place, I would repeat my earlier comments about the ability of the NHS commissioning board to drive forward higher quality, informed by the new quality standard produced by NICE. More particularly I think we can do a lot through the tariff. At the moment, best practice tariffs are starting to play a role in encouraging and driving best practice at hospital level.

My Lords, tomorrow is the 63rd birthday of the NHS. Would the Government give the NHS the birthday present of eliminating local differences in stroke services by implementing the recommendations in the stroke strategy? In that way, when we all break into song next year when the NHS is 64 years old, we will actually have achieved something very important.

It is very appropriate that the noble Baroness should remind the House of the NHS’s 63rd birthday. I can think of few better presents than that which the noble Baroness has outlined. I can say only that the efforts within my department, and indeed throughout the NHS, continue unabated to ensure that stroke patients are treated to the highest possible standards and that unacceptable variations are eliminated.