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Health: Stroke Care

Volume 735: debated on Monday 13 February 2012


Asked by

To ask Her Majesty’s Government what assessment they have made of the consistency of care for stroke patients across England, and whether the progress made in London will inform the development of their policy on stroke care.

My Lords, stroke patients are getting faster and better treatment than ever before. The latest data show that more than 80 per cent of stroke patients spend the majority of their hospital stay on a stroke unit—a 20 per cent improvement since 2009. We want the stroke community to share and learn from what works, such as the London model of providing stroke services. The stroke improvement programme plays a central role in disseminating this knowledge.

I thank the Minister for his response. I remind him of the debate on stroke that we had very recently. The evidence is very clear that early intervention with stroke, as with many other diseases, plays a key part in ensuring that the cure is of longer standing. The noble Earl will know that last year’s CQC report highlighted the huge differences and inconsistencies in what happens. It would be good if we could have an assurance that the London model will be rolled out and taken on board by the national commission.

My Lords, I agree with the noble Baroness that the London model has, indeed, been a model for others to follow. All Londoners now have 24-hour access to hyper-acute stroke care regardless of where they live, and London has one of the highest rates of thrombolysis for any large city in the world. It may not be appropriate to replicate precisely a model of care which works well in a densely populated capital as regards more rural areas, but that is where the expertise of the stroke improvement programme is essential in working with stroke networks across the country, sharing best practice and improving outcomes for stroke patients.

My Lords, is the Minister aware that although the London system is good, London has not always been at the forefront of this area? As the noble Lord, Lord Walton of Detchant, is not here to make the point, is the Minister aware that thrombolysis—the “clot busting” system—was introduced in Newcastle and was used there very effectively long before it reached London?

I, too, refer to the debate that we had recently on stroke. The Minister greatly praised the work of an organisation called Connect. I declare an interest as my daughter is a director of it. It is a third-sector organisation which works across the country but mainly in rural areas. Connect and many other third-sector organisations are worried that, in light of the squeeze on local authority and NHS budgets, their funding will cease and this wonderful and vital work will be lost.

My Lords, we are well aware of the issue raised by the noble Baroness. Indeed, it was raised during the listening exercise last year. PCT commissioners are identifying all their clinical contracts as part of a stocktaking exercise and over the next year will be using the information collected to identify those contracts that are due to transfer to the new commissioning organisations next year. We will work with both providers and commissioners to ensure that there is a smooth transition and continuity of care for patients and service users.

Is the Minister able to give an assurance that stroke care networks and the help given by the NHS stroke improvement programme will survive after the current review undertaken by the Government?

My Lords, I can give the assurance that the noble Lord seeks. The NHS Commissioning Board authority has made it very clear that stroke networks have been immeasurably helpful to patients and there is every intention of continuing with them.

My Lords, have the Government monitored the impact of individual health budgets which were introduced by the previous Labour Government? What effect have individual health budgets had on the commissioning and delivery of stroke services?

My noble friend is right: individual health budgets have enormous potential in the case of stroke patients. I do not have any specific data on that in my brief, as it is still relatively early days for the personal health budgets. However, if I have further information to give her, I will gladly write.

My Lords, the CQC report highlighted huge problems for stroke patients in consistency of care and support after hospital discharge and for long-term stroke survivors in the community. Early supported discharge from hospital involves the majority of rehabilitation taking place at home and is therefore geared to the home setting, yet it is available in only 37 per cent of PCT areas. This is such an important area for progress and obviously a key way of refocusing resources into the community. How will the Minister ensure that this situation is addressed now and under the new health structures? Can he confirm to me that the CQC will continue to monitor the progress of the national stroke strategy and produce further special reviews, given that I understand the team which delivered this last report has now been disbanded?

My Lords, the unwarranted variations in services are quite clearly unacceptable. The value of the CQC report is that it shines a spotlight on where variations in care need to be addressed. We believe that that will help all stakeholders involved in improving opportunities for people who have experienced a stroke. As regards post-hospital care, on which the noble Baroness rightly focuses, the accelerating stroke improvement programme, which is quite new, is already doing very good work. It was developed specifically to improve care in areas where progress needs to be faster, and that work will most certainly continue.

My Lords, has the Minister yet had a chance to reflect upon this morning’s report that illustrates that survival rates and the reduction in the death rate from strokes, cancer, heart attacks and many other serious diseases have improved considerably over the past few years? By any standards, when comparing productivity in terms of quantity and quality, there has been a huge increase in productivity. Since the premise behind the Health and Social Care Bill was that there had been little or no increase in productivity in the National Health Service, will he share with us his reflections on that report?

The premise of the Health and Social Care Bill is rather different from the one that the noble Lord cites. We believe that there is a damaging and avoidable variation in care across the country. Of course the outcomes in many areas of clinical care have improved immeasurably, as he rightly says, over the past few years—not least in heart attack and stroke. However, we still have some way to go and clinical commissioning, we believe, will take us in the right direction. Stroke features in two of the domains in the NHS outcomes framework, representing work that we have put in train: domain 1, “Preventing people from dying prematurely”; and domain 3, “Helping people to recover from episodes of ill health or following injury”. It is those measures to which the NHS will be held to account.