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Stroke Victims: Treatment

rose to ask Her Majesty’s Government what steps they intend to take to ensure the efficiency and effectiveness of the treatment of stroke victims, in light of the report of the Comptroller and Auditor General, Reducing Brain Damage: Faster access to better stroke care (HC 452). The noble Lord said: My Lords, in the early hours of Tuesday 8 May 2001—just five years ago—I was carried by ambulance from my home to the Royal Free Hospital in London, where it was decided that I had suffered a stroke. A few days later, I was moved to the National Hospital in Queen Square. I had spent not even one night in hospital in over 50 years. My weight, blood pressure and cholesterol were in order. I did not smoke; I drank moderately, took some exercise and had a careful diet. I had never thought much about health problems or how the body works. Some years earlier, atrial fibrillation had been diagnosed and I settled down to a regime of Warfarin, but that seemed routine in late middle age in order to avoid the possibility of a heart attack. I knew of strokes. One had killed Tony Crosland, a friend and cabinet colleague. Yet in my naivety I thought that a cardiac problem and a stroke were wholly detached—one was of the heart, the other of the head. As far as I recall, stroke had never been mentioned by my doctors during my Warfarin years. I tell this story because many are innocent, as I was, about stroke, as it has a low profile among diseases, as is clear in the audit report, and because the consequences of stroke can be fatal to the victims, or they can be left severely disabled. I had no physical consequences of my stroke—I was very lucky—but my reading, writing, speaking and comprehension were severely affected. I can still say ““questions”” when I mean ““answers”” and ““she”” instead of ““he”” and get the wrong preposition, and find it difficult to grasp telephone numbers. But I am immensely grateful for my recovery to the speech and language therapy service of the North Middlesex Hospital, which I attended for two and a half years of speech therapy. In passing, I pay tribute to the Stroke Association for its research, welfare and campaigning, and to Different Strokes, a relatively new charity developed by young stroke survivors to support their special needs—and at least 1,000 young people under 30 every year suffer a stroke. I pay tribute too to Speakability, another charity, which cares for patients with special problems and assists their rehabilitation. The performance of the Department of Health and the NHS is the key to preventing strokes and handling the consequences, and the recent National Audit Office report gives me serious concern, especially as many hospital trusts are faced with financial deficits. As an example, I refer to the Royal Free Hospital and the Royal Free Hampstead National Health Trust, where I became a patient. I have had correspondence with the Minister of State, Rosie Winterton, in which I asked whether any reductions were being made in the NHS stroke services in England and Wales, given the problems that had arisen from overspending. I understood that her reply was no, but then learned that the Royal Free intended either to close the stroke unit or to reduce its facilities. Rosie Winterton now says that the hospital plans, "““to redesign its stroke services””—" ““redesign”” is a familiar euphemism—and to reduce the number of designated stroke services, which seems quite contrary to the advice of the National Audit Office report. She also promised that the chair of the Royal Free Trust would provide me with new information. She wrote to me on 29 April but, three weeks later, I have heard nothing at all from the Royal Free. I would be very grateful to be told what is really happening to the Royal Free, whether it is the case that no cuts are being made in NHS stroke services in England and Wales as a result of overspending, and whether any other changes arising from overspending are consistent with the recommendations of the audit report, as in paragraph 9 of the report’s summary, for example. I welcome the improvements in stroke services made by the Department of Health over the past few years. I am glad that we now have a dedicated stroke unit in many hospitals and I was delighted to open the new stroke unit in the North Middlesex Hospital last year. I recognise that the Department of Health has a national strategy for the next stage of stroke development, although I am cautious about ““strategies””—a buzzword that sometimes avoids or delays necessary action. But overall, given that it is careful, disciplined and restrained, the National Audit Office report is very disturbing. The Public Accounts Committee of the House of Commons goes further; it calls the report ““scathing”” and ““deeply shocking”” and says that there have been, "““shameful lost opportunities and lost lives””." Over 100,000 strokes occur every year and stroke accounts for 11 per cent of deaths in England and Wales. Between 20 and 30 per cent of people who have a stroke die within a month, and many others suffer moderate or severe disability. In comparison, more than three times as many women die of stroke than of breast cancer. The key findings of the report say that the Department of Health has not given as high a priority to stroke as to other conditions and that an emergency response to stroke, with efficient and effective acute care, is lacking. Services for coronary heart disease have been well established for many years, but stroke services are still in their infancy, revealing disproportionate differences in resources and status. Rapid admission to hospital and access to specialised stroke care, including brain scanning, is vital for ensuring the best possible outcome for patients. For many it is a matter of life and death. It is not enough for the Department of Health to say that there have been real improvements over recent years and that it hopes to make further progress. It is urgent now to accept all the recommendations of the audit report and to implement them without delay. I understand that the Public Accounts Committee will report in three or four weeks’ time, in the middle of June, but I hope that the Minister can reassure me tonight that the Secretary of State is already acting on the audit report.