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Stroke Victims: Treatment

My Lords, I, too, pay tribute to my noble friend Lord Rodgers of Quarry Bank and to the noble Lord, Lord Clinton-Davis, for a most apt, elegant and eloquent introduction to a really serious subject. I declare an interest. Fortunately, I have not experienced a stroke, but I have answered the phone when the call has come to say that someone several hundred miles away who is very dear to me has had one. So I know a bit about it from that respect, and because of that experience, I have taken a particular interest. I have sat in A&E departments watching A&E doctors trying to make that FAST diagnosis in the middle of a very busy A&E ward. My noble friend Lord Rodgers has organised this debate in a timely fashion. Not only do we have the National Audit Office report from November 2005, we have the report of the Public Accounts Committee of 8 February 2006. Furthermore, we have Professor Ian Philp’s report on the first five years of the implementation of the NSF for older people, which includes a standard on stroke care. Of all those documents, the most interesting and revealing issue to arise—from the NAO report—is the model of care adopted in Australia, where stroke is classified as a medical emergency and medical teams are organised to treat it as a fast stream disease. Were it to be replicated here, it would not only save patient lives, as has been said, but it would decrease the number of people who are left with dependencies and disabilities after a stroke. Moreover, that approach would save the NHS a great deal of money. That ought to be the key factor that the Government pay attention to. The national audit of stroke was due to start collecting data in April this year. Even without the benefit of that information, it is clear that there has been a great deal of improvement in stroke care over the past decade; not as much as there has been on chronic heart disease and cancer, but there has been less investment in stroke care. Between 1992 and 2002, stroke mortality declined by about 30 per cent in people aged under 75, but the chance of a stroke being fatal has remained constant at about 25 per cent. The average length of stay in an acute hospital bed has declined from 34 days to 28 days, but at any one time 20 per cent of acute beds are occupied by people who have had a stroke. The key problem is accurate diagnosis before a patient enters an acute hospital. The new GP contract specifies that people who have had strokes should be identified and treated within protocols agreed with specialists. Have those protocols been developed and implemented? Furthermore, do they include ambulance staff, who are often the people who spent time with stroke patients during the first few critical few hours? I am concerned because last week NHS Direct announced several thousand job losses. What impact will those cuts have on people who are trying to get information and make the sort of diagnosis that the noble Baroness, Lady Gardner of Parkes, talked about? Anyone who has had a stroke, or cares for someone who has had one, knows that agonising period when you wait to find out what type of episode has happened and what the consequences are likely to be; whether it is a blood clot or a cerebral haemorrhage. The NAO report identified that failure to have rapid access to a scan is a major cause of delay in treatment. The Public Accounts Committee report showed more clearly that it is not always about access to the machinery and the kit; it is about having access to the staff who have the capacity to understand and read the scans and to interpret the data. Where those staff are available in A&E departments, the whole care pathway becomes much faster and people get much quicker access to appropriate care. I say that from experience. It makes a huge difference when the scanning equipment and the staff are in the A&E department and there is quick access to DVT nurses, for example. I have experienced that at St George’s when I have been accompanying people. It is part of its ground-breaking work on hypertension, and it proves the benefits of having an integrated care pathway. In evidence to the Public Accounts Committee, Professor Roger Boyle, National Director for Heart Disease at the Department of Health, referred to a stroke research network. Will the Minister give further details of that? How will it be organised and resourced? Will the development of the network be dependent on the support and involvement of PCTs and ambulance trusts as well as acute trusts? If so, will the current restructuring of PCTs and ambulance trusts delay or impede the network’s development? Will it all be caught up in that magical, although frightening, phrase used by my noble friend Lord Rodgers of Quarry Bank—““service redesign””? I want to pick on one point in the report of the Public Accounts Committee. There was great discussion about the high incidence of strokes among certain communities—particularly the African-Caribbean population. I was struck that Professor Boyle reported that people from those communities appear to have a disposition towards high blood pressure and a higher resistance to treatment compared with other groups. Therefore, there is a far greater need to ensure that people in those communities are aware of the risks and that they take the sort of prophylactic action that the noble Baroness, Lady Rendell, talked about. Professor Boyle talked about the difficulty of reaching those communities. Has the department considered the extent to which it is possible to get messages to people through community networks and groups within those areas and to get specialists from the health service to work alongside the people and community groups there? Finally, I want to touch on the issue of rehabilitation. Anyone who has had a stroke—we have heard some tremendous examples this evening—or anyone who has cared for someone who has had a stroke will know that there is huge scope for recovery. People can relearn speech, regain mobility and learn new mechanisms for coping with the tasks of daily living, but that takes an awful lot longer than a six-week intermediate care package. It is possible to regain one’s facilities and abilities to an extraordinary extent. Without that possibility, people would never be able to stand up and speak with the eloquence of the noble Lord, Lord Clinton-Davis, or my noble friend Lord Rodgers of Quarry Bank. But one of the most difficult things for people who have had a stroke is the ability to regain their confidence—confidence to stand up and speak; confidence to get on a bus; and confidence to have a bath when there is no one around in case they fall. It is possible to do that with time and help. One of the key points in effective rehabilitation in the future will be the extent to which specialists within the NHS are willing to share their knowledge with those of us who are amateurs but who have time. I once heard a gerontologist at a conference say that we know that in stroke rehabilitation going for a walk is extremely beneficial. Doctors and nurses do not have time to take people for walks. Volunteers and carers do have time but no one has ever told them that that is a good thing to do. Communication between professionals and those who will be there throughout the long period of regaining skills will be the key to the future management of this condition, which will affect many people. It is true that a stroke can be devastating, but it is equally true that great minds need not be damaged by a stroke. It is possible, with help, for someone who has had a stroke to lead a life which is a great example to others, and I thank my noble friend Lord Rodgers very much for the opportunity to make that clear.