Health: Stroke Victims

asked Her Majesty’s Government how and when they will implement the proposals contained in the Department of Health report, Mending Hearts and Brains, in respect of stroke victims. The noble Lord said: My Lords, at short notice and on a rather quiet day, I am very pleased that several noble colleagues are able to be present on this occasion. A year ago, on 23 May 2006, I raised in the House the treatment of stroke victims in the light of the National Audit Office report, Reducing Brain Damage: Faster Access to Better Stroke Care, published the previous November. It was seen to be a thoroughly depressing report and, in July 2006, following its examination, the Public Accounts Committee shared that concern. Finally, late in October 2006, we had the Government’s response, which did not seriously dissent from the original National Audit Office report and broadly agreed with the recommendations of the PAC. Given those three documents, I said in a general NHS debate in the House on 7 December that, although I conceded that there had been significant improvements in stroke treatment in the past five or six years, the tone of the Government’s response had been bland and lacked urgency. In replying, the then Minister, the noble Lord, Lord Warner, said in a reassuring way that many of my concerns were covered by Professor Roger Boyle’s report, Mending Hearts and Brains, published earlier that week. So I turn to Professor Boyle’s document in the hope that the Minister will clarify the Government’s purpose and intentions. First, I should be grateful if the noble Lord, Lord Hunt, would explain the terms of reference for Professor Roger Boyle as the national director for heart disease and stroke and the role of Department of Health directors. Secondly, I should like to know the status of the document and to whom it was addressed. Thirdly, given the substance of the document, what has happened since it was published six months ago? Is it being implemented in, for example, a pilot? Fourthly, what is now the timetable for what Professor Boyle calls the clinical case for change, and how will the transition be handled if it gets as far as that? If I appear critical about some aspects of the document, I am agnostic about the conclusions. My focus is only on strokes and, primarily, on Professor Boyle’s document. Once upon a time, civil servants advised Ministers in private and Ministers explained policy in public. There was a clear distinction. As a Member of Parliament, I would never criticise a civil servant by name; nor would a civil servant have been publicly exposed critically. What is the role of Department of Health directors? I assume that they are public servants, hired and fired by Ministers. Do they make and advocate policy only within the political view of the day, or do they have a degree of independence, encouraged occasionally by Ministers to fly a kite? What happens in a change of government? Do they stay, or do they go? I should like a formal definition of ““directors””, perhaps from the Cabinet Office. I should make it clear that judging by my contact with Professor Boyle through the All-Party Parliamentary Group on Stroke, he is an outstanding professional, deeply committed to solving problems. But Professor Boyle's named document is controversial and its style is puzzling. Mending Hearts and Brains and its twin, Emergency Access by Sir George Alberti, galloped into the public domain on 5 December last, the very day that the Prime Minister addressed primary care trusts. He said that the two documents were, "““a compelling and vivid account of change and why it is necessary””." Mending Hearts and Brains is an odd document, apparently prepared in haste, with language from the industrial relations division of the department, and sometimes it reads as if aimed at 10 year-olds. It states: "““Pensioner Benny Parsons was enjoying a game of golf when the first chest pains hit him””." His wife, Betty, ““frantically”” called 999. Later Benny said: "““I didn’t think I was going to make it””." Thanks to all and sundry, Benny proudly says: "““I think that what these paramedics are doing is fantastic””." Apart from Benny and Betty, there is Kevin, who was delighted that he had not been sent to a routine A&E department, and grandmother Mary, who was sent direct to Royal Bournemouth Hospital. ““I am so lucky””, Mary said. I do not know what the target audience made of the document, but who is it meant to persuade? Apart from the ““Vision””, as it is boldly called, what is now happening? Much of the document is descriptive. There are diagrams for what is called ““‘Hub and Spoke”” care—I think they are an odd shape, given my days on a bicycle. On page 11 of the document, Professor Boyle says: "““I am currently working with a range of experts to draw up a new national strategy for stroke care””." He continues that they will probably, "““recommend exploring models for ‘hub and spoke’ stroke treatment with round-the-clock, seven days a week access toa scanner and clot-busting drugs as well as making recommendations for improvements to the other parts of the patient journey””." I am sceptical about yet another strategy for this and that but, six months later, what progress has been made, and when will we be told the outcome? Every strategy needs a clear objective, an assessment of resources and a staged timetable. I assume that much of the work has already been done, hence the document and the Prime Minister's speech. When is the strategy to be implemented, over what period, and who pays? Let me briefly explain some of my anxieties. Sir George Alberti shares Professor Boyle's scriptwriter. There is nothing wrong with that because Emergency Access complements the picture. But Sir George's document starts with another vignette of what could happen if a walker in the Lake District had a heart attack on Scafell Pike. He would want, Sir George says, to be taken not to the A&E department of Carlisle hospital—by implication it lacked and would always lack the full necessary facilities—but to the state-of-the-art James Cook Hospital in Middlesbrough. He would want to be taken by road, or possibly by air. In practice, going to Middlesbrough by road is 80 to 100 miles cross-country and Carlisle is about 50 miles, partly on a motorway, so it is not axiomatic that, even when accompanied by the new super paramedics, Middlesbrough would be the natural place to go, especially in bad weather. As for a helicopter taking off from Scafell, perhaps in fog, that is not an attractive option. I do not want to score a point, but before reaching conclusions I would like to see the full picture, the practical reality of how stroke victims would be looked after in different parts of the country, urban and rural, in town centres and where the population is thin and scattered. As for the transition, what will be done to improve existing stroke facilities and acute hospitals until the limited number of specialist centres of excellence for stroke are established? In the interim, will everything mark time, except for the new-model favoured few? Will there be no new stroke units, no more scanners, no more hospitals routinely scanning patients? The latest figures from the 2006 national sentinel audit show that only 15 per cent of patients are admitted to a stroke unit on the same day and only9 per cent of patients are scanned within three hours. That is simply not good enough. Professor Boyle wrote: "““We’ve proved what redesigning services and treatment can do for heart disease. Now is the moment to capitalise on the upsurge of interest in stroke care amongst NHS professionals to do the same for stroke””." However, redesigning services does not always work, and what matters most is the patients—the victims and potential victims of stroke. I would like to share Professor Boyle’s vision, but I need to be convinced by something rather more substantial than Mending Hearts and Brains.