Health: Stroke Victims

My Lords, I congratulate the noble Lord, Lord Rodgers of Quarry Bank, for instituting this very necessary debate. At the present time, it is impossible to do too much to raise public awareness of cardiovascular disease. Heart disease, stroke and related conditions account for two-thirds of all premature deaths in England, as well as leaving patients with often terrible physical and communications disabilities. The Department of Health’s recent publication, Mending Hearts and Brains, is an report by Professor Roger Boyle, the national clinical director for heart disease and stroke. In it, he refers to qualifying as a doctor in 1972 and to the limited treatments available to patients at that time. I well remember the case of my father, who first became ill with a stroke in 1969 that left him with a severely distorted face, poor co-ordination and soon, after a second stroke and a heart attack, unable to walk. As I remember it, and as Professor Boyle points out, the only treatments offered to heart attack victims were heroin to ease the pain and a defibrillator in case of cardiac arrest. As to stroke, no treatment was given to my father because stroke was regarded at that time as an inevitable consequence of old age, a more or less usual preliminary to death, although he was only 69 when the first stroke debilitated him. He suffered further strokes, but as he was basically strong, he withstood those onslaughts and suffered greatly. My father was a man of considerable intellect, an enthusiastic mathematician, a cabinet maker and a painter. After the first stroke, he was unable to do much with his hands and his painting became a kind of unintended impressionism. He lived until 1973, gradually growing more incapacitated until he was bedridden. It was a sad end for a man of his gifts, as it would be, indeed, for anyone. Since then, things have changed for heart attack patients, and work is being done to repeat those strides forward for stroke, or as Professor Boyle calls it, "““the brain's equivalent of heart attack””." Comparable advances for stroke have not yet been made. There are similar numbers of strokes and heart attacks, but awareness of this equally devastating condition has been slower to reach the public. A major advance that we should all know about is the recognition of the paramount need for a healthier lifestyle. In my father’s day—he was born in 1900—people believed that a healthy diet consisted of hot meals that were home-cooked, even though they included large amounts of roasted food, fat, butter, home-baked sugar-laden cakes and pastry. These days, with our more enlightened attitude to diet, we might call these the junk foods of the early 20th century. Born and brought up in Plymouth—Cornish cream country—my father made his own clotted cream, using the whole milk from Jersey cows, as his mother had made it. For years he ate it every day. He never smoked, but the exercise he took was inadequate—short walks with an elderly dog. His blood pressure was sky-high. We now know that over 40 per cent of all strokes could be prevented if people kept their blood pressure under control, used statins to lower high cholesterol, took regular exercise even into old age and restricted themselves to a low-fat diet of fruit and vegetables, fish and whole grains and pulses. That giving up smoking is the first rule of health should by now go without saying and the soon-to-be-in-force ban must be a major contributor to better health in the population. Stroke needs to be treated as a medical emergency. At present, according to the national sentinel stroke audit published a few days ago, only 9 per cent of patients were scanned within three hours of stroke, and only 15 per cent were admitted to a stroke unit on the same day and only 12 per cent within four hours of arrival at hospital. Lack of early treatment is partly due to ignorance. Few people know what to look for and even if they suspect stroke, they have no idea that early treatment is essential. By the time one reaches my age, one inevitably knows contemporaries who have recently suffered stroke. One friend of mine, a man, in spite of collapsing, was not recognised as a victim of stroke for several days, because his wife was unaware of a simple formula, first mentioned in your Lordships’ House, as far as I am aware, by the noble Baroness, Lady Gardner of Parkes, in a previous debate on this subject. She did this House and the public a great service in explaining this. She repeated the face-arms-speech test or FAST. This simple expedient requires anyone witnessing what may be a stroke to call 999, then to check if the person can smile. Has his mouth or eye dropped, as my father’s did? Can he raise both arms? Can he speak clearly and understand what you say, as my father could not? My friend is improving now, but progress is slow and might have been much faster if he had been taken immediately to a hospital where, ideally, he could have been admitted to a stroke unit and could have received specialist care from a multidisciplinary team. A brain scan is the only way of identifying whether a patient is experiencing a haemorrhagic stroke caused by bleeding or an ischaemic stroke caused by clotting, so that appropriate action may be taken. Clot-busting drugs can reduce the chance of death and disablement in eligible patients, but they need to be given within three hours and are dangerous for patients with haemorrhagic stroke if bleeding has already taken place. More bleeding may have disastrous consequences. Therefore, rapid scanning is essential to ensure that patients receive the correct treatment. Too few people arrange regular appointments with their doctor for blood pressure monitoring. It is worth buying oneself a blood pressure monitor and being taught to use it correctly, as a surprising number of people have no idea whether their blood pressure is low or high. One hears often of people who, on the grounds that they believe themselves to enjoy exceptionally good health, never go near a doctor and never have their blood pressure checked until they suffer an ischaemic stroke. These days, hardly a month goes by without me hearing of another victim whose brain damage might have been avoided. I ask my noble friend whether he agrees that, in the light of Professor Boyle’s report, we need a campaign to raise public awareness of the importance of reacting to suspected stroke with speed. Would he agree, too, that the FAST technique should also be explained to everyone likely to be in the presence of a suspected sufferer—and that of course means all of us? I am a daily reader of newspapers, yet I cannot recall a feature article published recently in any so-called quality newspaper dealing with stroke, its prevention and treatment. I may have missed such a feature, but I am very conscious of the dangers of stroke and, therefore, I am particularly sensitive to information about it and comment on it. Truly it is the forgotten disease, unglamorous and mostly afflicting the ageing, yet cardiovascular disease across the world is killing more people than AIDS, TB and malaria combined, and in England more than all the cancers put together.