Health: Stroke Victims

My Lords, I am speaking tonight simply because the noble Lord, Lord Rodgers, sent me a note asking me whether I would speak. I did not have time to reply to the note and I thought it was better just to arrive, which is what I have done. I was delighted in listening to the noble Lord’s speech. If ever anyone has come up with a series of taxing questions for the Minister to reply to, it is the noble Lord in his speech. I had written ““sceptical”” on my notes just before he said that about himself, so obviously my assessment agreed with his own. This is an interesting document. The stories it contains are part of the technique of bringing things home to people in a realistic way. Many people will be reached by those tales who would not know anything about the rest of the document at all. So they may have done a bit of good and he should think about that. I recently had here as my guest one evening for another medical debate the president of one of the Royal Colleges. She was out with her husband, walking in Cumbria or somewhere like that, when he had a completely unexpected heart attack, and she saved his life then and there. We cannot all be fortunate enough to have the right person with us if we are in that situation, but it was quite extraordinary that that had happened. She was able to tell me that story when she came into one of our other debates. The noble Baroness, Lady Rendell, of course, has repeated my bit about FAST, which I would have repeated. But it bears repetition because one of the problems is that people have no idea that they are having a stroke. The article by Professor Boyle concerns both heart and stroke situations and he said that the only treatments available for hearts in 1972 were very limited. I served for 17 years on the National Heart Board and I recall a staff member retiring after 40 years at the hospital telling us that when she started the only treatment for heart conditions was bed rest. So she had been there in an era even before Professor Boyle in 1972 and you can see how there was a great element of progress from that time to 1972, and there has been a much greater element of progress here. I have read Mending Hearts and Brains and I respect the views put forward by Professor Boyle. He has done much to help people with heart conditions and is admired for this. He says: "““I am now working to repeat those strides forward for stroke””." I hope that he succeeds. My first direct experience of a stroke was when my husband was affected in 2003. I telephoned him from the House that afternoon and I realised something was not right when he told me he was ““not himself””. He really had no idea what was wrong. He was an experienced dentist and used to assessing patients’ conditions, but he failed completely to recognise his own. I went home immediately and insisted that we go at once to accident and emergency. He was reluctant and did not want to waste people’s time. I insisted and we went. When Professor Boyle makes the point that accident and emergency adds a delay that can mean it is too late, this is exactly right. Kevin was not moved to the stroke ward until some six hours after arrival in A&E, which was about three or four hours after the cerebral thrombosis. The first scan was done within 24 hours but should really have been done as soon as he reached the hospital, and, of course, he should have presented earlier for treatment. But teaching people in general how to recognise a stroke is one of the major difficulties. Speed is of the essence in treatment but the first step is to get the patient to realise that they are in need of treatment. If the patient does not start off by calling for the emergency service, then the chart setting out whether you should go to the treatment centre or to A&E is a waste of time if the patient is sitting at home and thinking ““I will just see how I get on””. I remember from my dental practice days—I might have been on the heart ward when I heard this—that patients who had heart attacks frequently thought it was nothing but a bit of indigestion, and would wait and see how they felt in an hour or two. Research was done to show that those patients who sat at home did not do well, and sometimes died before they got any treatment at all. People had then become aware of and alert to the need to call for treatment. I repeat the reference to the FAST system, although the noble Baroness, Lady Rendell, set it out so well that I do not need to go through it in detail. It would make a big difference if we could get the message of the facial, arm and speech test through to people. Having decided that they have probably had a stroke, they must be trained to call for help within a matter of hours. As has been said, it should be within three hours. This differentiation between a bleed and clot is then an essential first step in treatment. They are exact opposites. If you are treating for one and the person has the other, that person is as good as dead. You need to know, and the whole purpose of the scan is to know what you are treating. When Kevin had his stroke, he made a fairly good recovery, although he was much worse for 48 hours after the stroke. He recovered as much due to willpower and good care in the specialist part of the Chelsea and Westminster Hospital. He was looked after very well, but willpower is an important element in recovery from stroke. I well remember when the Duke of Norfolk—Miles—had a bad stroke here, and just by sheer willpower recovered his speech. He lived a good many more years—I think another seven or so. A major element is the patient’s own wish to recover. Another major element is how well they are cared for in terms of rehabilitation and whether their local authority looks after them well, giving them the aids and the confidence they need at home. According to Professor Boyle, people will spend less time in hospital and go home more quickly. When they go home, it is even more essential to see that the support is available to help them make a full recovery. The services in the specialist units are great. At the time Kevin had his stroke, thrombolysis was not practised at all in the Chelsea and Westminster. I do not know whether it is yet. At the meetings of the Stroke All-Party Group, I have heard from a number of professors, including one in particular from Newcastle where thrombolysis is used successfully. It is used in Australia and the United States. Clearly there is a change taking place in the treatment of strokes due to a thrombotic effect, and this must be good. Again, it comes back to that essential factor, that above all we must know what we are treating and the patient must be aware of the need for treatment.