Health: Stroke Victims

My Lords, I am sure that we are all grateful to the noble Lord, Lord Rodgers, for what I thought was a pretty forensic analysis of my department’s approach to strokes. I assure noble Lords that, after an extremely good debate, I will ensure that the very substantive comments that have been made will be reflected by officials in writing the strategy. I do not need to repeat the statistics. It is very clear that stroke has to be a major priority for the National Health Service. As we heard from the noble Baronesses, Lady Masham, Lady Gardner and Lady Rendell, who spoke so eloquently of their personal experiences, there is no question but that we need to do much better in future. I also fully accept that the message of public education is vitally important. I echo their congratulations to the Stroke Association. It is clear that the public need much more information. The point made by the noble Earl, Lord Howe, about blood pressure tests was very important. Equally noble Lords have shown really wonderful examples of the power of recovery, where the will is there. We need to ensure that we do everything to enable stroke patients to recover in the most effective rehabilitative approach as possible. I confirm that the strategy that we want to take forward will focus as much on rehabilitation as it does on the hub-and-spoke approach and all the other things that need to happen in dealing with stroke as an acute care incident. I thank the noble Earl, Lord Howe, for his acknowledgement of the improvements that have taken place. There have been improvements: the older people’s national service framework, starting in 2001, devoted a considerable amount of that NSF to stroke; it set out a range of measures and there is little doubt that it has had a major impact. It resulted in nearly every general hospital which caters for people with strokes having a dedicated stroke unit. A recent audit by the Royal College of Physicians shows that the quality of stroke units is improving and as a result of that and of other measures that have been taken, the rate of stroke mortality is falling. For people under 65, the three-year average death rate from stroke has fallen by 23 per cent from 1993-95 to 2002-04; for people aged 65 to 75 the death rate has dropped by30 per cent over the same period. There is clearly no room for complacency. We have to do more. This is where the various reports that noble Lords have quoted come into their own. We need to reflect first of all on the importance of the NAO report published in 2005 which gave a very helpful series of measures that needed to be taken. That was followed by the ASSET report produced by the department, designed to inform commissioners of the kinds of services they ought to commission. I will come back to the question raised by the noble Baroness, Lady Barker, and the noble Earl, Lord Howe, about how we ensure that the service does what we want it to do. Having a commissioning model and effective commissioning will be crucial to making sure that we see a consistency of approach throughout the country. Different messages need to be got out there. It is just as important that commissioners understand what they ought to be commissioning. Professor Boyle’s report was aimed at informing clinicians of the kind of developments in service that we want to see. The noble Lord, Lord Rodgers, asked me about the role of national clinical directors, or tsars, as we sometimes call them. I had a particular role to play when I was last in the department; I recruited the first director Mike Richards to be the cancer tsar. I remember going to see him in his office in St Thomas’s. We measured each other out and, as they say, the rest is history. I pay tribute to the tsars as a whole and to Professor Boyle in particular for the work they do. In answer to the noble Lord, they have three important remits: one is to work with stakeholders and improve the delivery of care in the service; secondly, to provide expert in-house advice to ensure developing policy takes full account of clinical issues; and thirdly, helping to spearhead change by engaging with health and social care professionals and providing visible leadership. That is their formal remit. In my experience as a Minister, they have been invaluable in having people with professional recognition because they have all provided excellent services themselves in the health service. They come in to the department, advise Ministers and officials, work with the profession themselves and have added value to the improvement of services that they want to see. They are public servants and are employed by contract so, in the unlikely event of a change of Government, any future Government would honour those contracts. They work within the parameters of the departments but, from the statements they have made from time to time, they also exercise a degree of independence. I say to the noble Lord that my experience has been that seeing them walk the corridors, knowing that this expertise is on hand, has enhanced the ability of the department to get a grip on some of these very pressing issues. The noble Lord read out some of the portraits given in the report Mending Hearts and Brains, but I thought that the noble Baroness, Lady Gardner, was right: there is a need to communicate. Yes, clinicians are very clever people and no doubt can read learned disquisitions on these matters, but, given the number of clinicians, there is also a clear case for communicating these things in an easy way, to get over to them the message that we want to give so that they fully understand the need for change. It is very important that, in getting stroke recognised as a major priority, we have clinical engagement not just from the stroke specialist, but from all clinicians who have a part to play in the provision of services and the development of policies. As the noble Baroness, Lady Barker, suggested, the key message is that we have to ensure thatthe symptoms of a stroke are recognised and that the individual is got into A&E services fast. I accept what the noble Earl, Lord Howe, said. We need stroke specialists on hand 24 hours a day, seven days a week; a nine to five, Monday to Friday service will not do. That applies as much to those people who provide diagnostic tests as it does to consultant staff. We know that we cannot deliver that in every hospital in the country. The noble Baroness, Lady Masham, suggested that there was a compromise here. I guess that, in essence, that is what hub and spoke is all about. The idea is to move to a network model in which commissioners work together to make sure that a patient is given access to the appropriate level of care and that, where highly specialist services are needed, they are provided. Also, once people are in recovery, they must be able to return to their local hospital for rehabilitation in a stroke unit. I very much accept the point raised by the noble Baroness, Lady Barker, about the importance of liaising with care homes where rehabilitation is needed for people who are resident in those establishments. My noble friend Lady Rendell asked where we are with the national strategy. It is being prepared; what I might call informal consultation is taking place with stakeholders. We hope to publish it in the near future, after which there will be more formal consultation. The aim is to reach conclusions in the autumn. I understand the frustration of noble Lords who wish the strategy to be published, as they want to see the costs and resources. However, I think it important that we prepare the ground carefully. That is what the commissioning document was about and that is why Professor Boyle published his document, which was aimed at engaging clinicians. We see the strategy as the final and in many ways most important part of taking forward our work, ensuring that priority is given to stroke services and that we can count on the NHS to deliver the service as effectively and consistently as possible. I understand the issue of implementation. I take the important point made by the noble Earl, Lord Howe, about the tariff and I will ensure that it is considered by the officials responsible. The role of the strategic health authorities will be very important in monitoring what is happening. We want commissioners for primary care trusts and GPs to take to heart the messages of the strategy. The role of the Government remains to ensure that that comes together in a coherent whole. I was asked about the actual costs. I am not in a position to anticipate the work that is in the strategy, but the noble Baroness, Lady Barker, was right to identify the fact that the NAO report said that, essentially, we can make more use of our current resources by a better reorganisation of services. That was a point well made. The noble Lord, Lord Rodgers, expressed doubt about the hub and spoke model, but there seems to be a strong clinical consensus that it is the way to go. I do not see a conflict between that model and the role of hospitals that currently have specialist stroke services. They will continue to offer specialist stroke services as now. The strategy and Professor Boyle’s report are about some of those hospitals having to offer a highly specialist service for those who have had a recent onset of stroke. We see the two concepts running together. That is really what the hub and spoke model is about. There will continue to be a valuable role for the specialist stroke services currently available in our hospitals. I accept that we have to avoid confusion or conflict. I have used up my time. A great deal of progress has been made on PACS. I am happy to write to the noble Baroness, Lady Barker, about that. There were reports in today’s newspaper about vaccines reducing blood pressure. We will have to see how it goes in trials, then NICE will be able to assess it, or the approach by which we assess vaccines will be followed. I am not aware of evidence on the effect of mangos, but fruit and vegetables are a very important part of a preventive approach alongside exercise and the other things that noble Lords have mentioned. Obviously we are looking at scanners as a possibility. I thank all noble Lords for their contributions. This has been a good debate and I will ensure that officials read Hansard because some very good points have been raised. I assure the noble Lord, Lord Rodgers, that national clinical directors have a valuable role. His report was directly aimed at frontline clinicians. It is part of a coherent whole that includes the NAO report, the commission report, Professor Boyle’s report and now the strategy. We are determined to build on the improvements that we have seen so that stroke is seen as a priority. We are committed to making that happen.