Stroke Sufferers

The only difficulty with the hon. Gentleman sitting immediately behind me is that clearly he is looking over my shoulder at what my next paragraph is about. He makes a very pertinent point, which runs on from the one about scans. We need to get people in the right place to have the scan. All local stroke networks should ensure that patients who could benefit from urgent care are transferred to an acute stroke centre that provides 24-hour access to scans and other specialist stroke care. In Nottingham, ambulance staff all use FAST—the face, arm, speech test—to identify emergency stroke patients. The Secretary of State said last year:"““We are consulting about upgrading strokes from category B to category A events so that ambulances arrive within nine, rather than 18 minutes.””—[Official Report, 11 July 2007; Vol. 462, c. 1484.]" For the Department to consult on a nine-minute difference shows how important the Secretary of State and the Department consider the matter. Will the Minister tell us whether that review—that consultation—on changing the category from B to A has been completed and what the outcome is? Those minutes really can be the difference between life and death for many hundreds of people. While I am talking about the way in which things are done in Nottingham, I will, if I am permitted, make a small boast. Nottingham university hospitals stroke services have been shortlisted for the forthcoming Health Service Journal awards in the ““improving access”” category for their work on TIA and hyper-acute services. There are four stroke units in Nottingham—one acute stroke unit and three rehabilitation units—and a system of virtual beds means that a bed is highly likely to be free for those patients who are FAST-positive. The stroke services are centralised in a 72-bed unit on the City hospital campus. There is direct access to the stroke unit through agreed protocols with the ambulance service. In other words, ambulance staff can drive by other medical facilities to go to the right place. That is not only permitted but encouraged. Thrombolysis—I keep getting my tongue twisted round that one—is available Monday to Friday from nine to five. That is excellent, but we need to be greedy. We need to say that it has to be available 24/7. Strokes happen at the most inconvenient time and they also happen at weekends. We have a daily one-stop clinic for high-risk minor strokes and acute care and rehabilitation were located in one unit in response to patient feedback. I now come to a number of points raised by colleagues. The third part of my argument is about the provision of after-stroke rehabilitation care, which my hon. Friend the Member for North-West Leicestershire mentioned. As I discovered in a debate on incontinence last year in Westminster Hall—I think that you may have been present, Mr. Williams—when it comes to NHS matters, treatments and state of the art technologies are not the problem. The problem is that in soft skills and empathetic aftercare, medical culture requires serious transformation. That is the hardest thing to do, but it is at least as important as the medication, surgery and all those other things that we are so good at. According to the Healthcare Commission, one year after leaving hospital, 80 per cent. of stroke patients think that they are not receiving adequate care. There is no magic wand and no one expects the Minister to pop up and suddenly deliver an answer to the problem. It needs lots of hard work, grinding organisation, staff training, supervision—all those things that are criticised under the general heading of bureaucracy. To make the health service work for an individual patient who has suffered something life changing, whether incontinence, a stroke or something else, we need the human interaction that, in many cases, makes life worth living. That must be examined and worked on over and over again. Seven of the 20 new national stroke strategy quality markers are directly linked to the support and community services needed by those who have suffered a stroke and their carers. They include high-quality rehabilitation, information, advice and the practical and peer support that colleagues have mentioned. Such support should be provided throughout the care pathway and in line with individual need. There is no one-size-fits-all solution. For my next question, will the Minister tell us how we secure effective discharge planning that is built around the needs of the individual?