Stroke Sufferers

First, I congratulate my hon. Friend the Member for Nottingham, North (Mr. Allen) on securing the debate on this important subject. Secondly, I apologise that the Under-Secretary of State for Health, my hon. Friend the Member for Brentford and Isleworth (Ann Keen), who leads on stroke policy, could not be with us this morning due to two long-standing ministerial engagements. I calculate that to answer 14 questions in nine minutes I will have to spend only about 35 seconds on each of them, so I shall throw aside the usual niceties of going through the history of the issue, as other hon. Members have done that. I shall not go into why we have a new stroke strategy or the importance of stroke, because those issues have been discussed so eloquently, not least by the hon. Member for Isle of Wight (Mr. Turner) in his moving and effective testimony. I shall move straight to answering the questions that have been asked. On awareness, my hon. Friend the Member for Nottingham, North will know that a major awareness campaign is planned for the spring. It will include the face, arms, speech approach that he advocates, as well as stressing the importance of dialling 999. It will be along the lines of the successful British Heart Foundation campaign that many people will remember from the past year or so, which used posters and advertising of great impact on our streets and buses. On prevention, my hon. Friend will be aware that we have asked primary care trusts to begin rolling out, from April 2009, vascular checks for the whole population aged between 40 and 74. As for when he can expect his check, in his local area, we expect the full system to be up and running by 2012-13. He has said that his area already has good practice and a good model, so he might get his check a little earlier. It is not only people's risk of heart disease, stroke and kidney problems that will be assessed. The system will also work on the preventive messages on lifestyle and public health that he has rightly identified as being important. Those issues are the same as those for heart disease, and include smoking, obesity and physical exercise. Where necessary, people will be recommended courses on weight management and even cookery, assistance with smoking cessation, exercise classes and walking clubs. My hon. Friend is right to say that prevention is very important. My hon. Friend is also right to stress the importance of rapid response, including the use of thrombolysis. That is recognised in the strategy, which is clear about the importance of acting quickly in the event of a stroke. It recommends the immediate referral for assessment of all patients with recent transient ischaemic attack—I, too, hate the acronym—or minor stroke. Those with a higher risk of subsequent major stroke will be assessed within 24 hours. For those with major stroke, the strategy suggests immediate transfer to a centre that provides hyper-acute services. On clot-busting drugs, my hon. Friend asked where we were on the roll-out of thrombolysis. The National Sentinel stroke audit of 2008 states that thrombolysis services are increasing rapidly, albeit from a low base. We should, as he said, be aiming for at least 10 per cent. of stroke admissions being thrombolysed. Services are being reorganised to achieve that, and we are funding specialist stroke training, but it is important that thrombolysis is given in a safe and appropriate setting. On scanning, I am informed that all hospitals now provide CT scanning, and that the great majority also offer MRI and carotid doppler scanning. However, access to imaging continues to present a major barrier to delivering high-quality care to all stroke patients, and the new strategy aims to address that problem. The ambulance review has been completed. Of the 70 recommendations that have been made, some have been introduced and the rest will be completed by 2010. I understand that recategorisation as category A has been recommended, and provisions to ensure that that is implemented are being put in place. On rehabilitation immediately after stroke, my hon. Friend has mentioned that operating across the seven-day week can limit disability and improve recovery. The strategy recommends that specialist rehabilitation should continue across the transition to home, or care home, to ensure that health, social care and voluntary services are joined up to provide the long-term care that people need. We have, as he has acknowledged, provided local authorities with £45 million—£15 million a year for three years—to develop improved models for delivering that joined-up care. As for whether information will be made public and how it will be monitored, we expect the evaluation of the strategy's implementation to provide details on spending and information on its effect. My hon. Friend asked whether the NICE-recommended target of 45 minutes of rehabilitation a day would be met and, if so, when. The strategy is a 10-year strategy, and we cannot comment on when any particular measure will be successfully implemented, but we expect all service providers to be making progress now. We intend to begin the evaluation of the strategy's implementation soon, and that will give us detailed information about what is happening locally. My hon. Friend stressed the importance of communication and helping people with speech. The strategy lists communication as a component of the joined-up rehabilitation approach, and will rely on a multidisciplinary approach being taken locally to ensure that patients receive the right support both in hospital and when they are discharged into the community. He rightly points to the recent problems that he has highlighted in a letter to my hon. Friend the Under-Secretary of State about speech therapy services in his local area. I am pleased to say that the PCT is now addressing those problems. My hon. Friend is absolutely right that the work force in both health and social care is important to the strategy's delivery. We have allocated £16 million of central funding to enable the training of new stroke-specialist physicians, thus allowing services to expand their stroke work forces appropriately. We have also established a national training forum to develop a stroke educational framework, and we are supporting leadership programmes to improve skills and provide champions for stroke services at a local level. He asked particularly about the competency framework, which is under development. It includes looking for suitable institutions to provide accreditation. We hope to put the framework out for consultation in the spring, and there will be funding to support work force development, but exact details of spending levels cannot be agreed until the framework is in place. On whether we are closing the gap between the UK and comparable western European countries, there have not been any international comparisons since the 2005 NAO report. However, the strategy is seen as a model by others. Professor Roger Boyle has been invited to Australia to give a presentation on how the strategy has been drawn up and how it will be implemented. A year into its implementation, we are confident that good progress is being made. Hon. Members have mentioned the importance of the operating framework, and I should like to reassure them that the data that are included in the indicators will be published. The performance of PCTs and acute trusts will be measured against that publication. The inclusion of stroke in the vital signs means that PCTs will have to take performance seriously. They and acute providers know that they will be closely watched and judged on their performance. Furthermore, Lord Darzi's report, ““High Quality Care for All””, has offered welcome reinforcement of the key themes of the stroke strategy. The independent health watchdog, the Healthcare Commission provides indicators that will help to measure progress on the stroke strategy.