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7.40 pm

Mr. Peter Viggers (Gosport): I would not be content for the House to rise for the Christmas recess without my taking the opportunity to raise again, very briefly, the future of the well known Royal Hospital Haslar. It is a local hospital in my constituency, but it is much more: it is the only military hospital in the United Kingdom. It is well known because I have raised this issue many times.

When defence medical services were in some difficulty, in 1998, a study group set up by the present Government reached the amazing conclusion that the way ahead for defence medical services was to close the only military hospital. The result, of course, has been catastrophic. The decision has turned the situation into a crisis and in four key faculties—anaesthetics, surgery, orthopaedic surgery and general medicine—defence medical services are now some 75 per cent. short of establishment. That is a grievous situation, both for defence medical services, because I believe that the armed forces are now restricted in their ability to deploy because of lack of defence medical services, and for the local community, which has lost its accident and emergency unit.

However, it is not all bad news, because we have had a vigorous campaign, widely supported in the area and by those in the armed forces. The good news is that we now have an accident treatment centre, which does not exactly replace the accident and emergency unit but is a helpful local facility. Moreover, reality has broken in: the Portsmouth Hospitals NHS trust and the health authority both now recognise that Haslar is a crucial and necessary part of the local health scene, and the latest strategic document produced by the national health service, jointly with the Ministry of Defence, called "A Strategic Vision", says that Haslar should continue until at least 2007, and that it should continue to provide a range of services to the armed forces and the civilian population.

My right hon. Friend the Member for South-West Surrey (Virginia Bottomley) expressed surprise that the police force in Surrey was now using private medical facilities. She and others might be surprised to hear that the armed forces, which have their own military hospital at Haslar, are now required to use civilian medical

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facilities as well, and a number of individuals have been treated by BUPA and other private medical systems. The problem is that although the immediate operation can be arranged through a private medical facility, if there are any complications, or if aftercare is required, the service man or woman must return to the service hospital at Haslar. In several cases, operations have been carried out in the private sector and the subsequent problems and complications have been handled in the public sector, back in the military hospital.

However, the situation is moving on. We are satisfied with "A Strategic Vision", and if only the words "until at least 2007" could be deleted and the word "indefinitely" substituted we would, I believe, be there.

First, a study group, composed of members of the Royal College of Physicians and others, is leaning towards the view that there needs to be more use of local hospitals. It believes that there is more scope for district diagnostic centres. There is a growing feeling in the medical profession that it is wrong to send all accident and emergency patients first to a district general hospital, from which it is quite often difficult to discharge them, and that it would be a better idea to admit patients first to a local hospital, after which, following proper stabilisation and diagnosis, they might be transferred to the district general hospital if necessary. If that study, which is due to be published before the end of the year, does indeed reveal that local district diagnostic centres should be used more extensively, attention will be drawn to the fact that precisely such facilities can be offered at Haslar, and throughout the rest of the country.

Secondly, there is growing awareness in the royal colleges that it is possible to have joint-centre working—that it is a good idea for trainee doctors at all levels to work partly within a district general hospital and partly within the local hospital community, linked with telemedicine, and that that provides a good range of experience for trainee doctors. Such joint-centre working would allow the Royal Hospital Haslar to work in conjunction with the Queen Alexandra hospital in Cosham.

Thirdly, I have written to the Secretary of State for Defence and the Secretary of State for Health and urged them to get their act together and have genuinely joined-up government. It is no good for the Ministry of Defence to announce the closure of Haslar without the Department of Health's taking a firm view on the future configuration of hospital services in the area. We now want a plan, jointly worked out by the Ministry of Defence and the Department of Health. We want that joint plan to give a future to the whole of the Haslar land area and the Haslar hospital within it, and to additional facilities that could be located in the Haslar complex.

That is the right way ahead. I firmly believe that we are winning. We are working to a plan that, in due course, will prove to be a better way ahead than the Centre for Defence Medicine, which has been located in Birmingham, and is causing some disappointment among those who work there. I believe that we are working our way forward and that the future will be good for Haslar and for the local community.

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7.46 pm

Mr. Graham Allen (Nottingham, North): I want to speak about the Government's treatment of strokes, but first I welcome the Parliamentary Secretary, Privy Council Office, to the Front Bench and take the opportunity to place on the record my thanks to him and his team for what they have done in connection with the modernisation of the House. It is one of the most important things that the Government have done in the past year or so—although I would ask my hon. Friend, despite the self-discipline of hon. Members tonight, to consider a mandatory speech limit, to enable Members to plan with some certainty. Unfortunately, the other evening seven Labour Members fell off the end of the Speaker's list in the European debate. It is perfectly within our compass in the House to impose such a limit, to help hon. Members on both sides of the House.

The Government's treatment of strokes is obviously an extremely important issue, and I have several questions that I hope that my hon. Friend will put to the Secretary of State for Health on my behalf as a result of the debate. Every year, 100,000 people suffer their first stroke. It is the third biggest killer in the United Kingdom and the single largest cause of severe disability.

Stroke is a devastating condition, and most hon. Members will know a family member or friend who has experienced it. The effects of a stroke can vary enormously, and depend on which part of the brain is damaged and the extent of the damage. It is the commonest cause of neurological disability, the commonest cause of epilepsy in older people, the second most common cause of dementia and, not surprisingly, the commonest cause of depression. Those affected by strokes, whether patients, their families or their carers, know what it is like to experience the life-changing effects that strokes bring.

Expenditure on strokes is already considerable. The costs in national health service and social services expenditure in 1995–96 were calculated to be £2.3 billion. The incidence of strokes is projected to rise considerably as a result of demographic change. It therefore makes sense to ensure that resources are used in the most effective way to ensure the best possible outcomes for families and their carers. There could be huge savings to the health service, social care budgets and the national economy.

My first question to my hon. Friend would be: will he ensure that the Department of Health conducts a thorough review of the way in which funding for strokes is allocated and accounted for? Let us not allow this great wagon of public spending to roll on without conducting a proper review and adjusting to circumstances as they change.

The Government are to be congratulated on recognising the need for improvement in the care offered to stroke patients. Standards for stroke care were included in the national service framework for older people, which covers England and was published in March this year. It is commendable that by April 2004, all people who are thought to have had a stroke, regardless of their age, can expect to be treated appropriately by a specialist stroke service.

Of the 100,000 people who suffer new strokes each year, 10,000 will be under the age of 55. Although in the past, many older patients have been denied specialist

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treatment because of their age, the same has been true of younger stroke patients. Their needs have often gone unmet because many have been unable to access stroke services, which are often designed for older patients. Much has still to be achieved to ensure that all those who have strokes receive the rehabilitation essential to give them the best chance of independent living by the Government's target date of April 2004. Will my hon. Friend the Parliamentary Secretary ask the Secretary of State for Health to let me know what progress has been made to date to meet the milestones laid out in the national service framework for older people?

The Stroke Association has recently undertaken a survey of NHS trusts to establish the current position. It also asked about plans to set up stroke units in general hospitals that treat stroke patients, but which currently have no such provision. Of those acute trusts in England reporting no stroke unit in one or more of their general hospitals, just over half have plans in place to develop a unit by 2004. Even hospitals with a stroke unit do not always have the capacity to treat all their stroke patients. Will my hon. Friend ask the Secretary of State to let me know what assessment his Department has made of the current provision of stroke units?

The national service framework sets out service models for managing stroke patients in hospital. The specialist stroke team, led by a clinician with expertise in strokes, brings together nurses, therapists, clinical psychologists and other staff able to respond to individual needs. Members of those multi-disciplinary teams will have experience and knowledge of caring for stroke patients. It is vital for patients to have access to knowledgeable staff who can provide expert care and advice.

Clinical psychology is another area of unmet need, and the numbers of trained staff are insufficient to ensure that all those who need this service receive it. Recovery from stroke can continue for many years, which is recognised in the national service framework. It is therefore essential that those who have had a stroke have continuing access to rehabilitation services in the community. Will my hon. Friend therefore ask the Secretary of State to indicate what action is planned to train adequate numbers of therapy staff in each of the required specialties?

The national service framework for older people commits the Government to take action to prevent strokes. Action to reduce the risk of a person having a stroke in the first instance is urgently needed. It is a startling reality that the health gap that exists in our society results in some minority ethnic and social groups experiencing a much higher risk of stroke. I could give the details, but I shall simply ask my hon. Friend to let me know how the Government will tackle the differentials between social classes and ethnic backgrounds.

Blood pressure is another factor, as is smoking, yet although those factors are taken into account with heart disease and cancer, with strokes they are often not taken into account. Will my hon. Friend therefore discover whether the Secretary of State has a national campaign to make people aware that they are at risk if they smoke or have high blood pressure?

My final concern is that stroke research is very much underfunded; it lags way behind the amount spent on cancer and heart disease research. The Stroke Association funds what research it can, and committed about £2 million in the past financial year, but that sum is only

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5 per cent. of what is available from the largest heart disease charity, and less than 2 per cent. of what is available from the two largest cancer charities. Recent research has confirmed the need for research into areas such as physical therapy for those affected by stroke. My final question is: will my hon. Friend ask the Secretary of State to list the stroke research currently undertaken by the Department of Health, and to re-examine the priority given to stroke research in recognition of the projected rising trend in the incidence of stroke?

My hon. Friend will be glad to hear that I do not expect him to answer all those questions this evening, but his general comments—and an undertaking that the Secretary of State for Health will drop me a line—will be well received not only by myself, but by the millions of our fellow citizens in the United Kingdom whose lives are often unnecessarily blighted by strokes.

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