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The hon. Member for South Cambridgeshire mentioned problems accessing scans—sometimes, people may be unlucky if they have their stroke at the weekend. The provision of stroke services is very much a lottery. In some parts of the country, systems are in place, everything works well and the process is smooth, so people in those areas will have a good outcome. In
other parts of the country, the process is not so joined-up, and that is where joined-up working is really needed.
I want to talk about aftercare. A third of acute stroke patients are left dependent or moderately disabled and our aim must be to reduce that figure, and taking some of the steps outlined earlier in the debate would make that possible. During their hospital stay, patients have access to help and care, but when they go home, they must suddenly readjust their lives. Figures for south London show that three to 12 months after discharge, only 26 per cent. of patients in need received physical and occupational therapy, and 14 per cent. received speech and language therapy. If an individual cannot do the things that they are used to doing, or cannot communicate properly, it is very frustrating for them. That leads to problems with depression, and to problems for other people in the house who have to adapt to the condition, too. We have a network of local stroke clubs that do excellent work in helping people to feel that they are, in many ways, once more part of society, and I pay tribute to them.
Mr. John Horam (Orpington) (Con): I entirely agree with the hon. Lady about stroke clubs. She mentioned south London, which includes Bromley, an area that I represent, where there is a shortage of space for stroke clubs. It would be helpful if the Secretary of State put pressure on primary care trusts to give more space to those very simple groups, which do a huge amount of good.
Sandra Gidley: I appreciate the hon. Gentlemen’s problem. Some of our local clubs are well funded by the people involved, but I appreciate that in other areas of the country that arrangement is not feasible or practical. Anything that helps the rehabilitation process should be considered. Often, there are rooms available that are not being used, and they could be used for such purposes. I ask that attention be given to aftercare. Perhaps we could use more therapists; we should consider carefully whether more of them will be needed for the future. The Select Committee on Health recently produced a report on work force planning, which highlighted the fact that there does not seem to be much in the way of such planning. The recent example of the training, and lack of recruitment and use, of physiotherapists highlights the problem. We also need to assess how much occupational and speech therapy we will need in future. We must ensure that people have access to those services, so that they can live a full, proper and useful life.
2.47 pm
Dr. Ian Gibson (Norwich, North) (Lab): May I welcome the Front-Bench team to the debate? It is nice to see them. I have not spoken with, or against, the Secretary of State for Health since the debate on top-up fees; I had fond memories while I listened to this debate.
An exhibition is on at the Wellcome Trust’s science foundation on Euston road. It is about all parts of the vascular system—the heart, veins, arteries and so on—and it takes us right from the day when William Harvey first showed that blood coursed around the body through arteries and veins. We have to remember
that there was a time when people did not understand that; we have come such a long way since.
I suffered a mini-stroke some three years ago, a month after I played Kenny Dalglish off the football field as part of the parliamentary team; I remember that well. It showed that strokes can happen to people who are fit and lively and that people do not see them coming. I did a lot of things that I should not have done; I say that now that I know first-hand what a stroke can look and feel like. After a hectic, busy week, in which I remember voting in the House on fox hunting—for the 20th time or something like that—I dashed off to Tel Aviv. I travelled overnight and had no sleep, and then I found myself out in Gaza with my right hon. Friend the Member for Southampton, Itchen (Mr. Denham), who is now Secretary of State for Innovation, Universities and Skills. We were shown around, and at night we dined and sang a few Irish songs; it was quite a jolly occasion. I went to bed wobbling a little, but I knew that that was not down to drunkenness. I absolutely knew what the problem was, but I thought, as all men do, “I’ll sleep it off, and then I’ll be okay again.” The next morning, I had a little problem shaving and so on. I phoned up my right hon. Friend, and then the fun really started.
I remember that we were in Ramallah at the time and were heading out to visit the Gaza strip. There was a bit of a hoo-ha—a fight—about which ambulance I should travel in. I instinctively wanted to be in a Palestinian hospital and ambulance, for various political reasons. We went through several checkpoints with guns pointed at us, and I was taken out of the Palestinian ambulance and stuck into an Israeli one. I have never seen anything like it—when we went into the Palestinian hospital at gunpoint with Israeli soldiers, the whole accident and emergency department emptied immediately.
The treatment was amazing, with an immediate scan, although we had probably taken about four hours to get from the hotel, through the checkpoints and so on. It was marvellous to meet UK surgeons who had given up their holidays to work with young people with heart problems who came in from the Gaza strip. The House can imagine the difficulties that that causes. We are fighting hard to get a heart unit in that Palestinian hospital, because those surgeons still go out there.
I take the opportunity of this gentle debate to say something about the subsequent treatment and what happened at the Norfolk and Norwich university hospital, which does not always win plaudits. It was one of the first PFI hospitals and it takes a lot of knocks, but the service is amazing, particularly in the stroke unit. I speak to the consultants quite often. I was lucky, given the delays in my treatment.
Norfolk and Norwich university hospital’s excellent 36-bed stroke unit was set up in 2002. It services about half a million people in the Broadland district, Norwich and south Norfolk. Before it opened, patients were scattered in various surgical wards. In the short time it has been open, the unit has brought them all together and it offers language therapists, physiotherapists and specialist nurses.
The unit has a great record for treating TIAs—mini-strokes. Major strokes after TIAs are quite likely in a small percentage of cases. They are medical emergencies and should be treated as such, just like an acute coronary
syndrome of some sort. Immediate, co-ordinated care, is essential on those specialist wards, and I am pleased that we have such a unit in Norwich. It is ambitious, and I shall speak about its plans.
Access to the unit and assessment is an interesting point. I welcome the Secretary of State’s recommendations in “A new ambition for stroke”. We have some fantastic services in the UK, and that will add to them, and to the one in Norwich, in particular. It is time to build on our successes. Stroke must be treated fast. Time is of the essence, and the document highlights the fact that the fastest access to treatment will lead to the greatest success.
Like most hospitals, Norfolk and Norwich university hospital admits stroke patients via their GP or accident and emergency, so patients may be assessed several times before they see a stroke specialist. An experiment is being conducted at Edinburgh university, where the specialist stroke nurse carries a portable phone and exchanges information with those in the ambulance. Attempts are being made to staff ambulances with people who understand strokes and can diagnose and even treat them immediately by administering drugs. The nurse at the hospital can be ready for the specialist process of stroke triage and can administer the first line of defence—clot-busting drugs—and arrange for CT scans before the patient arrives. About 30 patients have been through the procedure, which is highly successful. The experiment, which involves no great expense, is just a better way of doing things.
Other research programmes are under way at the hospital. At present it is thought that stroke treatment must be administered within three hours. An international stroke trial is investigating whether that period can be extended.
I am very involved in stem cell research, and I declare an interest as a member of the UK Stem Cell Foundation, which Sir Richard Sykes chairs. Another member is Sir Richard Branson. If one knows the right people who are interested in this area, it is possible to collect £90 million overnight, from great champagne merchants and so on. We are trying to induce the Medical Research Council to talk to us about conducting joint experimentation and joint assessment of treatments. I think that that will eventually work out, after a few initial problems.
Stem cells seem to migrate to the damaged part of the brain, which is interesting because it might repair some of the cells. There is great hope that stem cells might be one way forward. That is why I am so pleased that the House has passed legislation, which has proved difficult in other countries.
Work is also being done on atrial fibrillation irregularity—the abnormal heart rhythm that the previous Prime Minister, for example, had. That can often increase the risk of stroke. Much exciting work is going on in the UK. We are examining the effects of increases and decreases in blood pressure. Amazing rehabilitation work has been done. I missed only one day of work after my mini-stroke, but I went to the rehab unit to see how it worked. Amazing treatments are available, both in hospital and in the community, depending on the patient’s requirements.
Some of the drugs that have been invented, many of them in the UK, are essential to help people get through the difficult periods. Warfarin, for example, and statins are often used. I bet that at least 80 per cent. of the Members of the other place are on statins and do not talk about it. I know quite a few people who are, and there is nothing wrong with that. Whether statins need to be made so widely available is a matter for debate, but they are handed out to try to prevent heart or blood problems of some sort.
Yesterday afternoon the unit at Norfolk and Norwich hospital presented to the PCT new plans for better services in ambulances and for educating people. Many people still do not know the difference between a stroke and a heart attack. There is a great deal of confusion about that.
I have mentioned the multidisciplinary nature of the unit’s work. The people involved are passionate about their work. The unit works with a unit for older people, and the combination of services, which is a small initiative, seems to help to produce results. The system will be a roaring success with such dedicated, highly trained people working in those units. Much good work is being done but much more, as we have heard, is still to be done. With the services of the scientists and medics in this country, we are just about world class. When we have the debate next year, I think the Opposition will have to admit it.
2.58 pm
Mr. Hugo Swire (East Devon) (Con): I join in the universal gratitude in the House at seeing my hon. Friend the Member for Isle of Wight (Mr. Turner), who has just absented himself. He is the living evidence that with the right medical care and the right mental attitude, one can recover pretty quickly from a stroke. It is great to see him back.
The word “stroke” is perhaps the wrong word to describe a terrible affliction. It afflicts people in different ways, and some doctors now refer to it instead as a brain attack, which better conveys the severity of it. It is a cruel and tragic affliction, and I very much welcome what we have heard about the change in the perception of sufferers. Most European countries rightly regard strokes first and foremost as a neurological condition rather than as an older people’s condition, but we still have a considerable way to go in trying to raise awareness. Three times more women die of strokes than of breast cancer each year. When one thinks about the excellent publicity generated about the appalling disease of breast cancer, it is clear that strokes have not had the same attention to date.
I want to make a couple of points about the need for speedy medical treatment and the importance of suitable rehabilitation facilities. I am extremely glad that the Minister, the hon. Member for Exeter (Mr. Bradshaw), who is now also Minister for the South West, is in his place, because he will no doubt wish to support me in what I say about many of our local facilities, some of which are in his constituency rather than in mine.
My first point concerns the need to get patients and stroke victims to a place where they can be assessed and treated as quickly as possible. I alluded earlier—the Minister was not here at the time—to the incredibly
important work of the Devon air ambulance service, which can get people from any part of the county into a hospital within about 15 minutes. It would be most welcome if Ministers at least acknowledged the work of air ambulances, which are funded entirely by voluntary contributions, and perhaps looked at how they can be supported in the longer term. Air ambulances are enormously expensive to run and maintain. Other charities in the county will say that it is more difficult for them to raise money because Devon air ambulance requires so much, but if one lives on Dartmoor or Exmoor or in the other more rural areas of our part of the world, one is very glad to know that it exists.
There is a difference in the statistics on the treatment of stroke victims in the county. Torbay and Newton Abbot hospitals in south Devon have won awards for their stroke treatment. It is interesting to note that on average they CT scan 60 per cent. of their stroke victims within 24 hours. Royal Devon and Exeter hospital, which is in the Minister’s constituency, scans only 30 per cent. of its patients within the first 24 hours, although it is in the upper quartile for stroke care. That postcode lottery is simply not acceptable. We need some assurances that the Minister will look closely at seeing how that disparity can be erased as quickly as possible.
Secondly, I want to talk about the shortage of acute stroke units. In my own constituency of East Devon, there is no acute stroke unit, just an eight-bed rehab unit in Budleigh Salterton. There was talk of having another one in Honiton, but that might not now happen, despite the fact that the county has a higher prevalence of strokes, at 2.8 per cent., than the national average of 1.57 per cent. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) said that only 22 per cent. of hospitals have early support discharge teams. We need to consider that carefully in terms of Devon’s provision. Does the Minister agree that an average wait of between five and 24 hours for a CT scan, rising to 25 to 48 hours at weekends, is unacceptable, given that CT scans offer the best chance of a successful rehabilitation?
Rehab is incredibly important. I should like to cite the example of a constituent who has come up against the postcode lottery of the current system. Adam Giles-Wilson has been in contact with me since as far back as April, and I have been trying to help him to sort out his problems. I cannot put it better than the words of his original letter to me:
“I had a ‘massive’ brain haemorrhage...at 31 in Sept 04, I underwent a 10 hour operation followed by another 10 hour operation in March 05. I was transferred to Taunton (from Frenchay) learnt how to walk, talk, etc. I was discharged & admitted as an outpatient to my local trust whom I’ve had to fight with to get any support, I had to fight to get a speech & Language therapist to treat me to teach me how to swallow properly as I was still having difficulties, I was told I was a low priority as I was under 65. I received Physiotherapy by someone not that experienced & unfortunately the treatment I needed was complex so we together saw an ‘expert’ once every 6-8 weeks”—
that is Heather Bright, the clinical specialist in neurological physiotherapy. He continues:
“All throughout my treatment I was paying for private treatment to get me better as quickly as possible & therefore getting me off of the NHS list too. My local trust has just reassessed me again following some specialist treatment by the
world expert Mary Lynch-Ellerington. Heather wrote to Mary asking for her opinion which concluded with Mary saying that I could get better & possibly back to ‘normal’, I realise there are no guarantees but I’m too young to give up & I don't believe the trust should either. I have asked for alternative help i.e. a referral to another nearby trust that could possibly help or funding so I can do whatever & however much I feel I can do.”
He goes on to say that he raised £11,000 for the NHS by running the marathon a year after he learned to walk. That is just one example; I am sure that other hon. Members can give similar ones. I am still trying to argue with the new primary care trust that he should receive the treatment that he needs.
What we have heard from Ministers is welcome. I am glad that we are taking strokes and the issues surrounding them seriously and giving them the publicity that they deserve. However, we should not congratulate ourselves too much. I said that the problem is not necessarily age related, and the case that I cited is living proof of that. However, I represent a constituency with a large elderly population, and it is important that they get the same treatment—the same access to scans and, vitally, the same aftercare—as people in other parts of the country. There was much talk at one point about using some of our community hospitals. I am fortunate to have community hospitals in Budleigh Salterton, Sidmouth, Seaton and Axminster, all of which have dedicated staff and good facilities. Perhaps it is to them that we should be looking for this kind of post-care treatment. I am not talking about people going in one or two times a week—there is often 24-hour care, certainly in the early days. The more quickly people come to terms with their disability, however temporary, caused by a stroke, the more quickly they learn how to live with it, combat it and overcome it, and the more quickly they recover and the fewer strains will ultimately be placed on the NHS and local services.
I am glad that this subject is being debated in the spirit of consensus. There is not much politics in it; it is too serious for that. I hope that the Under-Secretary will have a word with the Minister. As I said, he is now also Minister for the South West and will no doubt wish to ensure in that new capacity that we in my part of Devon are treated the same as those in Torbay and south Devon, so that we can reach the extremely good figures that are being achieved there.
3.9 pm
Mr. Lee Scott (Ilford, North) (Con): I have relatives and friends who have suffered strokes, so I am aware how debilitating strokes can be, in both the short and the long term. I should like to pay tribute to the two local hospitals serving my constituency, King George hospital and Whipps Cross hospital: may they long continue to offer services to my constituents.
Every year, more than 110,000 people in England will suffer a stroke, while more than 750,000 live with disabilities caused by strokes. After heart disease and cancer, strokes are the third biggest cause of death in Britain and the largest single cause of severe disability. Almost one third of patients die in the first month after a stroke, with about one in 20 surviving stroke patients needing long-term residential care. As we have heard, three times more women die of strokes than of breast cancer. The NHS pays out more than £2.8 billion
treating strokes. Overall, they cost the wider economy about £4.2 billion in lost productivity, disability and informal care. I fully recognise what has already been achieved, but we need to ensure that the public are fully aware of the dangers of strokes and of the crucial need to call 999 immediately if someone is suspected of having a stroke.
The Healthcare Commission has stated that
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