Westminster Hall
Tuesday 18 November 2008
[Hywel Williams in the Chair]
Stroke Sufferers
Motion made, and Question proposed, That the sitting be now adjourned.—[Mark Tami.]
9.30 am
Mr. Graham Allen (Nottingham, North) (Lab): It is a great pleasure to serve under your chairmanship for the first time, Mr. Williams, in this important debate. A number of colleagues from both sides of the House are here this morning, some of whom have suffered strokes and some of whom have family members and close friends who have suffered strokes. I am sure that that applies to almost everyone in Westminster Hall this morning.
In my constituency last year, 72 people were killed by strokes. A stroke is a brain attack—the brain equivalent of a heart attack. It is caused by an interruption of the blood supply to the brain, and one in 10 of us will die as a result of a stroke. If we thought of a stroke as a heart attack needing the same emergency and specialist response, followed by sustained treatment, we could save thousands of lives and thousands of years of disability.
In my city, 700 people had a stroke last year. One third of strokes result in death, one third of sufferers recover and one third are left with a disability. Strokes are also the leading cause of severe adult disability. One in four long-term beds in the NHS are occupied by stroke patients. The disabilities resulting directly from strokes are more widespread than those resulting from any other cause, and can blight people’s lives for years and even decades.
For many years in the UK, stroke was the poor relation in the health service. The Stroke Association, the work of which I commend, as I am sure will other hon. Members, labelled the United Kingdom as having
“the unenviable reputation of having one of the worst outcomes for stroke patients in Western Europe.”
However, I congratulate the Government on what they have done to rid themselves and our country of that reputation, and the gap is slowly beginning to close.
I have 14 questions, and I have sent them with a copy of my speech to the Minister. If he cannot answer any, I shall be pleased if he will write to me and other hon. Members. First, will he tell us whether we are in fact closing the gap between the UK and western Europe on stroke outcomes, which is one of the strongest measures that we can look for? The Secretary of State has said:
“we know that if a stroke patient is treated quickly, and the simple things are done right, death rates can be halved and outcomes can be substantially improved.
So we have two clear aims in this strategy: to reduce the number of strokes experienced each year and to ensure that we provide effective acute and follow up care when strokes happen.”
Bob Spink (Castle Point) (UKIP):
The hon. Gentleman—my hon. Friend—has brought an important matter to the House, and I congratulate him on the way
in which he started the debate. I declare an interest because my mother had a stroke about eight years ago and has not said a word since, although she is happy. My son is a consultant neurosurgeon, and deals with strokes.
Early intervention is the key to a decent quality of life after a stroke. If the Queen had a stroke, she would go from a paramedic to a specialist stroke-busting drug within three hours. That is for sure, but why cannot Mrs. Smith in Hadleigh have that same treatment? Will the hon. Gentleman’s questions to the Minister include asking him how we can get rid of the postcode lottery and ensure that everyone in this country receives the early treatment that makes all the difference to their lives afterwards?
Mr. Allen: It is always instructive when hon. Members, from whatever side of the House they come, bring personal experience to bear, and that applies to the hon. Gentleman’s comment. On the Government’s objectives, I will let the Minister explain how the Government have done so far, but if the hon. Gentleman allows me to make my case, he will hear that we now have a strategy, for the first time, on some aspects. I hope that we shall move towards implementation and action on those aspects.
There have been many improvements, even in the past two years. Next month will be the first anniversary of the launch of the national stroke strategy for England. At that time, the Secretary of State said:
“It has the potential to create a revolution in stroke care.”
What a marvellous comment for any Secretary of State to be able to make about any issue—that it will create a revolution if we do it right. He also said:
“The strategy is constructed around twenty ‘quality markers’ of a good stroke service covering four key areas”—
I shall cover those four areas this morning. They are:
“raising awareness and prevention; the importance of rapid assessment and treatment; provision of rehabilitation and care after stroke; and developing the workforce to meet these markers.”—[Official Report, 5 December 2007; Vol. 468, c. 70WS.]
Although we are only a year on from that publication, there are some good initial signs that stroke care is now being afforded a higher priority by health and social care providers. The most obvious example is that the existing cardiac networks throughout the UK have taken on the additional responsibility of stroke, so there are now 29 stroke and cardiac networks covering the whole of England. In addition, the operating framework for the NHS now identifies stroke as a national priority, and in addition to that, the requirements on primary care trusts are reinforced in the three-year operational plans that they must put forward, which are monitored and performance-managed by strategic health authorities. Implementation of the stroke strategy is a “must-do”. It is no longer a Cinderella; it is no longer marginalised; it is no longer on the periphery. It is now a “must-do” at the centre of the operational plans. I am sure that all hon. Members welcome that.
Monitoring will include two key indicators: the number of patients who spend at least 90 per cent. of their time on a stroke unit, and the percentage of patients with higher risk transient ischaemic attacks—mini-strokes—who are treated within 24 hours. When will the information on progress on those two indicators be published so that all of us—MPs, the Stroke Association, stroke patients and so on—will be able to measure progress?
David Taylor (North-West Leicestershire) (Lab/Co-op): Will my hon. Friend give way?
Mr. Allen: I shall gladly give way to my hon. Friend. There are a number of hon. Members in Westminster Hall this morning, and I shall give way generously to any colleagues who wish to intervene.
David Taylor: I congratulate my hon. Friend on securing this one-and-a-half hour debate, during which 25 people in the country will have a stroke, 10 of whom will die. Many of them could be saved, but only one in 20 of those who could benefit from clot-busting drugs will receive them. Improving the provision of those drugs would drive those figures down.
Mr. Allen: My hon. Friend often plays the straight man to me, and he has again fed me the perfect line to take me on to raising awareness and prevention. I agree with the points that he made, and I will reinforce them in my next couple of paragraphs.
More than 40 per cent. of all strokes could be prevented if people kept their blood pressure under control, monitored cholesterol levels, ate healthily, stopped smoking, and took regular exercise. I am not yet on to awareness; I am talking about prevention. The Government have introduced a programme of vascular checks for 40 to 74-year-olds, which I would like to know a little more about. Will the Minister tell me when I, as a 55-year-old, and perhaps others here can expect to receive our personal invitation for a check under that important step forward? Is it possible to use similar techniques to identify and target those with a family history of or a propensity for strokes and give information on how to avoid them, and what they and their families should do at the outset? The first moments when someone detects that a person does not quite look how they did yesterday are crucial. What can we do to get information to the people in families with a propensity for stroke to enable them to see that action needs to be taken really early and quickly? Will the Minister consider the techniques of direct mail and the use of data tracking to ensure that we get to those people much earlier?
Both public and professional awareness of risk factors and symptoms of stroke are frighteningly low. The face, arms and speech test—FAST—relates to some of the key signs to act on early. Someone may notice that a person is not speaking as accurately as they did before, that they have trouble raising an arm or have a slight drooping or tingling of the face. The symptoms of stroke are often not as dramatic as those of a heart attack, in which people may clutch their chest and fall to the ground in agony. However, the symptoms of stroke are of equal importance. If we can act early, we will save thousands of lives and prevent years of unnecessary disability.
It is worrying that people do not know—I admit my own ignorance on this—that when a person has a stroke, they should dial 999 in the same way as when someone has a heart attack. That means that a person suffering a stroke can be treated quickly. I have one small quibble with the fantastic people—those in the voluntary sector and the professionals, who do an incredible job—who have provided some of the information for me on this subject. When we are trying to raise awareness, can we please not use acronyms and medical jargon? We
should talk in a way that ordinary people understand, so that they can obtain treatment and help themselves and their families. When we talk about TIAs, coronary heart disease, aphasia, vascular, FASTs and so on, it is little wonder that people are confused. If we keep things simple, we will raise awareness throughout the UK in the same way as awareness has been raised of some of the key symptoms of heart attack.
The issue of professional awareness also needs to be examined. Some 20 per cent. of GPs admit to not referring one in five cases of mild and major strokes to hospital immediately. It is honest of them to say that, but we need to ensure that they are aware of the issue so that they can rectify the situation and save lives. Last year, the Stroke Association invested £500,000 in a press and radio advertising campaign to raise awareness of the fact that
“stroke is a brain attack”.
To implement the kind of sustained wide-ranging campaign that we need to make permanent improvements, the Government must play a role and take the lead, alongside the great work being done by the Stroke Association. I hope that when the Government do that, they will also consider the impact that raising awareness will have because there will obviously be an increased demand on services. I also hope that the Government will consider the impact on stakeholders, including those who offer advice and support to the public, as they may well have a steep increase in requests for their services.
I am pleased to say that my city is apparently doing well in relation to strokes. We are already responding to the national strategy and the Nottingham City primary care trust and Nottinghamshire Healthcare NHS Trust are holding a week-long campaign this week that will encourage people to become more aware of the symptoms of strokes and to change their lifestyle. Nottingham City PCT has commissioned community services, such as the new leaf stop smoking scheme, health trainers, exercise referral schemes and food and cooking schemes to support people at risk in the community and encourage them to be more active and eat more healthily. Lack of exercise and an unhealthy diet are important risk factors for stroke.
A locally enhanced service, which is basically the incentivisation of GPs, has been commissioned with all GP practices to identify and manage patients who are at high risk of cardiovascular disease. I am happy to say that it includes a partnership scheme with the pharmaceutical industry in Nottingham called “happy hearts”. That scheme is doing well. The “change makers” project also works with local community volunteers to improve awareness of stroke symptoms and risk factors. So, as a result of Government action and colleagues from all parties repeatedly raising the matter—including a debate that took place around 18 months ago on the Floor of the House—we have progressed from a big national strategy to real projects on the ground. What further plans are there to improve public and professional awareness of stroke symptoms and what people should do at the onset of a stroke? Equally important, what plans are there to make those campaigns sustainable? One-offs are really welcome, but it is also important to have a sustained campaign to change our view and the culture surrounding the treatment of stroke.
I now come to the point already made by my hon. Friend the. Member for North-West Leicestershire (David Taylor) about the need for rapid assessment and treatment.
Time is of the essence when treating stroke. According to the Secretary of State, there is a window of only three hours in which stroke patients must be seen, scanned and treated. For each one-minute delay, 2 million neurons are lost from the brain, yet people who know this subject far better than me say that awareness of stroke is at the level of awareness of heart disease that existed 10 years ago. We still have a lot more to do, but that does not mean we need bags more money—of course, resources are always welcome—but the Royal College of Physicians has clearly stated:
“we do not necessarily need more resourses just better organisation of what we have already”.
Mr. Paul Truswell (Pudsey) (Lab): I congratulate my hon. Friend on securing this important debate. May I give an example that reaffirms what he is talking about and perhaps touches on a point made earlier about treatment being not a postcode lottery but an organisational matter? I am aware of a couple whose experiences were very diverse. The wife suffered a severe stroke and was admitted to a specialist stroke unit. After six weeks, she was discharged having made almost a total recovery, apart from some speech impairment. She had no further episodes. A short time later, her husband was admitted via an accident and emergency department to a geriatric unit and died two weeks later from a second stroke. Does that not exemplify what we are talking about in terms of organisation: one couple and one place, but two pathways and two outcomes?
Mr. Allen: My hon. Friend has put it more eloquently than I can. I am not going to say that everyone will be as right as rain, but if we get to people early and give them the right treatment, they can go on to lead a full and productive life. In essence, during a stroke parts of the brain lose oxygen, which is the source of life for the brain. The longer the brain is left to suffocate, the greater the damage that will take place and the greater chance there is of irreparable damage. Early intervention is really important. My hon. Friend has clearly described the stark contrast between what happens if a stroke is dealt with quickly and what happens if it is not dealt with quite so expeditiously.
Nigel Mason of GE Healthcare goes further than the Royal College of Physicians and says
“reconfiguring staff and procedures for a daily two-hour immediate access clinic would save lives and generate £42 million savings as well”.
We all care about the individuals concerned, but even if we consider the matter purely in terms of a sensible way to manage resources, we can save immense amounts of money by getting it right. There are many other examples of that.
Stroke patients are around 25 per cent. more likely to survive, they make a better recovery and they spend six days less in hospital if they are admitted to a stroke unit, rapidly assessed and receive specialist care from a multi-disciplinary team. The national stroke strategy sets a clear standard to ensure that effective urgent care is in place, including transfer to an acute stroke centre that provides scans and thrombolysis—I hope I have got the pronunciation correct—where appropriate. The medical profession will shriek at this, but, for ordinary mortals, thrombolysis is basically souped-up aspirin. The national stroke strategy also refers to prompt admission
to a specialist stroke unit. All those things in a line mean that we have done a great deal to reduce the number of deaths and disabilities arising from strokes. In addition, one of the hopes in the strategy is for more specialist stroke nurses to be available. We are only a year into the strategy, but perhaps the Minister will give an indication of when he hopes to have complete coverage, and when every hospital will have a stroke nurse.
With regard to thrombolysis, which is probably better known to people in the business as clot-buster drugs, the Secretary of State said last year:
“Right now, less than 1 per cent. of people who have a stroke are receiving thrombolysis. If we can get that number up to 10 per cent., 1,000 people a year would regain their independence, rather than die or be disabled for life. By following the guidelines set out in this strategy, 1,600 potential strokes can be averted through preventive work and a further 6,800 deaths and disabilities can be avoided.”
What a prize for something so simple and inexpensive; 6,800 deaths and disabilities could be avoided. Clot-busting, thrombolytic drugs can be the difference between someone leaving hospital on foot and beginning a lifetime in a wheelchair. In Ontario, 37 per cent. of patients get clot busters. Will the Minister bring us up to date on the level of use of clot-busting drugs in this country? The Secretary of State said more than a year ago that it was less than 1 per cent., but I am sure that that figure has improved. Perhaps the Minister will tell us how well we are doing and what the curve is. I do not expect the figure to leap to 37 per cent., but we would like to know what the curve is to ensure that people receive those very simple drugs at the moment when they need them most.
David Taylor: My hon. Friend has moved on to mobility, which is one of the problems that frequently follow a stroke, whether it is a transient ischemic attack or a severe stroke, but is there not a need to do more for those who have a communications disability? I am referring to disabilities relating to speaking, understanding, reading and writing. About 250,000 people have to grapple with such a disability for years and years. Will my hon. Friend commend, as I do, the Leicestershire County and Rutland primary care trust? It has a specialist stroke unit at Leicester general hospital, where stroke victims go, but then they are discharged via two rehabilitation units. One is in Coalville community hospital, which covers the northern part of the county, and the other is at Market Harborough. That type of initiative can help a great deal, can it not?
Mr. Allen: Again, my hon. Friend is absolutely right, and again he is at least five pages ahead of me in my argument. I will come on to some of the issues that he raises. I am very happy to commend the organisations to which he referred. I will speak about those issues later, but next I want to say a few words about scans.
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