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18 Nov 2008 : Column 6WHcontinued
Mark Simmonds (Boston and Skegness) (Con):
I, too, congratulate the hon. Gentleman on securing this very important debate. If I may, I should like to follow up the intervention from the hon. Member for North-West Leicestershire (David Taylor) with regard to community care after a patient has been treated in hospital and is back at home. There seems to be great inconsistency across the country. There are some excellent examples of outreach services, particularly in the north-east, which
I have seen myself, but that does not seem to be the case everywhere. I hope that the hon. Member for Nottingham, North (Mr. Allen) will come on to that issue.
Mr. Allen: I thank the hon. Gentleman for his comments. Yes, I will come on to those issues, and no doubt the Minister will respond on the patchy nature of provision. We need to look for the trend lines. Is something improving, and is it improving everywhere? Is there convergence in levels of provision? It would be unfair to say in a years time, Has this problem been solved? Of course it will not have been, but colleagues on both sides of the House will hope to see the trend lines going in the right direction.
Why do we do scans? I understand that the main reason is to exclude the other cause of strokes, which is a bleed in the brain. Clearly, we do not want to administer clot-busting drugs if the cause is a bleed, and a scan will immediately eliminate that possibility. The National Institute for Health and Clinical Excellence recommended in July 2008, just a few months ago, that a brain scan should take place within one hour of someone being admitted to hospital. The strategy emphasises the need to improve access to scans and stipulates that brain imaging should be performed in the next scan slot, or within 60 minutes of a request out-of-hours. In 2006, only one in 10 people were scanned within three hours. We need a tight target to make scans available 24/7. Any unit unable to deliver scans by a particular time should not be called a specialised stroke unit. I hope that the Minister will consider that. In Sweden, 100 per cent. of those who need a scan get one, and we should aspire to that in this country. Will the Minister tell us the percentage of scans in the UK and in my own city of Nottingham, and by what date we aspire to reach 100 per cent.?
Bob Spink: The hon. Gentleman is being most generous in giving way. Does he agree that the ambulance service has a part to play, as it is not just a question of getting someone to a hospitalany hospitalas quickly as possible; it is a question of getting someone, even if it takes 15 minutes longer, to the right hospital for specialist treatment of their problem? If someone gets into a hospital and then has to be transferred to another hospital to have that work done, valuable time is often lost.
Mr. Allen: 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 FASTthe face, arms and speech testto 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 reviewthat consultationon 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 Nottinghamone acute stroke unit and three rehabilitation unitsand 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. ThrombolysisI keep getting my tongue twisted round that oneis 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 HallI think that you may have been present, Mr. Williamswhen 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, supervisionall 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?
David Taylor: Can I insert subsection (a) to that question, unless it is down as the next question on my hon. Friends list? As part of rehabilitation after discharge from hospital, the stroke unit or a community hospital, does my hon. Friend agree that stroke clubs are important? People get a great deal from such clubs, which are often run by volunteers, stroke victims, families and carers on a shoestring. Such clubs play an important part in getting people back on to their feet with greater confidence. Many MPs visit stroke clubs. I have the good fortune to be the president of Ibstock stroke club, and I know how valuable the work done by it and similar stroke clubs is for the process of rehabilitation and recovery.
Mr. Allen: I know from reading up for this debate and from past debates, how committed my hon. Friend is to this topic, and the effort that he has put into it over many years. I agree with him, and I will come on to say a few words about stroke clubs and the difference between them and communication support groups, which are also very important.
As part of the stroke improvement programme, there is a central national teamI am pleased to say that it is based in the east midlandswhich supports the development of the 29 local stroke care networks I mentioned. In Nottingham, a well-established partnership works across the local health and social care community through the stroke services strategy group with representation from the Stroke Association and an excellent relationship with @astroke, the local patients forum. There are also strong local research links with the university. Professor Marion Walker and Ossie Newell, a stroke survivor, were winners of a local media reach out award for their work in developing research and rehabilitation programmes for people who have had strokes.
My next question is about rehabilitation. NICE recommended 45 minutes of rehabilitation a day. Does the Minister know when that target is likely to be met? What steps are we taking towards it? As part of the national stroke strategy, the Department of Health published a local authority circular last May entitled, Demonstrating how to deliver care for adults in the community. It stated that councils with adult social services responsibilities in England receive funding to deliver long-term stroke care for adults in the community, and it encouraged more joint working between health and social care providers. That is important to enable stroke survivors to receive a seamless transfer of care from the hospital to the community, and to ensure that they receive the support they need for as long as necessary.
Does the Minister know specifically whether information about how that grant is spent by local authorities will be made public, so that we can see the implementation of the stroke strategy as it unrolls and overall monitoring can take place? The money is apparently ring-fenced, and we must ensure that it stays that way. The funding, however small, must be sustainableI do not know how many debates in Westminster Hall I have attended where I have said that. Quick bursts of activity for one year or for three, are often worse than useless. I would prefer to have smaller amounts of money sustained over a longer period, so that people know where that central core of money is and can build around it.
Colleagues from all parties have mentioned community services. A particularly pleasing part of the new strategy are the references to the value of communication support
groups for stroke survivors. The Stroke Association has pioneered work in that area with its Lost without words campaign. Communication difficulties include aphasia and speech impacts, which affect approximately one third of stroke survivors. Without support, survivors can experience problems including depression, isolation and an inability to return to work. Currently there are no communication support services in the Nottingham area. The group Aphasia Nottingham aims to help, but it is entirely voluntary and receives no statutory funding. However, there is a real need for that service in Nottingham.
At present only 12 per cent. of stroke survivors in England have access to communication support groups organised by the Stroke Association. That figure is even lower in my area, which I share with my hon. Friend the Member for North-West Leicestershire. Historically, there have been challenges to the discharge of stroke survivors back into the community, thereby creating bed blocking. Nationally, a community stroke team is in place, and from January next year, there will be a system of early supported discharge, which should help to address that problem. Nottingham City primary care trust is currently recruiting a team for that system.
Community care for stroke survivors is fragmented. The level of care that someone receives seems to depend on the area in which they live. In Nottingham, adult social services care for stroke survivors, and a 12-week programme called Stroke Ability is heavily exercise-based and has elements of prevention and awareness work. As my hon. Friend said, there are a number of stroke clubs in the area. From next year, a further family and carer support service in the south of the county will be funded by new local authority funding to help people with the transition from hospital to home. It is imperative that the Government encourage local authorities and PCTs to take account of the communication support needs of stroke survivors in their communities, and ensure that they keep that money ring-fenced for stroke-specific services.
Finally, the National Sentinel audit of stroke care by the Royal College of Physicians has proved an extremely useful tool for monitoring the implementation of standards and service improvements in the acute sector. However, there has not been a similar focus on monitoring community services. The Healthcare Commissions patient survey 12 months after discharge from hospital was published in 2006, and gave an excellent snapshot of the standard of care and support for stroke survivors in the community. For my 13th questionthere is just one more before I sit downmay I ask the Minister whether further surveys along those lines or an extension of the Royal College of Physicians auditing process into community care will be undertaken?
My final and briefest question is about the development of the work force to meet the markers that the Secretary of State mentioned when announcing the strategy. In Nottingham, we have a stroke training programme for all staff working for the stroke service, and we have one of the 10 Government-funded medical stroke specialist training posts. However, although the funding is welcome, again it is non-recurrent. We need specialist staff with stroke knowledge and skills, and Department of Health training for an agreed competency framework. When will that framework be ready and how will it be managed? Will units receive accreditation for providing different
levels of specialist care? How much sustainable support are the Government providing to all levels of stroke care staffing?
I hope that I have been generous in accepting interventions to allow a large number of colleagues to contribute, and I apologise for taking up a lot of time. I believe that the Government are to be congratulated heartily on putting in place an excellent, although long overdue, stroke strategy. People who care about this subject, from all parties, inside and outside this House, campaigned for it for a long time. We must now put stroke awareness high on the agenda and ensure timely and urgent treatment to improve the quality of life of people suffering the after-effects of a stroke. I hope that this debate gives the Minister an opportunity to tell us what progress has been made since the national strategy was announced and what milestones he hopes can be achieved over the next year. The key message that I have received in putting together this debate is that it is not so much about money, but about organisation. As with so much public policy, if we choose to intervene early, the impacts will be cheaper, more effective and, in this instance, will save many lost and broken lives. I thank you, Mr. Williams, for allowing me to make my case at some length.
Hywel Williams (in the Chair): I wish to start the wind-up speeches at 10.30 am. I hope that hon. Members will bear that in mind, so that everyone can get in.
Mr. Andrew Turner (Isle of Wight) (Con): I congratulate the hon. Member for Nottingham, North (Mr. Allen) on securing this important debate. If others bring to it as much wisdom as he has, we will be tremendously privileged.
I am pleased to take part in this debate, particularly because almost two years ago I suffered a serious stroke. It is often said that every stroke is different, but still I would like to say a few words about my experience. When I first came round in hospital, I was in a pretty bad way. Two friends were there with my partner, Carole, and one leaned over me and said, Dont worry, your solicitor and your undertaker are here. I am very glad to say that I did not need either of them professionally, but I did, in those first few weeks, have to learn, almost from scratch, how to function and communicate again.
I could not walk properly, so physiotherapists worked with me to restore my movement. My vision was affected. For a while, I could not judge distances, and I kept bumping into things. Over and over again, I had to use flash cards to help me to remember the words for dog, horse, cat, cow and so on. I have paid tribute before to the staff of St. Marys, my local hospital, and am pleased to do so again, for the excellent care that I received. I know I am very, very lucky. I have recovered from my stroke well and medical tests show that I am at no greater risk of another stroke than anyone else of my ageindeed, I am at less risk than many people.
I am sure that other hon. Members will make valuable contributions about the medical needs of stroke sufferers, but I shall raise a slightly different issue. I was in
hospital for six weeks. After I was discharged, I needed no further medical treatment, although I did receive a fortnightly hour of speech therapy. In many areas, even that is not available owing to a lack of qualified therapists. That support was invaluable to me, but equally important was the experience of simply talking to lots of different people, and the mental stimulation that that brings.
As I said before, I was very lucky. My movement came back relatively quickly, and I could get out and about and meet people. It must have been trying for them, sometimes, because I could not always find the words I needed to get my ideas across. Almost one third of stroke sufferers are left with some kind of communication difficultyit is called aphasia, and it is a hidden disability. I looked all right, my mind was functioning as it always had, my thoughts were in perfect order, and I was still the same person, but my brain sometimes let me down in getting the correct words out in the right order.
Aphasia has been likened to a filing cabinet falling over and all the files getting mixed up. The filing cabinet in my brain is now getting itself in order, but sometimes I still cannot find the exact word that I need when I need it. If that ever gets me down, I think of the blindness overcome by the right hon. Member for Sheffield, Brightside (Mr. Blunkett) or the silent world of Lord Ashley, who was so effective despite being completely deaf, and I remember that things are not that bad. Before my stroke, I could make a speech like this off the cuff, but these days I need to use notesalthough, actually, I have found that having to think before opening ones mouth is not necessarily a bad thing for an MP, and I commend it to colleagues in all parties.
I had the support of friends and family and was able to get out and about. As I am well known on the Isle of Wight and islanders are a friendly lot, I had plenty of people to talk to, but not all stroke sufferers are so blessed. Many are elderly and live alone. Aphasia makes them lose confidence, which makes it even harder to communicate. That is where the voluntary organisations come into their own. The Isle of Wight is home to just 130,000 people, but they have lots of voluntary support, including from the Stroke Association, the stroke club and Different Strokes, which do an amazing job. They provide the information that people need about every aspect of life following a stroke.
Such voluntary organisations arrange weekly exercise classes and events where people can meet others experiencing the same problems. They provide a forum where people can get the mental stimulation that they need from talking to other people without embarrassment. Quite simply, they make people realise that they are not alone, which is a great help. Such voluntary organisations gave me enormous support, and I thank everyone involved on the island. There are too many individuals to mention, but it is humbling that so many people willingly give up so much of their free time to help others.
Without the help and support of so many islanders, I simply would not be here today. I could have simply given up, but with so many people willing to help me to get well again, that was never really an option. However, the first time that I stood up to speak in the House after my stroke was a most terrifying experience.
My plea is for everyone to recognise and applaud the work that the charitable organisations do in helping people on the road to recovery. The support that they give can improve confidence and independence. It
can overcome isolation and depression and improve communication skills. It is not the job of the national health service to provide someone to whom victims can talk. I know from experience how important talking is to recovery. The greatest help that can be given to many sufferers is the opportunity to communicate, and to practise talking so that they can build up their speech again. It is something that charities do very well, but it is also something simple that anyone can do.
I would never have chosen to have a stroke; however, I have learned a great deal from it. I hope that I can use that knowledge to bring an extra dimension to my life.
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