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18 Nov 2008 : Column 13WH—continued

10.21 am

Mark Williams (Ceredigion) (LD): It is a particular pleasure to serve under your chairmanship, Mr. Williams. We are indebted to the hon. Member for Nottingham, North (Mr. Allen) for raising this very important debate. However, I am sure that he will understand when I say that tributes should be directed to the hon. Member for Isle of Wight (Mr. Turner) for his contribution. The test of time will show that he has been an inspiration to many thousands of people who have had the same experience.

I represent a Welsh constituency, so the responsibility for Government policy that affects my constituents is a matter for the Welsh National Assembly, and I am reminded by the Chair not to stray into devolved matters. Like the hon. Member for Isle of Wight, I want to spend a few minutes talking about the invaluable work of the voluntary sector and, in particular, of two or three organisations with which I have had the privilege of working over the past couple of years.

The hon. Gentleman said that we cannot build rehabilitation services without the voluntary sector. We have heard a lot about the Government’s laudable 10-year strategy and the contribution that social services departments make, but we must also acknowledge the work of the voluntary sector; without it, the lives of many thousands of people would be considerably worse. It has risen to meet the challenges mentioned earlier. For example, strokes are the third most common form of death in the United Kingdom, accounting for 9 per cent. of the deaths of men and 13 per cent. of women. The Aberystwyth and district stroke club in my constituency has 60 members, 40 of whom have had strokes. Many carers attend the meetings. We have not heard a huge amount about the carers and the unique advice and support that should be directed toward them.

The Aberystwyth and district stroke club was borne out of frustration with the lack of provision, yet, in its 20-year history, it has never received any public funding. A similar such point was alluded to by the hon. Member for North-West Leicestershire (David Taylor). The club has been reliant on the generosity of businesses and local residents to keep it going. It offers important confidence-building services, weekend breaks and help for people who may not have the chance or the resources to get away. It runs a bus, which is funded by the lottery’s “awards for all” scheme, which costs between £4,000 and £5,000 a year. However, more importantly, it enables stroke victims to meet other people in the same position as themselves—people who are some way along the path to rehabilitation, and who can offer the wisdom of their experience.

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A central focus of the debate so far has been the need for immediate care and diagnosis. Everybody in this Chamber will agree with that goal, which has been raised by the Aberystwyth and district stroke club. Many of its members have had to wait 24 or 48 hours for a scan.

Like many others here, I represent a rural constituency. If we put into that context the misfortune of suffering a stroke and mix it with living in some of the most isolated and scattered communities in the country, it is a frightening experience. Ambulance times are already challenging. I ask the Minister to comment on the role of telemedicine throughout the country. The service has been pioneered in my constituency in Bronglais hospital, in Aberystwyth, and plays an invaluable role in assisting early diagnosis. It brings the expertise that may be available elsewhere into more scattered communities—a point made by Professor Boyle in his analysis.

We were disturbed to hear the story from the hon. Member for Pudsey (Mr. Truswell) about the couple in his constituency. We need to remind ourselves that recovery from stroke can be an incredibly long-term process; 25 per cent. of all long-term beds in hospital are occupied by stroke patients. We need to ensure that support is available in hospital and that the voluntary mechanisms are in place to enable people to have the moral support and encouragement to make the long journey to full health.

I applaud the Government for their announcement about the ring-fenced money, but I echo the views of the hon. Member for Nottingham, North about the need for us to monitor where that money is going and to ensure that our social services are delivering the services that we and the Government expect of them. For those who are able to live at home after suffering a stroke, the support provided by the voluntary sector is invaluable. I know that we are only a year into the strategy, but will the Minister tell us whether an early appraisal has been made of the adequacy of the ring-fenced funds?

Some voluntary groups have raised real concerns about the grants and funding made available to them. Positive Action for Stroke, which is based in my constituency, has had real difficulty obtaining funding. The Progressive Action Group in Aberystwyth faces similar concerns. I hope that the Minister will reflect on the importance of voluntary organisations in helping those who have had strokes, even if he cannot get into the nitty-gritty of the funding. Some public bodies have been reluctant to fund voluntary groups when lottery funding has not been available, and it has been a great challenge to find alternative sources of funds. If the Minister pointed the voluntary groups in the direction of funding, that would be very welcome.

I want to emphasise the importance of the services that voluntary groups offer. Progressive Action arranges what it calls “fun activities”, such as computing and arts and crafts. However, such activities also help stroke victims to return to the employment market. We have heard about the depression faced by many stroke victims. Again, in a rural constituency, that should be seen in the context of rural isolation, the feeling that one is not getting the services to which one is perhaps entitled, compounded by the health condition that has to be endured.

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The ability to have organised breaks and activities allows people to be much more active than they might otherwise be. We are all aware that activity and dialogue, which the hon. Member for Isle of Wight mentioned, are integral to recovery. Such activity also ensures that victims can redevelop motor skills. The care is delivered as part of a care package, but once that time in hospital has ended, the recovery process can go on for many months and years. Having help and support outside the hospital environment is extremely valuable in aiding recovery. It is also very beneficial for people to be able to make new friends, and to meet those who have had similar experiences and been through the same process.

The hon. Member for Nottingham, North put his case very concisely. I, too, believe that part of the emphasis should be on the importance of raising awareness to prevent strokes. However, as the hon. Member for Isle of Wight said—my contribution is humble compared with his—it is important to recognise the work done by the voluntary sector in providing assistance to those affected by strokes.

I want to finish by praising the work of our health professionals. We have talked about developing skills and expertise in our hospitals. We have all had our family experiences in these matters; mine involved a dear aunt. I remember the fateful phone conversation when her husband told me that she had suffered a stroke and had lost the power of speech. She was a chatty, enthusiastic and vibrant individual who did a huge amount for her community: then—stop. Two years on, she has recovered her power of speech and is as active a member of the community as she used to be. That is no small tribute to her abilities and enthusiasm, but also to the health professionals who have helped her so much, and to the voluntary sector.

10.30 am

Greg Mulholland (Leeds, North-West) (LD): I congratulate the hon. Member for Nottingham, North (Mr. Allen) not only—nor most importantly—on securing the debate, but on the speech that he made, and the many points he put to the Minister. I pay tribute to his work and that of members of the all-party group, and I want to echo his comments, which were widely applauded around the Chamber, about the vital and wonderful work of the Stroke Association. The number of questions in the hon. Gentleman’s speech went up from 13 to 14 by the time he delivered it, so presumably he came up with another one overnight; he has helpfully shared his speech with us. I think that we all agree that if the Minister can answer the 14 questions, today and on a continuing basis, we shall be much closer to assessing our progress in the past year.

It is a pleasure to follow my hon. Friend the Member for Ceredigion (Mark Williams) and to hear something of his personal experience of the issue—something that has echoes around the Chamber, whether the experience is personal or whether it concerns constituents, as in the case raised by my neighbour, the hon. Member for Pudsey (Mr. Truswell).

Mr. Truswell: I just want to correct a misconception. The case that I quoted did not concern constituents. To be honest, it was my mother and father.

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Greg Mulholland: That was my mistake. I thank the hon. Gentleman for that correction.

I want to echo the comments of my hon. Friend, and I pay tribute, too, to the hon. Member for Isle of Wight (Mr. Turner). It was incredibly humbling to hear of his personal experience, as well as enormously informative for us all. I think we all want to thank him for sharing it, and for his contribution to the debate. I reiterate what has been said about his being an inspiration to many people who have suffered strokes, in showing what people can do and how they can come back from a stroke. The way in which he has served his constituents is a tribute to him. The hon. Gentleman also made an interesting point when he mentioned the wisdom of thinking before we speak. Many hon. Members should remember that—and I certainly do not exempt myself from that group.

I had a vivid reminder about strokes a few weeks ago, when the mother of one of my best friends unfortunately suffered a severe stroke. She was in the highlands of Scotland and it was only thanks to the response of the air ambulance, and the wonderful medical care that I am delighted to say she received, that she is still with us. She is now recovering. It is a slow recovery but she is making good progress.

As we have heard, the effects of stroke can vary enormously. Stroke is the third biggest cause of death in the UK—there are about 50,000 such deaths every year—and the largest single cause of disability. Each year, 110,000 people in England alone suffer a stroke. Stroke affects more women than breast cancer. It is estimated that the overall costs of treatment for strokes and related and subsequent disabilities is a staggering £2.8 billion a year. As we have heard in eloquent speeches from the hon. Member for Nottingham, North and other hon. Members, the debate is important because we must ensure that care of the best quality, including consistent access to treatment, is available for those who suffer strokes, but also because of the need for prevention. That is why the Liberal Democrats warmly welcome the national stroke strategy, which was published in December. The chief executive of the Stroke Association, Jon Barrick, described it as

What the debate is about—as I am sure we would all agree and the Minister would acknowledge—is checking that we are taking that momentous opportunity, and seeing whether people are receiving better care than they were 10 months ago.

The initial signs are that some progress is being made. Even before the strategy was announced, 97 per cent. of hospitals had a stroke unit, and more than 90 per cent. of stroke units providing acute care had access to brain imaging within 24 hours of admission. That is a big increase—82 per cent.—since 2004, and is to be commended. However, there are certain points that we need to examine, and the audit this year by the Royal College of Physicians found that only 45 per cent. of hospitals could meet the recommendation made in the strategy that high-risk patients who had a transient ischemic attack or mini-stroke—and I share the wish of the hon. Member for Nottingham, North to use ordinary phrases that mean something to people—should be examined and treated within 48 hours. Given that the Stroke Association has pointed out that meeting that
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one target could result in an 80 per cent. reduction in the number of people going on to have a full stroke, the standard is one that needs real focus both now and as the strategy progresses.

A requirement has been placed on primary care trusts to set out their plans for improving stroke services for 2008-09. The House should welcome that, and monitor it. However, the Stroke Association has voiced concern that an absence of national targets and time scales for those targets in the strategy may affect progress. It is important to say that some strategic health authorities have gone further than the strategy specifies, and have included a timetable for the implementation of selected recommendations, but serious consideration should be given to setting a timetable across the board for implementation of the targets, so that we can achieve the speed of change that we need, and be confident that people are getting consistent access to services in all areas. Good progress has been made, which is enormously encouraging, and we all welcome that. I want to ask the Minister whether we can examine progress annually. Today’s debate is useful, but we should continue to monitor what happens.

Most of the debate today has rightly focused on issues such as prevention and acute hospital treatment and care, but the speech of the hon. Member for Isle of Wight in particular dealt with the huge importance of long-term care and community support following a stroke. The importance of effective long-term care and the need for stroke sufferers to be active participants in their treatment has been well documented. According to the Stroke Association, only about half the individuals who have experienced a stroke receive the rehabilitation that they need in the first six months following their discharge from hospital. In the next six months only one in five receive the help, support and treatment they are deemed to need. That is something on which the strategy should focus, and I hope that the Minister will agree.

One of the most important issues in the debate is embodied in one of the figures that has been quoted: 40 per cent. of strokes can be prevented. The importance of awareness of strokes cannot be overestimated. One concern is that polling by the Stroke Association found that one in five GPs do not refer about 20 per cent. of cases of mini-stroke. Just over half of GPs said that they would refer someone with a suspected stroke immediately. A concentrated effort must be made to ensure that strokes are regarded as nothing short of a medical emergency, in which time is of the essence, and that all treatment is recommended with that in mind. I am aware that NICE and the Royal College of Physicians recently published guidelines, and I hope that there will be a concerted effort across the board.

I pay tribute to the Government for the £12 million that is to be invested in the next few years in awareness activity. That is a common-sense thing to do, considering the enormous cost of £2.8 billion that I have already mentioned. I should like an assurance from the Minister that any public awareness campaign will take account of the needs of some ethnic minority groups that are at greater risk of strokes, and of the possibility that it may be more difficult to reach those groups. Finally, there is a need for more research. The Stroke Association funds £2.5 million of research, and we must always look for ways to improve what is done.

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To conclude, this has been an excellent debate. It could not have been more timely and I do not think that it could have been more informative or constructive for all of us. I simply urge the Minister to allow us all to continue to contribute to monitoring the progress of this very important and very welcome strategy, and I look forward to hearing his response to the debate.

10.39 am

Mark Simmonds (Boston and Skegness) (Con): I am pleased, Mr. Williams, to see you in the Chair.

I want to reiterate the comments of other hon. Members in congratulating the hon. Member for Nottingham, North (Mr. Allen) on securing this important debate. I also want to congratulate him on the very comprehensive and detailed way in which he introduced this significant topic. He set out very clearly the importance of ensuring that the Government maintain the momentum that has been generated recently, first by the National Audit Office report, then by the Public Accounts Committee report and finally by the stroke strategy, which was released roughly a year ago. I thought that he made his points in a very constructive and thoughtful manner, and hopefully the Minister will respond in a similar vein.

The hon. Gentleman was right to congratulate the Stroke Association, which does fantastic work in this area. I will not repeat them, but he was also right to highlight the four key markers that the Government set down. He was also correct to summarise the four distinct areas—the patient pathway—of awareness, diagnosis, treatment and subsequently community care and rehabilitation. If all those areas are addressed, that will make a significant difference to patient outcomes. The Minister will probably not have time to answer in detail all of the 14 questions that the hon. Gentleman put to him today, but I am sure that he will respond in writing to the hon. Members who are here with answers to all of those excellent questions.

I also must say to my hon. Friend the Member for Isle of Wight (Mr. Turner) that his contribution today was exceptional and inspirational, and I am delighted to see that he has clearly made a full recovery and is back on full form, both in articulation and humour, which is very good to see. He was absolutely correct to highlight the important contribution of the charitable and voluntary organisations, particularly in rehabilitation and community support. He was also right to ask all of us, irrespective of our party political persuasions, to thank and congratulate the people involved in those organisations. As an additional question, it would be helpful if the Minister would address the point made both by my hon. Friend and by the hon. Member for North-West Leicestershire (David Taylor) about the potential to fund or assist charitable and voluntary organisations in the community and rehabilitation aspects of their work.

We heard, too, from the hon. Member for Ceredigion (Mark Williams), who raised the important issue of the contributions of the voluntary and charitable sector. Furthermore, he stressed the overriding importance of people who have experienced strokes meeting others who have gone through a similar experience, if only to ensure that those people understand that they are not
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alone and that they are not unique in their experience of stroke. The hon. Gentleman was right to highlight the problems that are exacerbated in large rural constituencies. I, too, represent a rural constituency—the Lincolnshire constituency of Boston and Skegness—and I suspect that we have problems that are similar to those that he faces in north Wales. I sometimes think that the Government do not necessarily address the needs of those who represent physically great but sparsely populated rural areas and provide the requisite funding, although that is not the specific issue that we are debating today. The hon. Gentleman was also right to praise health professionals who are involved in stroke care.

Of course, there is cross-party support for the enhancement of stroke services, particularly those that improve patient outcomes and survival rates, although it must also be said that, despite the stroke strategy, we still have fairly low survival rates in the UK in comparison with some other EU countries. Nevertheless, we recognise and welcome the progress that has been made since the publication of the stroke strategy, particularly in the development of stroke networks. However, it was a shame that it took the Government so long to produce that strategy, and I suspect that they did so only in response to the highly critical reports from the NAO and the Public Accounts Committee.

Despite all the evidence that care in a specialist stroke unit increases a patient’s chance of survival and recovery by 25 per cent. and reduces their stay in hospital by six days, in 2006 just 15 per cent. of stroke patients were admitted to stroke units on the day of admission. I accept and acknowledge that that is a slightly historic statistic. However, it would be helpful if the Minister could update it, either today or subsequently, particularly in the context of the overriding importance that is now correctly attributed to stroke and stroke care, both in the operating framework, which identifies stroke as a national priority, and in the primary care trusts’ operational requirements, which was a point quite rightly made by the hon. Member for Nottingham, North.

There are some background statistics that I briefly want to put on the record, because some of them are worrying. The national audit by the Royal College of Physicians this year showed that only 45 per cent. of hospitals were able to meet the target in the stroke strategy of investigating and treating high-risk patients with transient ischemic attack, or TIA, within 24 hours, and yet that is clearly one of the key methods of identifying patients at risk of stroke and preventing patients from going on to have a full stroke.

Fast access to stroke units and fast treatment is a key to a patient’s survival, whether that treatment is the CT scans that were mentioned earlier or the three-hour time limit for thrombolysis. These two methods of treatment must be linked, as the hon. Gentleman pointed out, so that the thrombolysis is not administered to patients who would not benefit from it or to patients to whose health it would be detrimental. One statistic that has already been given is from Sweden, and it is absolutely startling compared with our own performance here in the UK; in Sweden, 100 per cent. of stroke patients have access to a CT scan within 24 hours.

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