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A quarter of British hospitals have no specialist stroke nurse and only 22 per cent. of hospitals have an early supported discharge team. Specialist teams working
in a multidisciplinary framework are best placed to improve outcomes and reduce mortality. Last year, I visited the North Tyneside general hospital near Newcastle, which has a fantastic specialist stroke team. That team not only works in the hospital but goes into the community, with outreach workers and specialist nurses. I very much hope that that the Minister will ensure that that model is rolled out across the UK.
One of the disparities that seems to exist between statements made by the hon. Gentleman and the previous Government announcements relates to the population screening that the Prime Minister announced in January. It was clear from the Prime Ministers announcement that the screening would be whole-population screening with cardiovascular checks, which would also include looking for tell-tale signs of a stroke. It would be interesting if the Minister could say, first, whether or not the funding has been provided to support that whole-population screening and also whether or not the clinical evidence supports that type of screening, or is the hon. Gentleman correct that screening should be limited to those between the ages of 40 and 74?
We also support the hub and spoke strategy for specialist stroke centres. Clearly, there is a direct correlation between specialist stroke centres and better patient outcomes and survival rates; in those centres, patients are scanned and given thrombolysis if appropriate and necessary. However, that does not necessarily mean that there should be closures of small stroke wards in local hospitals. Indeed, Manchester is perhaps the best example of a good system; in the local service plan for Manchester, a hyper-acute unit has been proposed, where all stroke patients would be taken for the initial scan and treatment, before they are referred back to their district general hospitals for treatment to be continued and for subsequent treatment in the community.
In the remaining few minutes, I have just a couple of additional questions for the Minister. Again, if he does not have time todayI clearly understand that this is the hon. Gentlemans debateit would be helpful if he could write to me. For example, how much of the funding pledged for the stroke strategy has been delivered? How many of the stroke centres to date have achieved all 20 quality markers for a good stroke strategy? I assume that not all of them have achieved that target and, if so, what is the time scale for enabling all stroke centres to achieve it? Would the Minister also say a little about the awareness campaign that will begin next year? Has thought been given to the fact that it may stimulate additional demand, and does the NHS have the facilities and sufficient capacity to deal with such additional demand? Furthermore, what are the Government doing to support the communication needs of people who have suffered a stroke? That point was quite rightly made by other hon. Members.
I also want to reiterate two key points made by other hon. Members; again, if the Minister does not have time to address them today, he and his team at least need to think about them. The first point is about awareness, including public awareness of stroke. A recent NOP poll demonstrated that there is both confusion and ignorance about the signs of stroke. Promoting awareness also includes the important factor of GPs. I was very concerned, as other hon. Members were, when I saw the statistic that about 20 per cent. of patients who go to GPs with a TIA are not referred on. The
second key issue that hon. Members have raised, which the Minister will want to address, is the concern about ring-fenced money going to local authorities. That money has clearly been used, in some instances, for purposes for which it was not intended. That issue needs to be looked at, because it could have a detrimental impact on stroke care.
In conclusion, we spend more on stroke services, as a nation, and there is rightly an increased focus on them, but we still have worse outcomes than comparable European nations. We should adopt more of the recommendations of the National Audit Office and the Select Committee on Public Accounts to enable our dedicated and hard-working stroke physicians, nurses and associated health care professionals to improve the quality of stroke care in the shortest possible time.
The Minister of State, Department of Health (Mr. Ben Bradshaw): First, I congratulate my hon. Friend the Member for Nottingham, North (Mr. Allen) on securing the debate on this important subject. Secondly, I apologise that the Under-Secretary of State for Health, my hon. Friend the Member for Brentford and Isleworth (Ann Keen), who leads on stroke policy, could not be with us this morning due to two long-standing ministerial engagements.
I calculate that to answer 14 questions in nine minutes I will have to spend only about 35 seconds on each of them, so I shall throw aside the usual niceties of going through the history of the issue, as other hon. Members have done that. I shall not go into why we have a new stroke strategy or the importance of stroke, because those issues have been discussed so eloquently, not least by the hon. Member for Isle of Wight (Mr. Turner) in his moving and effective testimony.
I shall move straight to answering the questions that have been asked. On awareness, my hon. Friend the Member for Nottingham, North will know that a major awareness campaign is planned for the spring. It will include the face, arms, speech approach that he advocates, as well as stressing the importance of dialling 999. It will be along the lines of the successful British Heart Foundation campaign that many people will remember from the past year or so, which used posters and advertising of great impact on our streets and buses.
On prevention, my hon. Friend will be aware that we have asked primary care trusts to begin rolling out, from April 2009, vascular checks for the whole population aged between 40 and 74. As for when he can expect his check, in his local area, we expect the full system to be up and running by 2012-13. He has said that his area already has good practice and a good model, so he might get his check a little earlier. It is not only peoples risk of heart disease, stroke and kidney problems that will be assessed. The system will also work on the preventive messages on lifestyle and public health that he has rightly identified as being important. Those issues are the same as those for heart disease, and include smoking, obesity and physical exercise. Where necessary, people will be recommended courses on weight management and even cookery, assistance with smoking cessation, exercise classes and walking clubs. My hon. Friend is right to say that prevention is very important.
My hon. Friend is also right to stress the importance of rapid response, including the use of thrombolysis. That is recognised in the strategy, which is clear about the importance of acting quickly in the event of a stroke. It recommends the immediate referral for assessment of all patients with recent transient ischaemic attackI, too, hate the acronymor minor stroke. Those with a higher risk of subsequent major stroke will be assessed within 24 hours. For those with major stroke, the strategy suggests immediate transfer to a centre that provides hyper-acute services.
On clot-busting drugs, my hon. Friend asked where we were on the roll-out of thrombolysis. The National Sentinel stroke audit of 2008 states that thrombolysis services are increasing rapidly, albeit from a low base. We should, as he said, be aiming for at least 10 per cent. of stroke admissions being thrombolysed. Services are being reorganised to achieve that, and we are funding specialist stroke training, but it is important that thrombolysis is given in a safe and appropriate setting.
On scanning, I am informed that all hospitals now provide CT scanning, and that the great majority also offer MRI and carotid doppler scanning. However, access to imaging continues to present a major barrier to delivering high-quality care to all stroke patients, and the new strategy aims to address that problem.
The ambulance review has been completed. Of the 70 recommendations that have been made, some have been introduced and the rest will be completed by 2010. I understand that recategorisation as category A has been recommended, and provisions to ensure that that is implemented are being put in place.
On rehabilitation immediately after stroke, my hon. Friend has mentioned that operating across the seven-day week can limit disability and improve recovery. The strategy recommends that specialist rehabilitation should continue across the transition to home, or care home, to ensure that health, social care and voluntary services are joined up to provide the long-term care that people need. We have, as he has acknowledged, provided local authorities with £45 million£15 million a year for three yearsto develop improved models for delivering that joined-up care. As for whether information will be made public and how it will be monitored, we expect the evaluation of the strategys implementation to provide details on spending and information on its effect.
My hon. Friend asked whether the NICE-recommended target of 45 minutes of rehabilitation a day would be met and, if so, when. The strategy is a 10-year strategy, and we cannot comment on when any particular measure will be successfully implemented, but we expect all service providers to be making progress now. We intend to begin the evaluation of the strategys implementation soon, and that will give us detailed information about what is happening locally.
My hon. Friend stressed the importance of communication and helping people with speech. The strategy lists communication as a component of the joined-up rehabilitation approach, and will rely on a multidisciplinary approach being taken locally to ensure that patients receive the right support both in hospital and when they are discharged into the community. He rightly points to the recent problems that he has highlighted in a letter to my hon. Friend the Under-Secretary of
State about speech therapy services in his local area. I am pleased to say that the PCT is now addressing those problems.
My hon. Friend is absolutely right that the work force in both health and social care is important to the strategys delivery. We have allocated £16 million of central funding to enable the training of new stroke-specialist physicians, thus allowing services to expand their stroke work forces appropriately. We have also established a national training forum to develop a stroke educational framework, and we are supporting leadership programmes to improve skills and provide champions for stroke services at a local level. He asked particularly about the competency framework, which is under development. It includes looking for suitable institutions to provide accreditation. We hope to put the framework out for consultation in the spring, and there will be funding to support work force development, but exact details of spending levels cannot be agreed until the framework is in place.
On whether we are closing the gap between the UK and comparable western European countries, there have not been any international comparisons since the 2005 NAO report. However, the strategy is seen as a model by others. Professor Roger Boyle has been invited to Australia to give a presentation on how the strategy has been drawn up and how it will be implemented. A year into its implementation, we are confident that good progress is being made.
Hon. Members have mentioned the importance of the operating framework, and I should like to reassure
them that the data that are included in the indicators will be published. The performance of PCTs and acute trusts will be measured against that publication. The inclusion of stroke in the vital signs means that PCTs will have to take performance seriously. They and acute providers know that they will be closely watched and judged on their performance. Furthermore, Lord Darzis report, High Quality Care for All, has offered welcome reinforcement of the key themes of the stroke strategy. The independent health watchdog, the Healthcare Commission provides indicators that will help to measure progress on the stroke strategy.
There have already been encouraging signs of early progress. The 2008 National Sentinel audit of stroke states that almost every hospital now has an acute stroke unit, and that, between 2006 and 2008, there were substantial improvements in organisational scores on the provision of and access to minor stroke services. We expect that the strategys implementation could prevent 6,800 deaths or cases of disability. A further 1,600 strokes could be averted through preventive work. I shall finish with a quote from Jon Barrick, the chief executive of the Stroke Association. He has said of the strategy that this is a historic time for stroke and a
momentous opportunity to transform the outcomes and lives of stroke survivors in this country.
I wish particularly to talk about commercial public service broadcasting, especially regional production quotas, the provision of regional news and non-news items and the development of local online services. I do so in the light of the Secretary of States statement last week that we needed a debate
to establish the best way in which to sustain the aspects that the public like and on which they depend, which will mean devising a new way of sustaining public service content beyond the BBC in the future.[Official Report, 10 November 2008; Vol. 482, c. 478.]
Regional news and productions from the nations and regions are at the heart of Ofcoms long-term vision for public service broadcastingaudiences value this programming, so our object is to sustain and enhance it for the long-term.
Those two statements set out one thing, but in September the chief executive of ITV announced massive cutbacks in regional broadcasting and regional news and non-news items. Then there was a further Ofcom review, the consultation on which will end on 4 December.
The current situation is that ITV receives its television signal spectrum from Ofcom free, in exchange for its public service broadcasting. In addition, it receives its position on the electronic programme guide and the unquantifiable commercial value associated with being a public service broadcaster. When the UK goes digital in 2012, it is expected that that spectrum will be worth considerably lessperhaps only £40 million, compared with £200 million now. The chief executive of ITV has warned:
In the very near future the various channel 3 licences will start to go negative, the cost of their obligations exceeding their benefits.
Im very disappointed that ITV has missed its regional production quota for two years. These are legal requirements and not things to be negotiated or brushed away.
The out-of-London production quota for ITV was originally set in 2005 at 50 per cent. Last year it was only 44 per cent., having been 46 per cent. in 2006. Stuart Prebble, a former chief executive of ITV, has said:
The original ITV network was designed as Britain talking to Britain, not London talking to Britain.
To save money, ITV has planned to cut more than 1,000 jobs by the end of next February, including 430 in regional newsrooms. We know that the UK has other public broadcastersthe BBC and Channel 4but Ofcoms research has found that the public overwhelmingly want to see regional news and programming as part of what is on offer on ITV. Michael Grade has said:
ITV does not itself want any direct public money. We wish only to operate as a free-standing commercial business.
In September 2007, ITV announced the reform of regional news in England and the Scottish borders, reducing the number of regions from 17 to nine. That meant abolishing existing sub-regional news bulletins such as Anglia west and east, and the merger of the two smallest regions, Border and Westcountry. ITV is a private business, and those changes will reduce the number of people employed by more than 1,000. ITV plc will prioritise prime-time regional news by reducing the amount of news broadcast in the daytime. Some news-gathering will be shared between large areas of the country, such as the West and Westcountry regions.
The minimum non-news regional quota will be cut from 30 to 15 minutes a week, and I wonder what value there can be in such short segments of programming. I have made the point to ITV that I would like to see that quota lumped together so that there can be longer programmes, although perhaps not every week. For Wales, STV and Ulster, the non-news minimum will be cut from three hours to one and a half hours a week. ITVs original UK production and peak-time current affairs requirements will remain unchanged, but the non-peak current affairs requirement will fall by 40 minutes a week. The quota for programmes made outside the M25 will be reduced from 50 per cent. to 35 per cent.
For Five, original productions will be reduced from 53 per cent. to 50 per cent., and from 42 per cent. to 40 per cent. in peak time. For Channel 4, programmes from outside the M25 will increase from 30 per cent. to 35 per cent., including a new quota for the devolved nations.
Andrew George (St. Ives) (LD): My hon. Friend is making a very strong case. He mentioned the Westcountry and West regions. Although recent negotiations resulted in their altering the proposal for the provision of evening news from six to 15 minutes, they will be providing a threadbare service with the same level of staff and resources as they would have had under the original six-minute proposal. That will give them no capability really to investigate or dig below, with what will inevitably be a thin and reactive service.
Paul Rowen: I agree with my hon. Friend. Indeed, I understand that in Plymouth, for example, the number of people in the newsroom will be reduced from 100 to six. I question whether any meaningful programmes can be produced by that limited number of people.
Border and Tyne Tees will be merged, but they will have separate 15-minute sequences in weekday programmes and separate late-evening bulletins. Of the 168 workers there, 91 are to go. Sub-regional output in single licence areas will be reduced in volume, but they will retain short sequences in peak time and after News at Ten. Fringe areas will see a few minutes of local news each day.
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