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1.48 pm

Laura Moffatt (Crawley) (Lab): I am delighted to be able to take part in the debate. I was pleased to hear the hon. Member for South Cambridgeshire (Mr. Lansley) talk about how we can prevent stroke and the devastation that it brings. I do not think there can be a family in the UK who has not been affected by stroke in one way or another and does not understand how difficult it is to live with the consequences.

My hon. Friend the Minister will understand if I start by talking about how we used to treat people with stroke and how we treat them nowadays. Stroke is one of the key indicators of how the NHS has transformed the way it deals with such devastating conditions. I am sure she remembers what we did when someone was admitted to the ward and we knew that they were suffering from stroke or some cerebral vascular accident. We made them comfortable in the ward and they stayed with us for several weeks. We put their affected arm on a cushion, walked them up and down the ward sometimes and hoped that all went well when they went home. How different it is today, thank goodness.

It was interesting to listen to the debate about the London reconfiguration of services. There was a time when we would not have even discussed where a stroke patient was admitted. In fact, for a while I was very concerned that we were considering the effects of a cardiac incident in much more detail and much more forcefully than we were ever thinking about the effects of stroke. We should therefore be congratulated on having this debate and on how we now address stroke.

My hon. Friend the Minister clearly set out the effects of stroke, and how frequently people are affected by it. In the UK, it kills someone every five minutes. When we cite the figures, it can sometimes be difficult to understand how devastating stroke can be. Eighty per cent. of strokes are caused by the clot—the one that
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could respond to thrombylisis. That is why it is so vital that people with stroke are treated immediately. I hope that in my brief contribution I shall be able to offer some examples of how we can address stroke and reduce the incidence of it, and make sure that the unfortunate people who suffer a stroke can have better treatment.

Crawley has a very diverse population, and 14 per cent. of people there come from black and minority ethnic groups. We do not know why—there is not the research for us to understand it—but such groups, and particularly Afro-Caribbean people, are disproportionately affected by stroke. I was therefore delighted when the South East Coast Ambulance Service NHS Trust decided to focus on three areas in Surrey, Sussex and Kent with a particularly high proportion of people having to dial 999 because of a stroke, and Crawley was one of those areas. The trust decided to think about the strategy for dealing with that, and to look at not only responding quickly and getting people into an appropriate unit swiftly, but what role the ambulance service could play in reducing stroke. That is why I am delighted to be able to talk about the work that that service has done.

We have debates about the reconfiguration of such services, and some of us—most of us, I think—have been through some very difficult and uncomfortable times, but stroke services illustrate why we have to make sure that these devastating events are dealt with in the best possible unit. Paul Sutton, chief executive of SECAmb, has always said that the problem is not to do with getting people who have experienced an event such as a stroke into the nearest front door, but with getting them into the right front door—that of an emergency centre that will be able to treat them properly. When our ambulance services arrive at a site, they often do not pick people up immediately and rush them to the closest institution. I know that people sometimes feel that they should do that, but time is taken to examine the patient and to understand what is going on. Often, the ambulance will stay at the home for some time, while staff take advice about how best to treat that patient and where best to take them. Stroke is one of those conditions that serve to illustrate why we have to make sure that patients go to the right place.

SECAmb has chosen Crawley as one of the areas on which to focus, and it will soon have on its streets ambulances with wraparound advertising for the FAST campaign. I do not think there is a single Member who will not accept that that has been the most amazing campaign. I pay tribute to the actors who took part in it—I genuinely hope they are actors—as I think they did an extraordinary job in taking viewers through the process of understanding what a stroke can look like. Their work has had a tremendous effect. Our ambulances will have all that advertising on their sides.

One of our stroke leads in SECAmb is David Davis. He is an amazing gentleman from Crawley. [Interruption.] No, he is not the Member who has just been referred to from a sedentary position; this David Davis is much better. He is taking a fantastic lead in getting out into the communities that most need to understand the causes of stroke. He will therefore be found in the gurdwara, in temples and in mosques, helping people understand about stroke. If I can make one plea to the Minister it is that I want David to do more of this work. I want him to be out there preventing stroke, but he has
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to do his other job as well, of course, and it is difficult for a busy ambulance service to be able to free up him up along with the colleagues who help with this work. I want to make sure not only that our ambulance service staff are visible out in our communities doing that fantastic work, but that we have enough paramedics and paramedic technicians to back them up and support them. I want that work to continue because I believe it is having a considerable effect in helping to reduce the number of strokes in our communities. We need to make sure that much more of that preventive work takes place.

Mark Hunter: The FAST campaign has featured in the contributions of several hon. Members, and it has, of course, been a great success, but I understand that the funding that supports it is in place for only three years. Does the hon. Lady agree that there is a danger that some of this excellent work could be undone if there is not a longer-term commitment to funding it beyond the current three-year period?

Laura Moffatt: I thank the hon. Gentleman for that intervention, but I believe that the health services move so quickly that in three years’ time we will have moved on to new campaigns. I certainly hope the FAST campaign becomes part and parcel of our understanding as citizens of what can happen to people. I see it very much in the same terms as the seat belt campaign in that there is an initial start-up process, but the point then becomes embedded in our psyche and in our understanding of how we address things. I am fairly certain that there will come a time when we do not need a stroke campaign, but that we will then have to focus on other causes.

We have talked about the need for a quick and adequate response for those with stroke, and it will be a disappointment to all Members if that falls short of the excellent stroke strategy requirements for treatment. I do not think any of us would shy away from being a critical friend of the NHS if that were necessary, and from trying to make the situation right if it had gone wrong. All of us would happily highlight these campaigns in order to make sure that all our constituents got the service they deserved if they were affected by stroke.

I believe the stroke strategy has given focus to the whole stroke campaign and an understanding of where we are going with it. Interestingly, in a recent review of health services in the north of West Sussex, stroke was one of the principal issues that was addressed to try to strengthen our services. Crawley hospital has an amazing stroke unit; people come to it quickly after their initial treatment and there is a great sense of camaraderie. The staff are tremendously well motivated and qualified to deal with stroke.

The Minister will completely understand my second plea to her, as she is a former nurse, and once a nurse, always a nurse. Stroke mainly affects people who are over 55, and more commonly over 65, and the treatment of it should be a well-respected specialism that takes its rightful place alongside all other emergency care. Those who deal with stroke should be well regarded by those within the wider profession and be regarded from outside the profession as engaged in a field that contributes enormously to well-being. It is not a second-class field.
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Those in the nursing profession used to say, “Oh well, I’m going to go and look after older people.” That should be seen as up there with the most interesting of services. By making sure there is such high regard, we will be able to ensure that the service continues to improve and attracts the very best quality nurses.

To make sure that that happens, we must ensure that the professionals in our communities come together. In February, my right hon. Friend the Secretary of State launched a well-being programme in Crawley, dedicated to ensuring that people are exercising, that they are dealing with issues such as hypertension, which of course is associated with one of the highest predispositions to stroke, that such conditions are being properly monitored and that diet is being addressed. We also know that those who are obese have a predisposition to stroke. This is about tackling all those issues at a very basic level within our primary care services and about our emergency services coming together to ensure that people are less affected by this horrible condition.

When somebody has a stroke and receives the initial treatment—we hope that goes well and that the damage to the brain is reduced—we must ensure not only that they get the care in hospital that they desperately need but that it continues. Local authorities have a huge role to play in ensuring that timely adaptions are done at home, but co-ordination can sometimes be a difficult issue for local authorities to face. They need to ensure that when people are at home—be it in their own private home or in local authority or social housing—and needing to stay mobile, because that is crucial following a stroke, the adaptions are done in a timely fashion so that life is at least decent for them.

We want to ensure that throughout the service, from the first moment that horrible event happens to when people start to make progress through speech therapy and physiotherapy, things are as good as they possibly can be. The way we can properly tackle this is by ensuring that more research is done. The Stroke Association is a great advocate of ensuring not only that the research is done but that people are treated properly, and it does excellent research in all sorts of areas. The Minister may be interested to learn that because of the work being done in Crawley, the Stroke Association gave SECAmb a beacon of good practice award. That is something of which we can be justly proud in our area.

That is not to say that we are going to rest on our laurels, because we must continue to fight for better services for people who have a stroke. We must make sure that the emergency care is as it should be; we must continue to do much more preventive work; we must ensure that everybody within the professions is up to speed, and that includes GPs, nurses and practitioners throughout the national health service and beyond; we must improve the co-ordination of services when people return home, to ensure that adaptions are done in a timely fashion; and we must support the excellent voluntary groups, which make life better for those who have had a stroke, allowing them to come together with others to share experiences and to laugh and cry together over what can be a devastating event for a family. That is so important, and those groups are such a crucial element to all the work, as the Minister has said. In that way, we can genuinely ensure that people who suffer a stroke in
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the United Kingdom—and in England and Wales in particular—will have the best possible outcome following what can be the most appalling thing that can happen.

Stephen Pound: I am grateful to my hon. Friend, not only for the knowledge and expertise that she brings to this subject but for her personal commitment to it. Does she agree that if we are seeing a move from the widely established stroke units to hyper-acute stroke units for our thrombolytic treatment, there is a problem when it comes to repatriating the patients from the hyper-acute unit to their home without the intervening phase of the ordinary stroke unit? Does she agree that an essential component of precisely the process to which she referred is that the patient move from the hyper-acute unit to a stroke unit and then home?

Laura Moffatt: I thank my hon. Friend for that intervention, because he precisely illustrates the difficulty. Stroke is such an interesting condition because it involves the immediate and pressing nature of trying to reduce the effect and then the very long and ongoing rehabilitation that needs to take place. My opinion is that intermediate stroke units have an enormous role to play; I have seen them working well in my constituency and I have no reason to believe they would not be right for the rest of the UK, particularly London, which I know he is very concerned about.

I hope that we feel passionate about stroke, because we should do. It affects so many families and we have made enormous strides in tackling it over the years. I am very proud to be able to visit the units and see how people are treated—I can certainly say that about Crawley. I very much hope that the Minister will be able to say a few words about the work of SECAmb, because I believe it to be a gold-star service.

2.5 pm

Greg Mulholland (Leeds, North-West) (LD): I, too, warmly welcome this important and timely debate, and pay tribute to Members on both sides of the House for their contributions and to the all-party group, which has done so much to push this important area of health care and health policy up the agenda. As stroke is the third biggest killer in this country, after heart disease and cancer, and the leading cause of adult disability, it must remain an absolute priority for the NHS.

The Minister has mentioned the cost of stroke care to the NHS. The relevant figure is £2.8 billion, and the individuals involved—those unfortunate people who have suffered a stroke—take up more than a fifth of all hospital beds in the country. This issue has an economic cost, as well as a real and tragic human one. Some 45 per cent. of those who suffer a stroke die from it, not to mention the fact that stroke causes the many levels of disability that other hon. Members have mentioned.

We all acknowledge that in the past stroke care did not get the attention or the funding that it deserved, given those stark statistics. Until a few years ago this country had one of the worst stroke care regimes in western Europe, but things have turned a corner and improved since the publication of the national stroke strategy in December 2007, which was warmly welcomed in all parts of the House. It is encouraging to see the impact that the strategy has already had and the improvements made since that very important milestone.


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It is also important that stroke was established as a “national priority” in the NHS operating framework of 2008-09, which obliges primary care trusts to set out their plans to improve stroke services. I emphasise to the Minister that although that welcome strategy is in place, we need to monitor things at the PCT level to ensure that improvements are happening on the ground. It is also important to stress that although the strategy is extremely welcome, the Minister must acknowledge that there are issues to address in respect of not having set time scales for some of the improvements within the 10-year period. Perhaps we need more milestones to aim for in order to see how the strategy is being implemented. It is excellent that we are talking about this nearly two years after the strategy was introduced, but it would be encouraging to say exactly where we are aiming to make tangible improvements in stroke care over the course of the 10-year period. I also welcome the Government’s announcement of their intention to commission an independent evaluation of the strategy and its implementation—that is enormously important, because we all need to follow its progress. Will the Minister let the House know when those results will be made public and when that process will be complete?

Several matters relate to the strategy and to stroke care in general. The first, as has been mentioned, is the great need for awareness of the symptoms of stroke and the need for proper referral from that point. Data from October 2008 show that 18 per cent. of public respondents had no knowledge at all of the symptoms of stroke. Rather more alarmingly, a 2005 National Audit Office report showed that only just over half of GPs would immediately refer someone with suspected stroke for the emergency care that is so crucial to the outcome for stroke patients from that initial point.

I want to echo comments made by other hon. Members about the Act FAST campaign, which we all agree has been enormously powerful in demonstrating the situation visibly and in an easy to understand way.

Mark Hunter: As my hon. Friend has said, the Act FAST campaign has been acknowledged by Members on both sides of the House. One of the direct consequences of the success of the campaign is that the number of calls to the Stroke Association’s helpline has increased by some 36 per cent. The association says—this is perhaps an indication that it is struggling to meet demand—that it estimates a 200 per cent. increase in the number of calls that have been abandoned while people were waiting to get through. It might be said that that is a consequence of the success of the campaign, but there is a real issue about support for the Stroke Association. I invite my hon. Friend to agree with me, and I hope that when the Minister responds later she will discuss what further support the Government can give the Stroke Association.

Greg Mulholland: I thank my hon. Friend for that valuable and important contribution, which addresses a point that I was about to make. I echo his comments in asking the Minister, in light of the extra volume of calls, what additional help hospitals and voluntary organisations are being and will be given, so that they can cope with the very welcome additional strain that has resulted from the success of the campaign. That is an important area for the Minister to concentrate on.


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Do the Government intend to do any quantitative analysis of the success of the campaign? I think that it would be very insightful. As has been mentioned by the hon. Member for Crawley (Laura Moffatt), have they considered the impact on particularly high-risk groups, such as those in certain black and minority ethnic communities—in particular those from south Asian or Afro-Caribbean communities? If the Minister can give us some indication of how the Government plan to target those particularly at-risk groups, that would be very useful.

Let me turn to prevention. Hon. Members have already said that that is absolutely crucial. When we consider that 20,000 strokes a year could be avoided through preventive work on high blood pressure, irregular heart beats, smoking cessation and the wider use of statins, we see that prevention is an absolute priority in dealing with strokes. Again, if we consider the economic impact, preventing just 2 per cent. of strokes in England would save £37 million of care costs. That is a matter that needs even higher priority in the strategy.

I welcome the NHS health check programme. It can highlight those most at danger from stroke, as well as those at danger from other conditions. How many people have been invited to these health checks, and are the most at-risk groups—the most susceptible groups—being invited? That is crucial, if the checks are to have the kind of impact that we all hope that they will in reducing the number of strokes that happen in the country.

On treatment, as has already been mentioned the most crucial thing for stroke patients is to arrive swiftly at a stroke unit. The concerns that suspected stroke patients are not being prioritised sufficiently within the ambulance service are very real. In terms of the provision of CT scans and thrombolysis, the importance of specialist stroke units cannot be overstated. The Stroke Association has described stroke units as

As other hon. Members have said, however, there are disparities in care between those who are admitted immediately to stroke units and those who spend time on general wards or in accident and emergency departments. The simple fact, borne out by the figures, is that patients who are admitted to stroke units quickly are more likely to survive and to make a better recovery. Again, we should consider the costs, the impact on patients and the length of time involved; such patients will spend less time in hospital than their general ward counterparts, who have a 14 to 25 per cent. higher mortality rate.

The 2008 Royal College of Physicians audit shows that there has been a huge increase in the number of hospitals that have protocols for ambulance service emergency transfer of patients to stroke units from 4 per cent. in 2004 to 49 per cent. in 2008. That is extremely welcome, but, as we have already heard, it is not happening up and down the country. I make reference to the particular concerns in London and echo the concerns about the somewhat arbitrary natures of the decisions that appear to be being taken.


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