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The provision of thrombolysis, as has been mentioned, is much too limited. I hope that the Minister will agree that that is an area where the strategy so far is not
achieving what we all hope that it will achieve. Last year, only 8 per cent. of patients received thrombolysis, even though 15 per cent. of patients were eligible for that kind of treatment. Both CT scans and thrombolysis fall below National Institute for Health and Clinical Excellence standards.
Mr. Lansley: Before the hon. Gentleman carries on, I think that he will find that just over 8 per cent. of the appropriate population receives thrombolysis. The appropriate population is about 15 per cent., and about 8 per cent. of those receive it. In fact, the proportion of stroke patients who receive thrombolysis is just under 1 per cent.
Greg Mulholland: Did I not say 0.8 per cent.?
Mr. Lansley: You said 8 per cent.
Greg Mulholland: I apologise and thank the hon. Gentleman for that correction. I meant to say 0.8 per cent. and appreciate the intervention. May I echo what he has said about the inadequacies in CT scans and thrombolysis? NICE guidelines clearly state that all patients should be scanned, diagnosed and treated with thrombolysis, if required, within an hour. We have to acknowledge that we have a long way to go before we achieve that.
Treatment of mini-strokes—TIAs—has already been mentioned. Effective treatment of TIAs is very important, as the risk of having a stroke within the first four weeks of a TIA is 20 per cent. According to the 2008 RCP stroke audit, only 45 per cent. of hospitals meet the stroke strategy’s recommendation of investigating and treating high-risk TIA patients within 24 hours, which means that 55 per cent. of them are not doing so. Again, there is a lot of work to do on that, and I ask the Minister to give us her thoughts on how the figure will be improved.
After-stroke care is the final area of focus in this debate. There are real concerns about stroke patients—and indeed their families, who clearly have an important role to play in the rehabilitation and care of stroke patients—not yet having their needs fulfilled in that regard. After-stroke care is essential to regaining and relearning skills, sometimes even basic skills of everyday living. Rehabilitation is therefore absolutely essential. There have been improvements in that area, but even so, only half of stroke survivors receive rehabilitation in the first six months after discharge, and only a fifth do so in the next six months. I am afraid that it is an area in which, so far, the strategy is simply not delivering.
Post-hospital rehabilitation needs to be organised while the patient is still in hospital, and not when they are discharged, and that has to be addressed. For example, home adaptations clearly have to be done before a patient returns home, so that they can carry on living their life, which is what we very much wish them to be able to do. The provision of information is an easy, cheap way to assist in the important process of rehabilitation, but there need to be improvements to that, too. The stoke audit of 2008 that I mentioned found that there had been little progress since 2006 in improving the amount of information given to patients and carers in hospital about reducing the risks of a further stroke. Of course, the whole purpose of
rehabilitation is not just recovery, but prevention of further strokes. Some 58 per cent. of those patients for whom diet advice was applicable are recorded as having received it, and much of the information that is provided is not particularly helpful. A survey carried out by the Healthcare Commission, admittedly back in 2005, found that only 55 per cent. of patients understood the information that they received in hospital.
I now come to the issue of care for those who are not able to return home. The voluntary sector does a wonderful job in many cases, assisting people in coming to terms with life after a stroke, yet the resources are simply not there, as is the case, I am afraid, for a great deal of social care for people recovering from conditions. I ask the Minister whether it is not time for the Government to consider making more resources available to voluntary groups to enable people to carry on living their lives in the community, or in specialist homes, if that is what medical professionals deem that they need. The whole issue of social care needs more work, and I ask the Minister to address the issue in her comments.
I welcome the opportunity for this debate. I hope that we can have such debates at regular periods throughout the 10-year strategy, no matter which party is in government. It is important that all of us with an interest in this area of health care continue to monitor the implementation of the strategy, because all of us in all parts of the House are absolutely committed to ensuring that stroke care is a priority for the health service, and is very much at the top of the health policy list. All of us will continue to have that commitment, and we want the strategy to succeed.
2.23 pm
Mr. Andrew Dismore (Hendon) (Lab): I particularly want to address the issue of the expansion of stroke services in London, on which Healthcare for London has recently been “consulting” as part of its stroke and major trauma consultation exercise. I put “consulting” in inverted commas, as it has been such a botched consultation that the public see that expansion of services as a cut. In my area, we have seen the unsightly picture of one NHS body advertising and lobbying against another, adding to the atmosphere of confusion and disinformation all round, and turning what should be a positive story into a negative one. Members of Parliament have been kept somewhat out of the loop, too.
Barnet and Chase Farm Hospitals NHS Trust wrote to me on 7 April to plead its case, as opposed to that of Northwick Park hospital, for being one of the proposed eight hyperacute stroke units, on the basis of its location. Its letter refers to its existing transient ischaemic attack centre and the need for a local stroke unit. It implied that current services would go as a result of the changes, but of course they will not; they will be continued, as will the services provided by TIA centres and local stroke units everywhere else, and certainly in my area.
Barnet and Chase Farm Hospitals NHS Trust then took out a full-page advertisement in the local newspaper—an advertisement that I can describe only as a scare story. It somewhat irresponsibly implied that cuts, which are not proposed, would be made, and that people’s chances of survival would be reduced if the trust did not get its own way. It exhorted people to write into the consultation supporting its views, without giving
a true picture of what is proposed, and it whipped up a climate of fear in the area. The Tory council then joined in the act, spending £42,500 on a letter to every household, signed by the leader of the council, who is the Finchley Tory parliamentary candidate. Again, it did not put the argument fairly, but I am pleased, or not pleased, to say that it gave the wrong details regarding how people should send their response by e-mail, so not many responses came in. That was rather a waste of £42,500 of council tax payers’ money.
That set off the local papers, which ran stories about NHS cuts, although no cuts, only an expansion of services, were proposed in our area. A headline in the Barnet press stated, “Council kicks out at NHS bid to ditch stroke unit”, although there is no bid to ditch any stroke unit. Slightly more responsibly, the Hendon & Finchley Times said:
“Every minute you lose is crucial.”
There has been no attempt by NHS London or Healthcare for London to show a true picture of what is planned. There was not one effort to write a letter to the local papers explaining what is going on, so a good news story ended up as a cuts story by default. This is my question for my hon. Friend the Minister: when will the NHS get its act together in explaining what is actually going on? When will clinically led plans—that is what the plans are—be properly explained by clinicians to the public? Is it not time that the NHS had a decent communications strategy, with proper, objective, wide consultation on such major plans? If we can do that locally, why can it not be done London-wide, and why has the NHS simply ignored all that is going on? It is simply unacceptable, because the proposals are a good news story.
Clinical evidence shows that patients are 25 per cent. more likely to survive or recover from a stroke if they get treated in a specialist centre. In London, there are big differences in the quality of stroke care. Rates of death in different hospitals vary considerably, and people in outer London have the most limited access to high-quality stroke services, which is why the proposals are particularly important. For some strokes, clot-busting drugs can stop and reverse the damage, but only after a high-quality scan has shown whether the patient is suitable for the drugs, so stroke patients need fast access to scanning facilities to have the best chance of recovery. Currently fewer than 10 per cent. of suitable patients are offered thrombolysis.
So what is proposed? As I have said, the proposals are not a cut. The NHS plans to invest more than £23 million a year extra in new stroke services for London, with more and better trained doctors, nurses and therapists to deliver those new services. There is a proposal for eight hyperacute stroke units, which will provide the immediate response in the first 72 hours after a stroke, or until the patient is stabilised. They will be open 24 hours a day, seven days a week. Anyone having a stroke in London will be taken to one of them to have a brain scan. If appropriate, they will receive the clot-busting drugs within 30 minutes of arriving at the hospital.
More than 20 stroke units will provide ongoing care once the patient is stabilised, and the transient ischaemic attack services will provide rapid assessment and access to a specialist within 24 hours for high-risk patients, or seven days for low-risk patients. Everyone in London
will be within a 30-minute ambulance drive of one of those services. Obviously, the issue of how long that journey will take is a matter of contention. It is easy for us who drive around in cars to try to compare how long it would take us to do a journey with how long it would take a blue-light ambulance, but there is no comparison.
The Tory leader of Barnet council—the Finchley Conservative candidate—has suggested that the figures are based on journey times at half-past 2 o’clock in the afternoon. As part of its analysis, Healthcare for London sourced the details of every single ambulance journey in London for three years—about 4 million records. It compared 100,000 blue-light journeys with 2 million other urgent ambulance journeys. It assessed the impact of the day of the week and the rush hour on the journey times, and it conducted a lot more detailed analysis besides. The figure is also backed up by the day-to-day experience of the London ambulance service in taking patients to eight specialist cardiac centres across the capital, so it is not surprising that the LAS supports the proposals. To give my own snapshot, I spent a shift driving around with the ambulance emergency services, and my experience supports the idea that the times are probably achievable.
Locally, research by my PCT in Barnet shows that people living in deprived areas are more likely to die of vascular diseases, to smoke and to be obese, and they are thus at greater risk of having raised blood cholesterol levels, pre-diabetes, diabetes or high blood pressure. They are also less likely to visit their GP and have vascular disease risk factors identified and managed. There is thus a higher risk and incidence of stroke in the most deprived part of the borough—the west—which is my constituency. That has been confirmed by the opinion of the PCT medical director, Dr. Andrew Burnett, with whom I spoke last night. Northwick Park is easier to access from the west, my constituency, than Barnet hospital—a matter to which I shall return.
For our part of London, consideration was given to Northwick Park, Barnet, University College hospital and the Royal Free. NHS London preferred Northwick Park to Barnet, because it provides better travel times and reflects existing patient flows. These arguments are supported by the London ambulance service. From my area the road to Northwick Park is mainly a straight, wide major road, whereas the road to Barnet is little more than a country lane.
Mr. Lansley: In its document, NHS London presented Barnet hospital and Northwick Park as alternatives. Will the hon. Gentleman explain why they need to be alternatives, and why it is not possible for both hospitals to provide scanning and thrombolysis?
Mr. Dismore: If the hon. Gentleman reads the consultation document from Healthcare for London, the answer is there.
Mr. Dismore: “The shape of things to come”, the compact document which is easier to handle when making a speech, states:
“We believe that hyperacute stroke care should be delivered in no more than eight sites across London”—
this is on page 20. It continues:
“This would optimise the number of patients being treated at each site, ensure expert teams are available 24 hours a day—improving survival and reducing disability”.
The hon. Gentleman will be aware that if the aim is to provide very specialised high-quality services, it becomes an argument— [Interruption.] If he will stop intervening from a sedentary position and let me make the point, I shall be happy to give way to him again. The argument in this case is very much the argument advanced back in the early 1990s by the Government, whom he supported, for the closure of Edgware general hospital and the merging of the accident and emergency department there with that at Barnet hospital, on the basis that by creating a critical mass of patients, a higher quality service could be delivered.
That is exactly what is being proposed in relation to the stroke units. If somebody were to convince me and Healthcare for London that an equally high-quality service could be delivered at Barnet hospital, I would have no objection. My concern is for my constituents—not for the whole of Barnet, not for Enfield, but for my constituents, who would find access to Northwick Park rather easier from the particularly deprived parts of my constituency than they would to Barnet.
Mr. Lansley: I had not realised that the consultation in London was somehow the fault of the previous Conservative Government, but then everything that the hon. Gentleman complains about is probably the fault of the previous Conservative Government. My point is not that some of his constituents should be advantaged by using Northwick Park rather than Barnet. I contend that there is nothing in the consultation document that demonstrates why it is not possible, as has been said, by NHS East of England, for example, for a large number of emergency departments to continue to offer acute care of stroke, including thrombolysis, as long as they are able to have, for example, immediate access to CT. The emergency departments of most hospitals increasingly have access to CT. The images can be sent somewhere else for interpretation—the specialist part—if necessary.
Mr. Dismore: I certainly do not hold the hon. Gentleman responsible for the consultation. His Government were not interested in spending an extra £23 million on services. They were interested in cutting services. The point that I am making is that a very similar argument was advanced by his Government for closing Edgware general hospital—that better A and E services could be delivered through the critical mass resulting from a bigger patient base at Barnet hospital than at the two hospitals, Edgware and Barnet.
I listened to what the hon. Gentleman said, and no doubt my hon. Friend the Minister will respond to it later. We need a critical mass of patients to be able to deliver high-quality services. We have a difference of view. Obviously, if it is possible to have stroke care at both hospitals, I have no objection, but if that is not possible, I prefer, on behalf of my constituents who live in the deprived part of the borough, the existing proposals for Northwick Park to the case for Barnet.
We debated across the Floor the subject of UCH and the Royal Free. Preference was given to UCH, although I agree with the hon. Gentleman that the services at the Royal Free are of a very high quality. As I explained to him, I raised the matter with the Royal Free. It has
accepted the proposal that it should work in partnership with UCH on the basis that UCH is able to provide better standards than the Royal Free at the National Hospital for Neurology and Neurosurgery, which is part of UCH. It is also important to point out that the Royal Free and UCH scored higher than Barnet on future clinical standards.
Given the criteria in the consultation, I understand why Northwick Park was preferred to Barnet. It is important to recognise that the hyperacute units are only part of the story. I object to the scare stories run by the Conservative party that we will see the closure of stroke units and TIA units across London, which is not the case. As far as I can see, not only in my constituency but in my sector of London, those units will continue. That is the general picture, from what I know of other parts of the capital. It is wrong to suggest that those units will close and to scare people in that way.
The TIA services for people who have had a mini-stroke will be provided at hospitals with hyperacute units or ordinary stroke units, as they are now. These assessment services will reduce the chance of someone going on to have a full stroke by up to 80 per cent. TIA and stroke services are provided at Barnet and at the Royal Free, as well as at Northwick Park and UCH, and they will continue to be there. The intention is to provide a comprehensive service, including the existing units at Barnet and the Royal Free.
An additional point that I put forward in my response to the consultation was that I would like to see continuing care and rehabilitation services provided at Edgware community hospital as well. The rehabilitation services there have extra capacity, which could be expanded to deliver additional help in a constructive way and closer to home for patients suffering from the long-term after-effects of stroke.
2.37 pm
Mr. Malcolm Moss (North-East Cambridgeshire) (Con): I begin by apologising to the Chair, the Minister, colleagues and Members in that I may not be in the Chamber for the full duration of the debate. I have other commitments at the Foreign Affairs Committee later this afternoon.
Strokes are one of the most widespread and expensive conditions in the UK, costing the nation around £7 billion every single year, and on current trends the prevalence is set to increase at a worrying rate. Years of neglect in this area of public health policy have left the UK with the unenviable reputation of having some of the worst outcomes for stroke patients in the whole of western Europe.
I was lucky enough in April to secure a Westminster Hall debate on cardiac and vascular health. May I take this opportunity to thank the Minister for honouring her commitment to answer the questions that remained outstanding at the end of the debate, and for the detailed responses that she sent me? It was during that debate that I highlighted the work of the Cardio & Vascular Coalition, which has published key recommendations for a new integrated approach to cardiac and vascular conditions for policy makers to consider.
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