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There is now a ridiculous conflict of interest, whereby the managements of the Conservative local authority and the local health service have fused. Therefore, the person who is charged locally, as the chief executive of what was called the PCT, with rebutting the accusation that the health service is not receiving investment, is being downgraded and is in decline, is exactly the same person putting out the propaganda saying that it is. The situation is quite surreal. I have raised the matter with Healthcare for London, but it prefers to make no comment. Just as in Hendon, where one part of the NHS is briefing against another, we now have a chief executive of the local authority who damns the health service in the morning and then, as the chief executive of the health service, tries to defend or praise it in the afternoon.
That cannot be allowed to continue, because at bottom it affects my constituents confidence in the local health service, which is excellent and improving. In my opinion, the only solution is to abandon at least those parts of the consultation that are discredited and were never consulted on in the first place, and which can only lead to a conclusion that is at best inadequate and at worst detrimental to patient care. I would ask my hon. Friend in responding to this debate to say that she will ask Healthcare for London to look at the situation again, because it is not satisfactory for us to go forward with, on the whole, an excellent proposal for stroke and trauma careone that will improve services and save liveswithout the certainty that things are being done with honesty and integrity, and in a way that will not confuse or undermine the health service in west London or peoples opinion of it.
Dr. Richard Taylor (Wyre Forest) (Ind): Let me start by declaring an interest, in that I am very much in the age group of those who can expect to suffer a stroke at some time in the not-too-distant future. I support the hon. Member for Vauxhall (Kate Hoey) and have visited the stroke unit at St. Thomass, which is absolutely excellent, and I would be delighted to go there, if I had to.
I will be as brief as I can and cover just three aspects, the first of which is emergency calls. It is crucial that emergency calls are taken seriously by all facilitiesthat is, by the ambulance people as well as by the doctors. I have long argued in favour of having another telephone number in addition to 999 for those who do not think that they are an acute emergency, but would like advice. That is particularly important for someone who gets a transient ischaemic attack, but then gets better and does not know what to do. It would be useful if they had another number that they could contact easily, which would tell them that such an attack is a serious warning that they have to act on.
Let me turn to stroke care networks. I would like the Minister to tell me in her winding-up speech what her idea of the stroke care network is. An article in the 21 May edition of the Health Service Journal entitled Sink or Swim deals with the importance of district general hospitals to local communities. We should be considering two different kinds of stroke unit, namely larger units in major centres and local units, which are crucial for sorting out people with transient ischaemic attacks and with strokes that do not necessarily need
thrombolysis. NHS East of England has already been referred to in the debate, and it is mentioned in the article:
Many district general hospitals are keen to retain core emergency services. NHS East of England has committed to retaining A&E and consultant led obstetrics at all its trusts and thrombolysis for stroke patients, at least part of the time.
It seems possible to have pretty widespread local stroke units that will deal with all forms of stroke, with a number of them being able to give thrombolysis as well. At this point, I must refer to the National Institute for Health and Clinical Excellences technology appraisal, which is mandatory. It states:
The Committee was aware that in the UK, physicians with experience in stroke care are not always the same as those specialised in neurological care. The Committee concluded that alteplase
should be used by a physician trained and experienced in the management of acute stroke and only in centres with facilities that enable it to be used in full accordance with its marketing authorisation.
That sets quite a high target for the stroke units that will be providing that therapy, but it is something that we should aim for. We have already heard that the time limit for administering that treatment is exactly three hours. For a patient to get to a unit, have the scan and receive the treatment within three hours is enormously demanding. That is why I hope that, as well as there being networks, some of the local units will also be able to provide thrombolysis, at least part of the time.
Speaking from an out-of-London perspective, I believe that transport is also crucial. If the major stroke centres are to be located only in a few places, we are going to need to use the air ambulance service much more than we do at the moment. That raises the question of when the Government are going to consider making some sort of contribution to running air ambulances.
I hope that the local stroke units will become widespread, but I must point out the necessity of their each having a complete team. They will need not only doctors and nurses but, as has been pointed out many times, speech therapists. Unless things have changed in the past few months, speech therapists are almost as rare as hens teeth. The units will also need physiotherapists and occupational therapists, but they, too, are shortage specialties. Rehabilitation is essential for the long-term care of people with strokes when one has not been able to prevent the completion of the stroke.
Finally, the Next Stage review recognises the risk that reconfiguration can make services fall down. The Under-Secretary of State in the House of Lords has made it clear that we must never reconfigure until alternatives are in place, otherwise there will be an untenable gap.
Mr. Brooks Newmark (Braintree) (Con):
I am delighted to follow the hon. Member for Wyre Forest (Dr. Taylor). I want to begin my speech on a personal note. My father-in-law, Sir John Keegan, had a stroke four weeks ago. He survived due to the swift response of his local ambulance service and the immediate care that he received at Salisbury district hospital in the critical first three hours following his stroke. I want to thank the doctors
and nurses in the Farley unit at Salisbury district hospital for all their after-care in the past four weeks. In particular, my mother-in-law, Susanne, my wife, Lucy, my brothers-in-law, Tom and Matthew, and my sister-in-law, Rose, share my gratitude.
As we have heard from my hon. Friend the Member for Westbury (Dr. Murrison)in whose constituency my in-laws livestroke is the countrys third largest killer. It is also the single largest cause of adult disability, a point made by my hon. Friend the Member for Buckingham (John Bercow) at the beginning of the debate. We all have constituents who have been affected and I suspect that most of us may have experienced a stroke within our own families, as I did recently. Yet for too long, strokes have been the poor relation in the NHS, so I welcome the long overdue national stroke strategy of 2007, which finally prioritised stroke care for health and social care providers. Our response needs to be commensurate with the sheer size of the problem.
The strategy has undoubtedly brought progress, but we must not stand still on the issue. Not enough patients are receiving the treatment and care that they need quickly enough and too many are subject to a dangerous postcode lottery. Inequalities in access to stroke units and long-term care all too often mean that where people live can dramatically affect the length of recovery from a strokeor even whether they recover at all.
If we want to improve stroke services, we must focus essentially on three elements: first, saving lives in hospital; secondly, reducing disabilities and long-term damage; and, thirdly, preventing strokes altogether. Speed is of the essence with a stroke. A scan and early treatment within the first three hours can, as we have heard, make the difference between complete recovery, a lifelong disability or even life at all. For example, a brain scan will crucially confirm the diagnosis of someone admitted to hospital. For people with ischaemic strokes, swift thrombolysis or treatment with clot-busting drugs within three hours will significantly reduce the chances of dying, yet last year, only 0.8 per cent. of patients received thrombolysis.
I know that having a specialist stroke unit can do much to improve survival rates and recovery times for stroke patients. Commendably, early access to a stroke unit has improved significantly since 2006. However, in 2008, one quarter of patients were still not being offered this servicea service that I know, through personal experience, really can make a difference. As our population ages, the demand for these specialist units can only grow, so we must ensure that we can cope.
Having swift and high-quality stroke services from day one makes sense for our countrys financial health, too. Caring for stroke patients currently costs the UK about £7 billion each year because of the long-term implications of a stroke and the detrimental effects of delays in treatment. Given that about a third of stroke survivors will be left with a moderate to severe disability, long-term social care is often a necessity, not a luxury. However, the Stroke Association says that rehabilitation and long-term care in the community is one of the weakest elements of a stroke survivors pathway. Only around half of those who have experienced a stroke receive the necessary rehabilitation in the first six months following discharge from hospital, which falls to a fifth in the following six months.
The transition from hospital back to the community can also be extremely difficult. Not only do about a third of stroke survivors have communication difficulties including, as highlighted in the Stroke Associations recent Lost without Words campaign, aphasia and speech impactsbut many experience a loss of confidence and independence as they struggle to regain their basic capabilities and rebuild their lives.
I am pleased that as part of the national stroke strategy, every local authority now receives a ring-fenced grant of around £100,000 a year for stroke services. However, I believe that the scheme is currently intended for only three years, so just as services are really starting to make a difference, I fear they may be shut down for lack of long-term financial support.
Finally, it is not enough to just to treat the symptom of the problem, as its cause is also important. We can reduce the likelihood of a stroke through preventive work on high blood pressure, irregular heartbeats and smoking, for example. That alone could prevent thousands of strokes each year, saving not only many families from having to watch a loved one suffer, but millions of pounds each year in care costs. For progress on stroke services, we must look carefully at three elements: the urgency of immediate health care; the long-term nature of recovery; and the opportunity to prevent strokes in future. Only if we can weave those into a more seamless approach, applied evenly regardless of where the patient lives, can we say that we are doing the best for the thousands of stroke sufferers each and every year.
Harry Cohen (Leyton and Wanstead) (Lab): I appreciate being given a few minutes to contribute to the debate, especially as I missed the opening speeches, for which I apologise to those on the Front Benches.
I praise the Government for the improvement that they have tried to make in stroke care. The service in the NHS has been patchy and unsatisfactory for too long, and that is not what is needed in a modern health service. The national stroke strategy and the efforts in relation to hyper-acute centres are moving it in the right direction. A consultation process has taken place in London, including my area of north-east London. As part of that consultation, I have written to express my dissatisfaction about the way in which Whipps Cross hospital, in my constituency, was treated. It had a good case for being a hyper-acute centrebetter than that for Queens hospital and the Royal London, which were the ones chosen. The decision has been made on the basis of having two locations, and Whipps Cross has missed out unfairly in that regard.
A lot of money will be needed to bring Queens and the Royal London up to a decent standard, and it is important that local hospitals such as Whipps Cross are not starved of moneys to run a good acute and TIA service. As money is pumped into the chosen centres, that is a risk. The Minister and NHS London must take on board the point that good local provision of acute and TIA services is still needed.
In my intervention on the hon. Member for Westbury (Dr. Murrison), I made a point about ambulance services. Further improvements are needed to enable ambulance services to act promptly, and perhaps we need to look at traffic arrangements to ensure that ambulances get to
centres on time for patients. The hon. Gentleman made a crucial point about the need for triage efficiency at A and E centres to deal with people as soon as they come in.
The hon. Gentleman also made a good point about acute services taking advantage of investment in telecommunication linksfor instance, to enable people who have reported there to get treatment without having to go off to the hyper-acute centre. That needs improvement, and the expertise needs to be in local hospitals.
In north-east London, another plan being considered includes the option of a reduction in beds. That would be wrong for stroke care, because the beds are needed for rehabilitation of patients. In a proper stroke care model, there is no case for a reduction in beds.
Improved rehab and community stroke care provision, which remain weak, are needed. We have talked about NHS provision for stroke patients being patchy, but that in local authorities is even patchier: some are good; others are not, or they set high criteria to be met before giving help. A good look at what local authorities do is necessary, and they should be helped to provide such support in conjunction with the local NHS.
Only half of people get rehab in the first six months after having a stroke, which is too low a figure. As has been mentioned, the figure falls to a fifth in the next six months, which is not satisfactory. Only a third of patients in England benefit from early discharge support, which enables them to be rehabilitated in their own homes. That position needs to be improved substantially. I think I am right in saying that according to figures provided by the Stroke Association, only 12 per cent. of people who experience communication difficulties following a stroke are given speech therapy, and I believe that only 6 per cent. of people in London receive such support. Much more needs to be done in that regard.
My last point about rehab and community stroke care concerns people who suffer transient ischaemic attacks. Because of the fear that they will go on to suffer a major stroke, those people need to be seen within 24 hours, but I understand that at present only 45 per cent. of them are seen within that time. It has been estimated that if the figure were 100 per cent., which is the Governments target under the national stroke strategy, the number of people subsequently suffering full strokes would fall by as much as 80 per cent.
There are many issues surrounding hyper-acute centres, acute centres and TIA services in the more local hospitals. While the Government are pushing ahead with the centres and trying to improve the service, they must not lose sight of local provision, which I believe can play a very important role. By that I mean provision either by local hospitals or by local authorities in conjunction with the NHS. A great deal of credit is due to the Government, but there is much more to be done, and they should not forget that local role.
I thank all Members who have contributed to this important debate. I am particularly grateful for the way in which they congratulated the Government. Of course we all recognise that there is more to be done, but by bringing us together the debate has demonstrated that consensus across the House is a vital ingredient if we are to make progress on an issue as important as
stroke. I acknowledge again the important work of the all-party parliamentary group on stroke and the contribution that it has made.
We are tackling all the work that needs to be done through the stroke improvement programme and the stroke care networks that it set up. The strategy is a 10-year plan, and there are no simplistic quick fixes to bring about the improvements that we want to see. We are the first to acknowledge that there is a long way to go.
In the short time available to me I shall respond to as many as possible of the points that have been raised, but if, as is likely, I fail to respond to all of them, I shall of course write to Members and ensure that all their points have been properly addressed.
My hon. Friend the Member for Crawley (Laura Moffatt) shared her experience with us, telling us how stroke patients had been treated in the past. Let us ensure that it definitely is the past. I, too, acknowledge the work done by David Davis with the South East Coast ambulance service: it is well known and recognised in the Department.
London Members in particular, including my hon. Friends the Members for Hendon (Mr. Dismore) and for Ealing, Acton and Shepherds Bush (Mr. Slaughter), have raised the scare stories that have been put about concerning closures that will not, in fact, take place, for instance at Barnet, Finchley and Charing Cross. I am more than familiar with that debate. No wonder the local community is engaged in the debate over Charing Cross. As long ago as 1992, when the then Conservative Government introduced the internal market, it was said that the market would decide whether Charing Cross or Hammersmith would stay open. There is no closure of Charing Cross; there will be no closure of Charing Cross. Imperial college is making sure that all the services that are coming from the Imperial College Healthcare NHS Trust are of the highest possible standard, but I note what has been said about the consultation, which ended on 8 May. Announcements are due on 20 July, I believe. If the process still needs to be looked and monitored in any way, I know that Members will make their views known to me. I will do my best to ensure that NHS London is aware of the debate and how that has progressed.
The hon. Member for Westbury (Dr. Murrison) asked about the category for stroke. I have some information to share, but our discussions will continue. The software
used to telephone-triage patients has recently been updated and is being rolled out across ambulance trusts. The new version includes questions based on the face, arm, speech test for stroke. Any patients with positive FAST symptoms will get a category A response, with a target to reach them within eight minutes.
My hon. Friend the Member for Vauxhall (Kate Hoey) again pointed out with regard to the consultation the important work that takes place at St. Thomass and at Guys. I also commend St. Thomass hospital, which Members consider to be their local hospital. The work that is done by Dr. Holmes and his team is excellent.
The hon. Member for Leeds, North-West (Greg Mulholland) looked in particular at BME groups and how checks are being made. Efforts are being made to target that population in particular so that they go for those all-important health checks. Most Members have been gracious enough to say that that is good work. We are continuing down that line.
Points have been raised by Members covering many situations. Out-of-hours services were again raised by the hon. Member for Westbury. Imaging was mentioned, as was the importance of out-of-hours work and seven-day-a-week, 24-hour imaging. It is critical that that happens. We are looking at the development of the professions and the training that will be required to achieve that. Incorporating telemedicine in the way the hon. Gentleman mentioned is important. Many areas are starting to do that.
It is critical, as we continue with the 10-year strategy, that stroke is a No. 1 priority for the NHS, providing extra funding and establishing the local stroke networks. We are firmly aiming at a revolution in stroke services over the next few years, which I believe we will see. The House will work together on that important issue. Members will be aware that it is important that all the matters that have been raised are addressed, but the consultation, the reconfiguration and the specialist units will continue. I thank Members for their contributions to the debate today.
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