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3 Jun 2009 : Column 92WH—continued
On average, someone suffers from a stroke every five minutes in England. There may be people in this room who have been touched by a stroke that affected either them or members of their family. Behind that unfortunate
statistic, however, lies a terrific cost for the NHS. At any one time, a quarter of all long-term beds are occupied by stroke patients. As those who care for their loved ones will testify, stroke survivors need long-term care and attention. In my many years as a nurse, I worked with stroke survivors and know the importance of dedication and continual rehabilitation, with staff trying so hard to bring quality back to once active lives. When sudden emergency hits, it is quite devastating—and it affects not only the stroke sufferer but of course the family.
To universal acclaim, the need for long-term care was recognised in the Department of Health’s 2007 national stroke strategy. The strategy underlined the impossibility of furnishing every accident and emergency department with a 24-hour stroke consultant service and open access to that all-important CT scanner. There simply are not enough people with the right skills to do it safely. The Royal College of Physicians and the National Institute for Health and Clinical Excellence both agree.
A and E is not the best place to treat stroke, and getting stroke patients directly to specialist units will put us in a position where more lives can be saved, which is what we want. Having worked in accident and emergency, I know that it is exactly what it says; to have people arriving after road accidents or particular traumas at the same time as someone who is suspected of having had a stroke can result in neglect to the stroke patient. Furthermore, the 2007 strategy document recommends that stroke services are co-ordinated into networks, supporting highly specialised centres of excellence. Networks have proven to be highly effective in treating cancer and heart disease, and we want to transfer and adapt that knowledge into the stroke strategy.
I am sure my hon. Friend is aware that the NHS responds to the national stroke strategy locally. NHS London is responsible for bringing stroke care for its population into the 21st century. At the moment, treatment throughout London varies radically. Each year about 11,500 stroke victims are admitted to hospital in London, 16 per cent. of whom die as a result of their stroke. There are outstanding examples of good practice, but we want to see them become the norm.
Consistent with national policy, the stroke strategy for London, published in November 2008, recommended that patients should be treated within three hours of having a stroke. To that end, stroke networks should comprise three vital elements. On the front line, the hyper-acute stroke units—HASUs—will provide an immediate response, with a CT scan and the appropriate drugs. Supporting stroke units will provide ongoing care and rehabilitation. Services for the mini-stroke—the transient ischaemic attack—will also provide rapid access to a specialist.
A consultation on the location of these services ran from 30 January to 8 May this year, and a remarkable 8,600 people responded. Taking account of those responses, a joint committee of primary care trusts will make a decision on 20 July about the location of stroke units across the whole of the capital.
Mr. Sharma: I am aware that consultation took place between January and the first week of May, but does the Minister have the figures? How many from Ealing and Southall responded to the consultation?
Ann Keen: I do not have the exact figures for that area to hand, but if statistics are available I will certainly let my hon. Friend have them.
As I said, a joint committee of PCTs will make a decision on 20 July about the location of stroke units. Under the PCTs’ preferred proposals, residents of Ealing and Southall suffering strokes will be taken to Charing Cross or Northwick Park hospitals for improved care. I am told that that is the local PCT’s preferred choice. The proposed locations of the HASUs will ensure that every Londoner is within 30 minutes of getting the treatment that they need. The PCTs anticipate that both Charing Cross and Northwick Park hospitals will also have stroke units. Depending on where they live, my hon. Friend’s constituents will either remain at those hospitals for ongoing care or be transferred to Hillingdon or West Middlesex university hospitals.
I must tell my hon. Friend that Ealing hospital did not bid to offer hyper-acute stroke care. The trust instead submitted an application to offer secondary and mini-stroke care. Bids were assessed by an independent panel of stroke experts from outside London. The panel assessed each bid on its merits. Influenced directly by the independent panel, the consultation proposals state that Ealing hospital should no longer provide acute stroke services.
I know that it is important to my hon. Friend, so I repeat that no decision has been taken to stop the commissioning of stroke services from Ealing hospital. The recommendation was proposed in the consultation. We must wait for the PCTs’ decision in July, so it remains a possibility that Ealing hospital could continue to provide stroke services. Indeed, as we speak, the trust and the local PCT are developing a proposal for delivering an effective, high-quality stroke service at Ealing hospital. The service would be part of the wider pan-London network. If that goal is achieved, the unit would have to meet the stringent Healthcare for London quality standards. The proposal is to inform the decision of the joint committee of PCTs in July.
Mr. Sharma: I thank the Minister for giving way again. I accept that further reports and proposals will be coming from the PCT. How many locally based voluntary sector health organisations—what we call the third sector—have been consulted? How many local GPs have been consulted, and how many other patients’ groups have been consulted on proposals for the future and the vision for the local PCT and the health area in my constituency?
Ann Keen: That point was very well made. I am sure that the PCT and the chief executive will be able to furnish my hon. Friend with answers. I am aware that he has a good relationship with them and meets them regularly when working in his constituency. I feel confident that they will be able to inform him.
Thanks to the standards being applied in London, and regardless of the outcome of the joint committee’s decision, Ealing’s residents can expect to receive world-class care if they have the misfortune to be affected by stroke. On 1 April, PCTs began the phased implementation of the NHS health check. The programme will cover everyone between the ages of 40 and 74, and it will asses the risk of stroke, heart disease, kidney disease and diabetes. Everyone will receive a personal assessment, setting out their level of risk and saying exactly what they can do to reduce it.
Members of the south Asian population in my hon. Friend’s constituency suffer strokes at a younger than average age, and many still of working age. The statistics are alarming. I know this from experience in my constituency, which is close to my hon. Friend’s. I understand how important it is to get stroke victims out of hospital and back to work and back to their families. It is imperative that people in that age group have the highest quality care, should they have the misfortune to suffer a stroke, so that we do not waste working lives. For the family, the emotional and financial consequences are high. Every one of my hon. Friend’s constituents will be within 30 minutes of that all-important hyper-acute stroke care. That speedy response will mean fewer people having their working life and their retirement marred by stroke.
The consultation does not propose the closure of any A and E departments or any loss of staff. Ealing hospital will continue to offer an extensive range of exceptional facilities for local residents. I realise that the first priority for all Londoners is to ensure that they have access to high quality care, and NHS London is working closely with the PCTs and other trusts involved to ensure enough beds and capacity for everyone.
My hon. Friend raised the secondary, but still important, concern about the time it takes for visitors to travel to the hospital. Although the new proposals will inevitably mean more travel for some, analysis has shown that average travel times will only increase from 31 to 42 minutes when travelling by public transport, and by three minutes when driving. I am not sure how those statistics were formulated, but I am sure he has as much faith in them as I do.
Mr. Sharma: I live in the area. In my earlier days, I worked as a bus conductor there. I travel by public transport daily. I am familiar, therefore, with travelling times from the Southall area to Ealing hospital as well as to Charing Cross and Northwick Park hospitals, which are miles away from Southall. Traffic congestion is a major problem in the area, and the reliability of public transport causes concern among my constituents. They feel that the times will be longer than was expected and quoted in the consultation.
Ann Keen: My hon. Friend raises an interesting point about an area that I know very well too. Depending on what celebrations are taking place in Southall at the time, travelling through the area can take some considerable time, so I share some of his concerns. However, we must focus on the safety of patients when they arrive at hospital having had the misfortune to suffer a stroke. They need the best expert care. I would like to continue my reply in that fashion, and perhaps later we can have a conversation outside the Chamber about transport in Southall.
The development of a high quality stroke service is a work in progress. Each stroke unit will be expected to achieve standards of excellence that London has not yet experienced. We hope that the proposed improvements to stroke services will save as many as 400 lives a year and save thousands more from serious disability. We should concentrate on those statistics. I saw them in practice over many years as a health worker. The service throughout London will be greatly improved, which will benefit my hon. Friend’s constituents.
The plans that I have outlined today are built on an outstanding dedication to the principle of patient and public involvement. More than 13,000 people visited 46 health fairs held in the capital throughout the consultation, and clinicians have been on hand to offer expert advice every step of the way. My hon. Friend’s local hospital, council and residents have all participated fully in the consultation—a consultation that demonstrated widespread support for the general principles of change. As I said earlier, I shall try to provide him with the exact figures later.
A stroke is a medical emergency. The signs and symptoms of a heart attack are now very familiar to us all, but stroke is an attack on the brain and its treatment also requires expert advice, support and help as soon as possible. A swell of good work has already begun to roll out across the country. The number of under-75s dying from stroke has fallen by a third in the past 10 years, and although far from perfect, it is clear that a heroic effort has been made already by health professionals to save, and improve the quality of lives.
In addition to extra funding to PCTs, the Department of Health has guaranteed £105 million over the next three years to train more staff and raise awareness. I am sure my hon. Friend will have seen the hard-hitting and successful FAST—face, arms, speech and time—campaign launched this spring throughout the media. The campaign highlights the need to check the person’s face immediately, to check whether they can raise their arms and whether their speech is affected and then, most vitally, to call 999. When that call is made to the ambulance service, the paramedics will then get that person to the appropriate unit as safely and as quickly as possible to save their life and enhance the quality of life afterwards. FAST will help public and professionals alike remember the symptoms and urgency of stroke.
Stroke is the third biggest killer in this country, and the largest single cause of severe disability. Men of south Asian origin and Bangladeshi and Pakistani women have a disproportionately high chance of suffering from a stroke, which is why stroke will remain at the top of the agenda for some time to come. I am sure that my hon. Friend will continue to champion and support health services, and in particular, stroke services within his constituency. I know that he recently had a very positive meeting with the chief executive of Ealing PCT, whose work, and that of his PCT team, I also acknowledge.
Mr. Sharma: I would like to take the opportunity to thank Ealing PCT for campaigning on this issue. There are sometimes differences of view, but generally I am very pleased with the services that it offers, so I am grateful for the Minister’s comments.
Ann Keen: I thank my hon. Friend for that intervention.
I urge my hon. Friend, however, not to be negative in some of his remarks or to raise unnecessary fears about the rest of the hospital and its staff, who are striving to achieve excellence, as he recognised. I encourage him to continue to engage with Ealing PCT and to fight for his constituents, as he does so well. We must all continue to improve stroke services for the benefit of his constituents and everyone else in the country.
11.27 am
UK Aid (North Africa)
2.30 pm
Daniel Kawczynski (Shrewsbury and Atcham) (Con): Thank you, Mr. Bayley, for calling me to speak in this important and topical debate. At Prime Minister’s questions this afternoon, the Prime Minister gave his condolences to the family of Mr. Dyer, who was killed in Mali. Mr. Dyer, a British citizen, had been taken hostage on the Mali-Niger border and, regrettably, was killed by al-Qaeda operatives. The Prime Minister said to the House—I think that I am quoting him verbatim—“We will be giving every possible assistance to the President of Mali in trying to fight al-Qaeda and to help that country.” I find that rather ironic. It shows just how good the Prime Minister is at spin because the reality is the Government have completely slashed our aid to north Africa. The House of Commons Library figures show that last year no money was spent on helping north African countries. Therefore, although the Prime Minister stood up and told the nation that he would do everything possible to help those countries, the reality—as always with this Government—is that there is no substance behind what he said.
I want to take the opportunity to challenge the thinking of the Department for International Development. In the past, challenging DFID was almost taboo. One was perceived as some sort of nutter, fanatic or extremist if one dared to challenge the great DFID and how it went about things. However, under difficult economic circumstances, the tide of public opinion is changing. People such as me, who have critical things to say about DFID, are a little more empowered and confident about challenging the Department and how it spends taxpayers’ money.
DFID spends 90 per cent. of its resources in the poorest countries in the world. Some might say that that is very logical. Of course, we should be helping the poorest countries in the world, and not giving money to the very wealthy ones—I will come in a moment to some of the wealthy countries that get our aid. However, it means that middle-income countries receive only 10 per cent. of the budget. As the right hon. Member for Gordon (Malcolm Bruce), the Chairman of the Select Committee on International Development, has said, one in three of the world’s population who survive on less than $1 a day live in middle-income countries. Yet those countries receive only 10 per cent. of our aid. I should like the Minister and my hon. Friend the Member for North-East Milton Keynes (Mr. Lancaster) to address that issue. In the run-up to the next election, my hon. Friend and others in the Conservative party will talk about how to address that anomaly.
As I said, north Africa received nothing last year, according to the House of Commons Library. None the less, those countries are our neighbours and are of great strategic importance to the United Kingdom. When I was in business, before entering Parliament, I visited north African countries many times. They are extremely friendly towards the United Kingdom, very positive and they want to engage with us, but they are grappling with huge issues. Illegal immigrants from all parts of Africa use them as a conduit for trying to gain entry to Europe. They are also being used as a conduit for drugs as they are smuggled from Latin America, via Guinea-Bissau, through them and into Europe. They are also
grappling with the terrible problem of terrorism and al-Qaeda. Mr. Dyer, our citizen, died as a result of that activity. I am very sad for his family.
As we speak, President Obama is en route to Egypt. He will make a major speech in Cairo tomorrow on the importance of the Arab world, and on the importance that he attaches to American relations with Egypt and the Arab League. Interestingly, whereas we give Egypt nothing, America gives it $1.5 billion a year. That is how seriously the Americans take Egypt. They understand the strategic importance of the country and of dealing with many of the issues that I have raised. That is why Americans give Egypt so much assistance.
As you know, Mr. Bayley, we are overstretched. As a country, we are borrowing billions of pounds, yet we can afford to give aid to China—more than £50 million—and we give more than £800 million to India. I do not see how we can justify expenditure in such other parts of the world. China, for example, is a very wealthy country: it has spent more than £20 billion on hosting the Olympic games, it has one of the largest armies in the world and a space programme. Yet we cannot give any money to north African countries, which are of strategic importance to the United Kingdom and are grappling with such serious issues.
I call on the Minister to assure me that aid to China will be stopped. The International Development Committee, of which I am a member, has endorsed the Government’s strategy of giving money to China. I fundamentally disagree with that, and I believe that the aid that we give to India should be reviewed as well. Interestingly, I appeared in an article in The Telegraph—not our Daily Telegraph I hasten to add, but the one in India. I made the front page when I called for aid to India to be cut. The Telegraph said what a fantastic MP I was. It said that I was the only one who was treating it seriously and with maturity. It said that I realised that it could look after itself without any assistance from the United Kingdom. I should love the Minister to look at a copy of the Indian newspaper because the journalists really supported my stance that India can go it alone and does not need financial assistance from Britain.
Malcolm Bruce (Gordon) (LD): The hon. Gentleman’s point is very important and should be fully explored. He is talking about a strategy that we should have towards middle-income countries, but which does not exist. He is quite right in exposing some of the inconsistencies in who we do and do not support, and he makes his case very well. Nevertheless, does he not accept that the success of targeting our resources predominantly on poverty reduction in the poorest countries has lifted DFID into the world rankings as one of the most effective aid agencies delivering poverty reduction? That does not undermine his argument, but it is important that he acknowledges that achievement.
Daniel Kawczynski: I agree. There is a lot that DFID does very well indeed, and it has very good branding around the world. I do not doubt the passion and sincerity of the people in DFID in the UK and around the world. When we visited Tanzania and Kenya we saw the passion for ourselves and just how committed those people are in assisting the world’s poorest. But as an Opposition MP it is not my job to smooth their feathers. My job is to scrutinise and assess some of the areas for development.
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