The Parliamentary Under-Secretary of State for Health (Ann Keen): I congratulate the hon. Member for Harrogate and Knaresborough (Mr. Willis) on securing this debate. As always, he shows an acute interest in the welfare of his local health service, and I commend the dedication with which he serves the needs of his constituents.
I should also like to pay tribute to my colleague and good friend, Ashok Kumar, the former Member for Middlesbrough, South and East Cleveland, who passed away today. He was a very good friend to me, and he was known for his quiet work in the House. I also want to pass on my condolences to his family and close friends, some of whom I know well.
The hon. Member for Harrogate and Knaresborough referred to his constituent, Jenny Jones, and I hope to make further reference to her during my speech. Time constraints mean that I cannot answer all his questions in full tonight, but I will of course write to him with a more detailed response. In December 2007, we launched the national stroke strategy, which sets out a radical and challenging agenda across the pathway from awareness and prevention to long-term care in the community for what is one of the major health conditions. The strategy defines a series of key quality markers for action and associated progress measures.
Stroke is a devastating condition for those who have a stroke and for their families and friends. Some 110,000 people in England have a stroke every year, and 900,000 people live with the consequences of stroke. For some 28 years, I worked as a nurse, and I was aware of the neglect of this serious condition. It involves a brain attack, and is a real medical emergency. I am pleased to be part of a team of people who have brought about the awareness of the condition that we now have. It is the biggest single cause of adult disability, with some 300,000 people being moderately to severely disabled as a result of a stroke. The aim of the strategy
is to modernise care and deliver the most appropriate treatment for each stroke. Our goal is a real revolution in NHS stroke services.
The hon. Gentleman asked whether I had read the important document produced by the Stroke Association. I have read it; I have always taken a great interest in the association's work, and in the work of the all-party stroke group, which also does excellent work. I certainly want to see the Stroke Association's proposals brought to the forefront and continued, because I have a personal knowledge of the situation from my nursing background as well as a commitment, through the post I am privileged to hold, to ensuring that everything possible is done to achieve the necessary awareness and to fulfil the proposals in the association's manifesto.
The national stroke strategy has been universally welcomed and, although it presents a 10-year plan and we still have a long way to go, we are making significant progress. The recent report from the National Audit Office, "Progress in improving stroke care", found that
"early indications are that implementation of the strategy is...starting to deliver improved levels of service and improved outcomes".
The strategy sets out a clear agenda for modernising and delivering the best stroke services, and we have done much to support its implementation, as the hon. Gentleman has acknowledged. The stroke improvement programme, which has been created in collaboration with NHS Improvement, has helped to establish stroke care networks to implement the strategy and assist in delivering improved services for patients and their families. There are now 28 stroke networks across the country that look at service improvement and development according to local needs.
Long-term care and support are an essential part of the stroke care pathway. In addition, choice and personalisation for people living with long-term conditions was a major theme running through the NHS next stage review's final report. Furthermore, the training of new stroke specialist physicians is being funded centrally, allowing deaneries to expand their stroke work force appropriately.
In addition to the allocations made to primary care trusts this year, we have also allocated central funding over three years to support the development of stroke services. The hon. Gentleman asked what assurances I could give that stroke support services developed by local authorities will continue beyond 2010-11. As far as tonight's debate is concerned, I can say that the ring-fenced grant was made in recognition of the particular importance of social care for stroke survivors. We have always made it clear that the funding for local authorities was for three years to pump-prime services that local authorities would continue to fund in the longer term, if they proved cost-effective and beneficial for stroke survivors.
When local authorities have invested in such services, they should be making plans now, in 2010-11-the last year of the ring-fenced funding-to mainstream them so that they are covered by existing resources. The ring-fenced funding will have alerted local authorities to the need to cater for stroke survivors in their service delivery plans when commissioning, which is key to the future commissioning of services for people with disabilities.
As part of the central funding that we have provided to support the early implementation of the stroke strategy, £45 million has been ring-fenced and given to 152 local authorities. That funding is to help local authorities to understand the needs of adult stroke survivors and their carers and to provide support services for them. It is particularly essential that we should include carers in our family of NHS support people. We need to understand the need for aftercare-I believe that, in the past, it has not been fully understood-so that people can survive this medical emergency. It is needed to get the family back into work and to get the survivor back into work. Only such aftercare can bring back the quality of life that only they, as part of that family, and those who visited that family would know to be absent. I am sure that people such as Jenny Jones are essential to those families-the hon. Gentleman read out such cases from the responses to his Facebook group.
I should emphasise that it is for individual local authorities to decide, based on local needs and the priorities of people with stroke, how best to spend the ring-fenced funding. That devolved authority can be frustrating, at times, for us all.
The funding averages approximately £100,000 a year to each of the 152 local authorities, including North Yorkshire. I understand that prior to the allocation of that national funding, the Harrogate Stroke Association was already in receipt of core funding from both North Yorkshire county council and the North Yorkshire and York primary care trust to support its drop-in service and support group. The core funding continues to be provided to the Craven and Harrogate area and has not been cut.
I understand that in 2008, an arrangement for additional one-off moneys was made between the council and the Harrogate Stroke Association that was intended to last for one year and to fund two co-ordinator posts. In actuality, it lasted for two years as only one co-ordinator could be recruited. A further £12,000 was allocated to allow the post to continue for two years. However, there was an understanding at the time between the council and the Stroke Association that the additional money was for 12 months only and an agreement was signed to that effect. It is that contract that is coming to an end, as planned, by the end of March 2010. It is for local authorities to act to ensure that the local needs and priorities they have identified for stroke survivors and their carers continue to be met. The council is still in contract with the Stroke Association for it to provide an equitable service across the whole North Yorkshire county.
Ann Keen: The funding is allocated across the county and I understand that the regional Stroke Association does that in partnership with local branches. We have always made it clear that the funding to local authorities is for three years to pump-prime services that they will continue to fund in the longer term. I urge the hon. Gentleman to continue to raise his concerns with the council, which I am sure will take great interest in this debate and might read that I urge that to happen.
On the wider provision of stroke services in North Yorkshire, the hon. Gentleman will know that its local authorities are working hard to develop services according to local needs and priorities. Indeed, that is the case throughout the country. Local authorities are the pivotal access point to a range of services that can benefit people who have had a stroke and who want to live independently at home. Local authorities are working with their NHS partners locally and with stroke networks and the voluntary sector to help individuals and carers at an early point to reduce the likelihood of increased dependence at a later stage.
The hon. Gentleman might know that the North Yorkshire and York primary care trust is working with North Yorkshire county council's scrutiny of health committee to raise awareness of stroke and to promote wider understanding of stroke care across the county. I understand that the PCT is also developing plans for early supported discharge and community rehabilitation services for stroke patients in each locality.
On a regional level, much work is being done to improve services further and to respond to the national stroke strategy. In the Yorkshire and the Humber strategic health authority's response to the next stage review, the improvement of stroke care is identified as a priority, and the pledge to
"save 600 premature deaths every year with better stroke care"
is key. Clinicians from across Yorkshire and the Humber have been involved in establishing and agreeing a stroke assurance framework that describes the stroke care standards, both core and developmental, that the SHA expects all primary care trusts to provide. Each PCT has submitted to the SHA a plan for working with local providers to meet the standards. Those plans are being assured by the SHA with expert advice from the stroke networks.
In addition, a review of vascular services across the region is currently being conducted by the Yorkshire and the Humber specialised commissioning group. Provisional service standards to improve outcomes for all vascular patients have been agreed, and work is under way to identify the most appropriate configuration of services needed to meet those standards. It is expected that that work will be completed by late summer 2010.
The hon. Gentleman has raised some important points tonight-some, but not all, of which I have been able to address. His point about research-based evidence is one of the most critical issues that he has raised. He talked about the cost-benefits of providing proper stroke support, and I agree wholeheartedly with him. To do anything else would be a false economy, and would have an impact on the livelihoods and lives of those affected and their families.
We now know about prevention, but even with our commitment-the advertising campaign, the speedy results, the expert clinical care and the imaging of those brain attacks-we know that we also need to look at the serious aspects of aftercare. The difficulty of measuring the quality and effectiveness of post-hospital care is recognised across all long-term conditions. It is an area the Department continues to work on, with health and social care services. The stroke improvement programme has been developing a minimum dataset of key performance indicators for the entire stroke pathway. I hope that will go some way to reassuring the hon. Gentleman.
Provisional service standards have been agreed that seek to improve outcomes for all vascular patients. Work is under way to identify the most appropriate configuration of those services. When implemented they should have a positive impact on outcomes and patient experience for stroke and other vascular conditions.
It is important to acknowledge the good work the voluntary sector is doing to help implementation of the strategy. I pay tribute to the support it has provided for stroke survivors over many years. Third sector organisations, including Connect, the Stroke Association, Different Strokes and Speakability, provide valuable services to survivors and their carers. They bring expertise and skills that support improvements in the quality of people's lives-their independence, well-being and choices.
I know that the hon. Gentleman is much impressed with the stroke support services available across North Yorkshire that the council and the Stroke Association have worked together to provide. I, too, commend those efforts. Much is also being done in the NHS locally to respond to the challenges set by the national stroke strategy, and I hope he will join me in commending the NHS in North Yorkshire for striving to provide a first-class stroke patient service.
I hope that the despair the hon. Gentleman referred to will not arise. I hope a Labour Government are re-elected so that we can continue our good work. I also hope to see the council and the local NHS continue to work together to ensure that patients are supported, not just at a critical time in their illness but to help them achieve a comfortable and independent life for as long as possible.
I wish the hon. Gentleman well in his retirement. I hope he stays in very good health and continues to work as hard as he has done as a Member of the House. I put on the record again my thanks to Jenny Jones and her team for their valuable work.