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I understand that so far 31 NHS bodies have applied to be regulated and we expect another 15 to do so. Interestingly, 11 organisations, including eight NHS bodies, have decided not to be regulated for one reason or another, but I accept the issue of cost.

I should be grateful if I could write to the noble Baroness on the question of HTLV.

I understand that the 30-year period for storage of data was brought about through negotiation. If the noble Baroness presses me to give a rational reason why that period was decided on, I am afraid that I cannot give one. I imagine that it was thought to be a reasonable length of time, although I understand her point about longevity. I am afraid that that is the best answer that we have in relation to that matter.

On Question, Motion agreed to.

Human Tissue (Quality and Safety for Human Application) Regulations 2007

The Minister of State, Department of Health (Lord Hunt of Kings Heath): My Lords, I beg to move the Motion standing in my name on the Order Paper.

Moved, That the draft regulations laid before the House on 25 April be approved. 16th Report from the Statutory Instruments Committee.—(Lord Hunt of Kings Heath.)

On Question, Motion agreed to.

Health: Stroke Victims

8.51 pm

Lord Rodgers of Quarry Bank asked Her Majesty’s Government how and when they will implement the proposals contained in the Department of Health report, Mending Hearts and Brains, in respect of stroke victims.

The noble Lord said: My Lords, at short notice and on a rather quiet day, I am very pleased that several noble colleagues are able to be present on this occasion.

A year ago, on 23 May 2006, I raised in the House the treatment of stroke victims in the light of the National Audit Office report, Reducing Brain Damage: Faster Access to Better Stroke Care, published the previous November. It was seen to be a thoroughly depressing report and, in July 2006, following its examination, the Public Accounts Committee shared that concern. Finally, late in October 2006, we had the Government’s response, which did not seriously dissent from the original National Audit Office report and broadly agreed with the recommendations of the PAC.

Given those three documents, I said in a general NHS debate in the House on 7 December that, although I conceded that there had been significant improvements in stroke treatment in the past five or six years, the tone of the Government’s response had been bland and lacked urgency. In replying, the then Minister, the noble Lord, Lord Warner, said in a reassuring way that many of my concerns were covered by Professor Roger Boyle’s report, Mending Hearts and Brains, published earlier that week. So I turn to Professor Boyle’s document in the hope that the Minister will clarify the Government’s purpose and intentions.

First, I should be grateful if the noble Lord, Lord Hunt, would explain the terms of reference for Professor Roger Boyle as the national director for heart disease and stroke and the role of Department of Health directors. Secondly, I should like to know the status of the document and to whom it was addressed. Thirdly, given the substance of the document, what has happened since it was published six months ago? Is it being implemented in, for example, a pilot? Fourthly, what is now the timetable for what Professor Boyle calls the clinical case for change, and how will the transition be handled if it gets as far as that? If I appear critical about some aspects of the document, I am agnostic about the conclusions. My focus is only on strokes and, primarily, on Professor Boyle’s document.

Once upon a time, civil servants advised Ministers in private and Ministers explained policy in public. There was a clear distinction. As a Member of Parliament, I would never criticise a civil servant by name; nor would a civil servant have been publicly exposed critically. What is the role of Department of Health directors? I assume that they are public servants, hired and fired by Ministers. Do they make and advocate policy only within the political view of the day, or do they have a degree of independence, encouraged occasionally by Ministers to fly a kite? What happens in a change of government? Do they stay, or do they go? I should like a formal definition of “directors”, perhaps from the Cabinet Office.

I should make it clear that judging by my contact with Professor Boyle through the All-Party Parliamentary Group on Stroke, he is an outstanding professional, deeply committed to solving problems. But Professor Boyle's named document is controversial and its style is puzzling. Mending Hearts and Brains and its twin,Emergency Access by Sir George Alberti, galloped into the public domain on 5 December last, the very day that the Prime Minister addressed primary care trusts. He said that the two documents were,

Mending Hearts and Brains is an odd document, apparently prepared in haste, with language from the industrial relations division of the department, and sometimes it reads as if aimed at 10 year-olds. It states:

His wife, Betty, “frantically” called 999. Later Benny said:

Thanks to all and sundry, Benny proudly says:

Apart from Benny and Betty, there is Kevin, who was delighted that he had not been sent to a routine A&E department, and grandmother Mary, who was sent direct to Royal Bournemouth Hospital. “I am so lucky”, Mary said. I do not know what the target audience made of the document, but who is it meant to persuade?

Apart from the “Vision”, as it is boldly called, what is now happening? Much of the document is descriptive. There are diagrams for what is called “Hub and Spoke” care—I think they are an odd shape, given my days on a bicycle. On page 11 of the document, Professor Boyle says:

He continues that they will probably,

I am sceptical about yet another strategy for this and that but, six months later, what progress has been made, and when will we be told the outcome? Every strategy needs a clear objective, an assessment of resources and a staged timetable. I assume that much of the work has already been done, hence the document and the Prime Minister's speech. When is the strategy to be implemented, over what period, and who pays?

Let me briefly explain some of my anxieties. Sir George Alberti shares Professor Boyle's scriptwriter. There is nothing wrong with that because Emergency Access complements the picture. But Sir George's document starts with another vignette of what could happen if a walker in the Lake District had a heart attack on Scafell Pike. He would want, Sir George says, to be taken not to the A&E department of Carlisle hospital—by implication it lacked and would always lack the full necessary facilities—but to the state-of-the-art James Cook Hospital in Middlesbrough. He would want to be taken by road, or possibly by air. In practice, going to Middlesbrough by road is 80 to 100 miles cross-country and Carlisle is about 50 miles, partly on a motorway, so it is not axiomatic that, even when accompanied by the new super paramedics, Middlesbrough would be the natural place to go, especially in bad weather. As for a helicopter taking off from Scafell, perhaps in fog, that is not an attractive option. I do not want to score a point, but before reaching conclusions I would like to see the full picture, the practical reality of how stroke victims would be looked after in different parts of the country, urban and rural, in town centres and where the population is thin and scattered.

As for the transition, what will be done to improve existing stroke facilities and acute hospitals until the limited number of specialist centres of excellence for stroke are established? In the interim, will everything mark time, except for the new-model favoured few? Will there be no new stroke units, no more scanners, no more hospitals routinely scanning patients?

The latest figures from the 2006 national sentinel audit show that only 15 per cent of patients are admitted to a stroke unit on the same day and only 9 per cent of patients are scanned within three hours. That is simply not good enough.

Professor Boyle wrote:

However, redesigning services does not always work, and what matters most is the patients—the victims and potential victims of stroke. I would like to share Professor Boyle’s vision, but I need to be convinced by something rather more substantial than Mending Hearts and Brains.

9.02 pm

Baroness Rendell of Babergh: My Lords, I congratulate the noble Lord, Lord Rodgers of Quarry Bank, for instituting this very necessary debate. At the present time, it is impossible to do too much to raise public awareness of cardiovascular disease. Heart disease, stroke and related conditions account for two-thirds of all premature deaths in England, as well as leaving patients with often terrible physical and communications disabilities.

The Department of Health’s recent publication, Mending Hearts and Brains, is an report by Professor Roger Boyle, the national clinical director for heart disease and stroke. In it, he refers to qualifying as a doctor in 1972 and to the limited treatments available to patients at that time. I well remember the case of my father, who first became ill with a stroke in 1969 that left him with a severely distorted face, poor co-ordination and soon, after a second stroke and a heart attack, unable to walk. As I remember it, and as Professor Boyle points out, the only treatments offered to heart attack victims were heroin to ease the pain and a defibrillator in case of cardiac arrest. As to stroke, no treatment was given to my father because stroke was regarded at that time as an inevitable consequence of old age, a more or less usual preliminary to death, although he was only 69 when the first stroke debilitated him. He suffered further strokes, but as he was basically strong, he withstood those onslaughts and suffered greatly. My father was a man of considerable intellect, an enthusiastic mathematician, a cabinet maker and a painter. After the first stroke, he was unable to do much with his hands and his painting became a kind of unintended impressionism. He lived until 1973, gradually growing more incapacitated until he was bedridden. It was a sad end for a man of his gifts, as it would be, indeed, for anyone.

Since then, things have changed for heart attack patients, and work is being done to repeat those strides forward for stroke, or as Professor Boyle calls it,

Comparable advances for stroke have not yet been made. There are similar numbers of strokes and heart attacks, but awareness of this equally devastating condition has been slower to reach the public.

A major advance that we should all know about is the recognition of the paramount need for a healthier lifestyle. In my father’s day—he was born in 1900—people believed that a healthy diet consisted of hot meals that were home-cooked, even though they included large amounts of roasted food, fat, butter, home-baked sugar-laden cakes and pastry. These days, with our more enlightened attitude to diet, we might call these the junk foods of the early 20th century. Born and brought up in Plymouth—Cornish cream country—my father made his own clotted cream, using the whole milk from Jersey cows, as his mother had made it. For years he ate it every day. He never smoked, but the exercise he took was inadequate—short walks with an elderly dog. His blood pressure was sky-high.

We now know that over 40 per cent of all strokes could be prevented if people kept their blood pressure under control, used statins to lower high cholesterol, took regular exercise even into old age and restricted themselves to a low-fat diet of fruit and vegetables, fish and whole grains and pulses. That giving up smoking is the first rule of health should by now go without saying and the soon-to-be-in-force ban must be a major contributor to better health in the population.

Stroke needs to be treated as a medical emergency. At present, according to the national sentinel stroke audit published a few days ago, only 9 per cent of patients were scanned within three hours of stroke, and only 15 per cent were admitted to a stroke unit on the same day and only 12 per cent within four hours of arrival at hospital. Lack of early treatment is partly due to ignorance. Few people know what to look for and even if they suspect stroke, they have no idea that early treatment is essential.

By the time one reaches my age, one inevitably knows contemporaries who have recently suffered stroke. One friend of mine, a man, in spite of collapsing, was not recognised as a victim of stroke for several days, because his wife was unaware of a simple formula, first mentioned in your Lordships’ House, as far as I am aware, by the noble Baroness, Lady Gardner of Parkes, in a previous debate on this subject. She did this House and the public a great service in explaining this. She repeated the face-arms-speech test or FAST. This simple expedient requires anyone witnessing what may be a stroke to call 999, then to check if the person can smile. Has his mouth or eye dropped, as my father’s did? Can he raise both arms? Can he speak clearly and understand what you say, as my father could not? My friend is improving now, but progress is slow and might have been much faster if he had been taken immediately to a hospital where, ideally, he could have been admitted to a stroke unit and could have received specialist care from a multidisciplinary team.

A brain scan is the only way of identifying whether a patient is experiencing a haemorrhagic stroke caused by bleeding or an ischaemic stroke caused by clotting, so that appropriate action may be taken. Clot-busting drugs can reduce the chance of death and disablement in eligible patients, but they need to be given within three hours and are dangerous for patients with haemorrhagic stroke if bleeding has already taken place. More bleeding may have disastrous consequences. Therefore, rapid scanning is essential to ensure that patients receive the correct treatment.

Too few people arrange regular appointments with their doctor for blood pressure monitoring. It is worth buying oneself a blood pressure monitor and being taught to use it correctly, as a surprising number of people have no idea whether their blood pressure is low or high. One hears often of people who, on the grounds that they believe themselves to enjoy exceptionally good health, never go near a doctor and never have their blood pressure checked until they suffer an ischaemic stroke. These days, hardly a month goes by without me hearing of another victim whose brain damage might have been avoided.

I ask my noble friend whether he agrees that, in the light of Professor Boyle’s report, we need a campaign to raise public awareness of the importance of reacting to suspected stroke with speed. Would he agree, too, that the FAST technique should also be explained to everyone likely to be in the presence of a suspected sufferer—and that of course means all of us?

I am a daily reader of newspapers, yet I cannot recall a feature article published recently in any so-called quality newspaper dealing with stroke, its prevention and treatment. I may have missed such a feature, but I am very conscious of the dangers of stroke and, therefore, I am particularly sensitive to information about it and comment on it. Truly it is the forgotten disease, unglamorous and mostly afflicting the ageing, yet cardiovascular disease across the world is killing more people than AIDS, TB and malaria combined, and in England more than all the cancers put together.

9.10 pm

Baroness Gardner of Parkes: My Lords, I am speaking tonight simply because the noble Lord, Lord Rodgers, sent me a note asking me whether I would speak. I did not have time to reply to the note and I thought it was better just to arrive, which is what I have done. I was delighted in listening to the noble Lord’s speech. If ever anyone has come up with a series of taxing questions for the Minister to reply to, it is the noble Lord in his speech. I had written “sceptical” on my notes just before he said that about himself, so obviously my assessment agreed with his own.

This is an interesting document. The stories it contains are part of the technique of bringing things home to people in a realistic way. Many people will be reached by those tales who would not know anything about the rest of the document at all. So they may have done a bit of good and he should think about that.

I recently had here as my guest one evening for another medical debate the president of one of the royal colleges. She was out with her husband, walking in Cumbria or somewhere like that, when he had a completely unexpected heart attack, and she saved his life then and there. We cannot all be fortunate enough to have the right person with us if we are in that situation, but it was quite extraordinary that that had happened. She was able to tell me that story when she came into one of our other debates.

The noble Baroness, Lady Rendell, of course, has repeated my bit about FAST, which I would have repeated but it bears repetition because one of the problems is that people have no idea that they are having a stroke. The article by Professor Boyle concerns both heart and stroke situations and he said that the only treatments available for hearts in 1972 were very limited. I served for 17 years on the National Heart Board and I recall a staff member retiring after 40 years at the hospital telling us that when she started the only treatment for heart conditions was bed rest. So she had been there in an era even before Professor Boyle in 1972 and you can see how there was a great element of progress from that time to 1972, and there has been a much greater element of progress here.

I have read Mending Hearts and Brains and I respect the views put forward by Professor Boyle. He has done much to help people with heart conditions and is admired for this. He says:

I hope that he succeeds.

My first direct experience of a stroke was when my husband was affected in 2003. I telephoned him from the House that afternoon and I realised something was not right when he told me he was “not himself”. He really had no idea what was wrong. He was an experienced dentist and used to assessing patients’ conditions, but he failed completely to recognise his own.

I went home immediately and insisted that we go at once to accident and emergency. He was reluctant and did not want to waste people’s time. I insisted and we went. When Professor Boyle makes the point that accident and emergency adds a delay that can mean it is too late, this is exactly right. Kevin was not moved to the stroke ward until some six hours after arrival in A&E, which was about three or four hours after the cerebral thrombosis. The first scan was done within 24 hours but should really have been done as soon as he reached the hospital, and, of course, he should have presented earlier for treatment.

But teaching people in general how to recognise a stroke is one of the major difficulties. Speed is of the essence in treatment but the first step is to get the patient to realise that they are in need of treatment. If the patient does not start off by calling for the emergency service, then the chart setting out whether you should go to the treatment centre or to A&E is a waste of time if the patient is sitting at home and thinking “I will just see how I get on”.

I remember from my dental practice days—I might have been on the heart ward when I heard this—that patients who had heart attacks frequently thought it was nothing but a bit of indigestion, and would wait and see how they felt in an hour or two. Research was done to show that those patients who sat at home did not do well, and sometimes died before they got any treatment at all. People had then become aware of and alert to the need to call for treatment.

I repeat the reference to the FAST system, although the noble Baroness, Lady Rendell, set it out so well that I do not need to go through it in detail. It would make a big difference if we could get the message of the facial, arm and speech test through to people. Having decided that they have probably had a stroke, they must be trained to call for help within a matter of hours. As has been said, it should be within three hours. This differentiation between a bleed and clot is then an essential first step in treatment. They are exact opposites. If you are treating for one and the person has the other, that person is as good as dead. You need to know, and the whole purpose of the scan is to know what you are treating.

When Kevin had his stroke, he made a fairly good recovery, although he was much worse for 48 hours after the stroke. He recovered as much due to willpower and good care in the specialist part of the Chelsea and Westminster Hospital. He was looked after very well, but will power is an important element in recovery from stroke. I well remember when the Duke of Norfolk—Miles—had a bad stroke here, and just by sheer will power recovered his speech. He lived a good many more years—I think another seven or so. A major element is the patient’s own wish to recover.

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