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House of Lords

Thursday, 18 March 2010.

11 am

Prayers-read by the Lord Bishop of Ripon and Leeds.

Royal Assent

11.06 am

The following Acts and Measures were given Royal Assent:

Appropriation Act, Marriage (Wales) Act,Co-operative and Community Benefit Societies and Credit Unions Act,Taxation (International and Other Provisions) Act,Church of England (Miscellaneous Provisions) Measure,Vacancies in Suffragan Sees and Other Ecclesiastical Offices Measure,Crown Benefices (Parish Representatives) Measure.

Children: Strokes


11.07 am

Asked By Baroness Rendell of Babergh

The Parliamentary Under-Secretary of State, Department of Health (Baroness Thornton): My Lords, we support the Royal College of Physicians' guidelines for the management of strokes in children and our work is centred around those guidelines. As the noble Baroness will know, a small number of newborns are vulnerable to strokes from intracranial bleeding, and are given vitamin K to prevent this. A large proportion of strokes in children occur in those with sickle cell, so we have implemented national antenatal and newborn screening.

Baroness Rendell of Babergh: My Lords, I thank my noble friend for that Answer. Is she aware that the Government's National Stroke Strategy for improving adult stroke care makes no mention of childhood stroke care? Is she also aware that 400 children in the United Kingdom succumb to stroke each year and that stroke is one of the top causes of death in childhood in the UK? It is likely that most stroke-affected children will be left with a disability of some sort. Does she agree that parents, family members and teachers should be made aware of stroke symptoms?

Baroness Thornton: My noble friend is right. The National Stroke Strategy does not refer to children because the majority of the annual 110,000 strokes occur to people over the age of 55. However, the main reason is that the clinical path for dealing with children who have strokes is quite different from that for adults. For example, a child who has sickle cell disease may

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require repeated blood transfusions and even a bone marrow transplant, so it is a quite different treatment path. That is why we use the Royal College of Physicians' clinical guidelines on how to treat children with stroke. I read with interest that the Stroke Association has produced a manifesto for children with stroke. We are looking at that and I am very happy to answer questions on what we intend to do about the different proposals in that.

Baroness Gardner of Parkes: My Lords, does the Minister agree that there are two major problems here? One is awareness of the condition. The Government's FAST campaign has been very successful, so could they not do something similar for children? Parents and teachers do not know what the problem is. The other problem is that of misdiagnosis. Children taken to A&E in time for an emergency scan are often sent away having been told they have an ear infection. There is a need for training of those receiving children in A&E departments.

Baroness Thornton: The noble Baroness is quite right. We know that public awareness of how to recognise and deal with stroke in children is an important part of this. Two Department of Health publications, the Pregnancy Book and Birth to Five, now contain specific references to how to recognise stroke in children and how to remedy it.

Lord Alderdice: My Lords, given the uncommon nature of these catastrophic events and therefore the difficulty of providing services right across the country, would the Government be prepared to consider developing a specific centre of expertise that could use an interactive video system in order to connect with centres around the country to ensure that the long-term rehabilitation of these children is appropriate? It is a complex process and different from that for adults.

Baroness Thornton: The noble Lord has made an interesting proposal. Two major research projects on stroke are taking place in our major universities, and I think that the noble Lord's proposal is one that we should take up and that the Stroke Association should take note of. It would be a good use of new technology.

Lord Patel: My Lords, the Minister referred to the causes of stroke in neonates. Do the Government believe that facilities for the care of neonates are adequate in the London region?

Baroness Thornton: I have no reason to doubt that they are adequate, but if they are not, I hope the noble Lord might tell me that there is a problem so that we can take it up.

Lord McColl of Dulwich: My Lords, is the Minister aware that childhood stroke may be as common as childhood cancer, and in many ways just as devastating for the families? Over the past year, the charitable income for childhood cancer in the UK was £224 million whereas that for childhood stroke was only £3 million? Can the Government help in this area?

18 Mar 2010 : Column 659

Baroness Thornton: We know that in England last year there were 420 cases of stroke in children. Half were caused either by sickle cell or pre-existing heart conditions, but in 10 per cent of cases, as yet we do not what the causes were. That is why research in this area is so important. I am not sure whether the case is yet made for a comparison with childhood cancer, but there is absolutely no doubt that, for those 420 cases, it is devastating both for the child and their family. We need to focus on making sure that diagnosis and treatment are swift and that the rehabilitation process is appropriate to the child.

Baroness Masham of Ilton: My Lords, is the Minister aware that babies can suffer bleeds in the brain while still in the womb?

Baroness Thornton: The reason that vitamin K is routinely administered to newborns is because it acts as a prophylaxis in order to prevent bleeding, which can cause strokes in newborns.

Baroness Howe of Idlicote: My Lords, the noble Baroness mentioned rehabilitation and referred to the Royal College of Physicians' guidelines on treatment and other rehabilitative needs following stroke. Will she expand a little on what the Government hope to do to improve services in this area?

Baroness Thornton: The key point about rehabilitation is that, as is the case for adults, it should start as soon as possible. The first few days of assessment of movement, positioning, swallowing, speech and communication have to take place as quickly as possible. What this requires for children is paediatric care as well as the medical care that adults would receive. It is also important that parents are involved in all these processes. The Royal College of Physicians' guidelines are clear on all these issues. We must improve abilities in movement and speech for children affected by stroke and we have to find ways of helping them to adapt. Their skills in daily activities have to be developed, and of course they must be given social, emotional and practical support following discharge from hospital and during their re-entry into normal life in school.

Baroness Tonge: My Lords, the Minister mentioned sickle cell anaemia as a cause of childhood stroke. How many trusts, where appropriate of course, have specialists who can deal with sickle cell anaemia? In particular, how many nurses have been trained to advise parents who have children with this condition?

Baroness Thornton: I do not have that information available, but I should be very happy to find it and inform the noble Baroness and the House.

Lord Foster of Bishop Auckland: Is the Minister convinced-

Baroness Howarth of Breckland: My Lords-

Lord Hunt of Kings Heath: My Lords, we have not yet heard a supplementary question from the Labour side.

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Lord Foster of Bishop Auckland: Is the Minister convinced that there is sufficient research and development in this area? Is she also convinced that there are sufficient specialists? If not, what is she doing about it?

Baroness Thornton: We are aware of two or three major research projects which we are funding to the tune of just under £1 million, although I shall check that figure. My noble friend will of course know that we are never satisfied with our progress and we are always looking for improvements. We have a strategy for dealing with this, we are monitoring that, and we are determined that we will give the required support to these children and their families.

Railways: Crossrail


11.17 am

Tabled By Lord James of Blackheath

Lord James of Blackheath: My Lords, I beg leave to ask the Question set against my name on the Order Paper. In doing so, I declare an interest as a former member of the Crossrail committee

The Secretary of State for Transport (Lord Adonis): Tomorrow, my Lords.

Lord James of Blackheath: This Question was described by a noble Lord yesterday as quirky, but I hope that the Secretary of State will confirm that it is anything but quirky. It is very serious, as 10 Hayne Street may be the site of the missing anthrax burial ground that has been lost for 488 years, since Christ Church, Spitalfields and the church at Charterhouse Square refused to accept the bodies of the 282 victims of the anthrax outbreak that wiped out the whole population of Hayne Street at that time. That was of course under the Church of Rome, before Protestant common sense arrived.

Lord Adonis: I am still waiting for the question, my Lords. However, if the question was whether I accept that there is an issue that needs further study in respect of 10 Hayne Street, the answer is yes. Crossrail understands that there is a very small possibility of buried human remains being encountered during the works at 10 Hayne Street. The advice that it has taken from experts at the Museum of Archaeology and Porton Down is that it is highly unlikely that the works would release any anthrax spores or bacteria causing plague. However, further sampling work will be carried out by experts in July. The results of any tests will be made available to the noble Lord and I will be happy to discuss them with him when they are available.

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Lord Brooke of Alverthorpe: My Lords, I declare an interest also as a former member of the House of Lords Select Committee on the Crossrail Bill. I am pleased to hear the Minister's response that the compulsory purchase is going ahead, but given that there appear to be divisions between the Mayor of London and the leader of the Opposition about the future funding of Crossrail, may not much of the compulsory work that has to be undertaken to facilitate the development of Crossrail be in jeopardy? Is the Minister concerned about this and will he take steps to try to get some kind of cross-party agreement that Crossrail will proceed, so that the difficulties faced by London travellers will be eased?

Lord Adonis: My Lords, there is no division whatever on this side of the House as to the importance of Crossrail. Therefore, provided that the electorate have the good sense to return us to government, Crossrail will proceed.

Lord Bradshaw: Will the Minister confirm that the Question that he has just been asked by the noble Lord, Lord James of Blackheath, was ventilated at the time of the inquiry into Crossrail and that there is no reason to suspect that it has not been taken seriously?

Lord Adonis: That is the case, my Lords.

Baroness Hanham: My Lords, perhaps I might ask the Minister, in relation not only to this site but to others where there may be archaeological remains or contamination, whether that is likely to put back the timetable for Crossrail.

Lord Adonis: No, my Lords. This has been taken account of in the construction schedule.

Health: Tuberculosis


11.20 am

Asked By Baroness Sharples

The Parliamentary Under-Secretary of State, Department of Health (Baroness Thornton): My Lords, we know that the problem of TB is limited to particular localities these days. In these areas, PCTs are able to set their own targets and standards as part of a local delivery plan agreed with their strategic health authority. In respect of standards of treatment, there are clear recommended guidelines from the National Institute for Clinical Excellence.

Baroness Sharples: I thank the noble Baroness for that reply. Could she please tell me what proportion of TB cases comes from abroad and what proportion originates in this country? Could she further tell me whether all cases are followed up?

18 Mar 2010 : Column 662

Baroness Thornton: In response to the second question: indeed they are. Our data show that around 70 per cent of the TB cases in England are among people born abroad, but who show no signs of the illness until they have lived here for many years. At the moment, as the noble Baroness will be aware, we have no test to predict who will develop TB in later life.

Lord Alderdice: My Lords, there is an understandable tendency to think of tuberculosis as an entirely pulmonary disorder. Could the noble Baroness tell us something about the ratio of pulmonary to non-pulmonary tuberculosis, and whether the ratio has changed over the past 10 or 15 years? That would help us to understand a little about the relevance of the question of whether people have come from outside the UK.

Baroness Thornton:I do not have the figures in front of me, but the noble Lord is indeed right that people think of tuberculosis as being something that affects only the lungs, which is not the case. My understanding is that you can get TB in virtually any part of your body: that is what we know to happen. In the UK, about 14 in every 100,000 people carry it. In parts of the world where TB is more prevalent, the number is 400 to 600 per 100,000. There is a large difference in the problem around the world.

Lord Dubs: My Lords, what is being done to raise awareness of TB, particularly among those communities where it is most prevalent?

Baroness Thornton: We have funded the UK charity TB Alert to work with PCTs on a long-term basis to develop a range of strategies and approaches to suit their local area. For example, in my home town of Bradford, TB Alert presented to 170 local GPs in a continuing education seminar, with important messages alerting them to the symptoms of TB. In London, we have a partnership with the Homeless Link concerning finding and treating, which we have discussed in your Lordships' House before. We are developing training in those areas with homeless communities where we know there is enormous vulnerability to TB.

Baroness Masham of Ilton: My Lords, has the funding been arranged for the excellent Find & Treat unit, which goes round homeless hostels and prisons to test for TB. The funding is due to run out in December. Should not the PCTs and NHS London renew the funding?

Baroness Thornton: The noble Baroness and I are completely at one on the importance of the mobile X-ray unit. It has, for example, identified 400 cases of TB, and works in prisons, homeless units and places across London. It is a very important part of the Find & Treat TB exercise in London. I regret to say that at this moment the PCTs in London have yet to co-operate to find the relatively small amount of money-somewhere in the region of £20,000 to £30,000 per year each-to keep the mobile units going. The noble Baroness and I need to join together in campaigning to ensure that the units can continue this very important work.

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