The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I being by congratulating my noble friend Lord Rodgers on securing this debate and giving us the opportunity to discuss the important issue of treatment and care for people who have had a stroke. I found much to agree with in all that he said. Stroke is a devastating condition that has an enormous human cost. It is our third biggest killer. Every year some 110,000 people in England have a stroke. A million people have had a stroke and a third of them have moderate to severe disabilities as a consequence. It is the largest single cause of adult disability and often has shattering consequences for families and carers. There is also a major economic dimension to stroke since the cost to the economy runs into billions of pounds every year. Indeed, the National Audit Office, whose recent report we are considering, estimates that in 2008-09, stroke had direct care costs of £3 billion within a wider economic cost of about £8 billion.
The Government welcome the National Audit Office report of 2010 which identifies significant and positive changes in the provision of stroke treatment and care since its report in 2005. As my noble friend said, it shows that acute care is improving with specialist stroke clinicians now available in all hospitals, and concludes that action taken since 2005 has improved value for money. That is very welcome news. However, as has been pointed out by a number of noble Lords, the NAO also identifies areas for further improvement—for example, in post-hospital care to match the progress made in acute care. It is clear that there is still more to be done. My noble friend Lady Neuberger drew our attention to several key items on the agenda. Before coming to future work, I pay tribute to the multidisciplinary teams in the NHS and social care whose energy and commitment are making the stroke strategy a reality. Charities, too, such as the Stroke Association, Connect, Different Strokes and Speakability have contributed a great deal to the significant improvements that have been made.
What are we doing? We are working with NHS Improvement to develop the accelerating stroke improvement programme to achieve in this current year further, faster improvement across the whole care pathway. This will help address issues that the NAO highlights and will support the NHS and its partners to make the necessary improvements. Five strategic health authorities have held events to start implementing this programme and arrangements are in hand for the remaining five to do so.
One of the key components of stroke treatment is for all patients who require it to have timely brain imaging. The stroke best-practice tariff encourages this, and direct admission to a stroke unit also improves outcomes. A stroke-skilled workforce is vital. The department has supported development of the stroke-specific education framework which, through the UK Forum for Stroke Training, will contribute to assuring the quality of stroke training. More stroke-specialised physicians have been trained and we are planning more training places in the coming year. We continue to work with the Care Quality Commission, Skills for Care, NHS Improvement, the ambulance service and local government to develop systematic ways of enabling all staff who look after people who have had a stoke to be stroke skilled.
Working with the CQC, we will support action to improve training opportunities for those caring for stroke survivors in residential and nursing homes. Many more stroke survivors could benefit from high-quality early supported discharge, which can improve outcomes. Stroke care networks and local authorities need to work together with commissioners and provider trusts to ensure that this part of the pathway continues to develop. The accelerating stroke improvement programme will be supporting this.
Stroke is a vascular disease and, as well as smoking and high blood pressure, its risk factors include an irregular heart rhythm called atrial fibrillation, or AF, which can be detected from the pulse. Some 12,500 strokes a year are thought to be attributable to AF. Improved diagnosis and treatment would prevent around 4,500 of those strokes annually and work is in hand to raise awareness of AF in both primary and secondary care, and to explore opportunities to improve this situation.
Quality, as ever, is key, and the House may wish to know that the National Institute for Health and Clinical Excellence has today published a quality standard on stroke as advice for the Secretary of State to consider. NICE quality standards provide a description of high-quality care across a care pathway, and I very much welcome NICE’s work in this area.
My noble friend paid tribute to the Stroke Association, as do I, and asked whether Ministers will meet it. I understand that my honourable friend the Minister responsible for stroke, Mr Burns, is planning to meet the Stroke Association in the reasonably near future.
The noble Baroness, Lady Thornton, spoke very powerfully about the Act FAST campaign. It has been evaluated in some detail and has proved to be very effective in raising awareness of the signs of a possible stroke and the need to treat it as a medical emergency. In addition, analysis of calls to 999 found that in the first four months of the campaign there was a 55 per cent increase in stroke-related calls. Qualitative research among healthcare and social care workers found that the public campaign has done a very good job of educating them about the signs of stroke and the need for urgency. The noble Baroness raised concerns about the funding allocation for the Act FAST campaign. She knows that as part of the efficiency measures announced by the Government all communications activity has been frozen, but we will make the case for exemptions where we believe that we have robust evidence, can generate a strong return on investment—if I may put it that way—and achieve measurable benefits to the nation’s health. I am absolutely sure that my honourable friend Mr Burns will have this issue fairly near the top of his list for the reasons that she stated.
The noble Baroness and my noble friend Lord Rodgers expressed concern about reconfiguration. The Government are clear that they do not expect reconfiguration to stop, but wish to ensure that plans are locally owned by residents, patients and particularly clinicians. Some areas have chosen to implement the national stroke strategy through proposals for significant reconfiguration of stroke services. NHS London has developed detailed plans in this regard. Those proposals are due to be discussed at forthcoming meetings to ensure that all stakeholders agree with the approach. I also have a note here about Greater Manchester. If the noble Baroness would like the details, I will gladly write to her.
My noble friend Lord Rodgers and the noble Baronesses, Lady Pitkeathley and Lady Thornton, expressed worries about the premature ending of ring-fencing for the stroke grant and about the message that this sends. It is important to note that the funding itself has not been cut. For 2010-11 it has been protected, unlike that in many other areas of local and central government as we tackle the deficit. The decision to remove the ring-fencing is consistent with the approach of the Department for Communities and Local Government, of the Treasury and of local government itself. The decision to remove ring-fencing was not taken lightly. The Government's view is that in this very challenging period for public finances it is important to give local government flexibility in local decision-making and in the delivery of front-line services, including social care. The local authority circular that accompanies the grant describes clearly the kind of services that local authorities might want to commission and provide using this funding. Local authorities are required to make a return to the department confirming that expenditure of the money has been incurred under the terms and conditions set out in the local authority circular.
As I expected, the noble Baroness, Lady Pitkeathley, spoke powerfully about the role of carers. The Government recognise that being given breaks from caring is one of the top priorities of carers when it comes to the support that they want. We are committed to using direct payments to carers and better community-based provision to improve access to respite care in particular. The noble Baroness is absolutely right that experience has shown that involving stroke survivors and their carers from the outset in the development of services is essential if those services are to match individuals’ needs and expectations. The grants have provided local authorities with an opportunity to focus attention on a group of people in the community who have very specific needs. Enhancing the quality of life and degree of independence of stroke survivors indirectly supports their carers and families as well.
It has always been clear that the grant money was for a three-year period, during which local authorities would have the opportunity to put in place service provision for stroke survivors and their carers. We anticipate that local authorities will endeavour to incorporate approaches that are proven to offer value for money into their longer-term plans.
Time is against me and I will probably have to write to noble Lords whose questions I have not answered. I say to my noble friend Lady Neuberger, in response to the key point that she raised, that age discrimination, as with other forms of unfair treatment, has no place in the health and social care system. The National Service Framework for Older People published in 2001, explicitly rejected age discrimination in health and social care, and Equality Act will give legal force to this.
The noble Baroness, Lady Thornton, asked when we would respond to the PAC report. We will do so on 8 July.
Finally, I thank the Comptroller and Auditor General and his staff for producing their stroke care report. As it says, there are clear patient and economic benefits from having a fast emergency response and early access to stroke units. We intend to ensure that the improvements that the report acknowledges continue, and we will support further progress so that our stroke services become among the best in the world.