Health: Stroke

Wednesday 14th November 2018 Lords Chamber

Question

15:37

Asked by

[Baroness Wheeler]

To ask Her Majesty’s Government what progress they have made in developing a national plan for stroke.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, a stroke programme board was established in March 2018, co-chaired by NHS England’s national medical director, Professor Stephen Powis, and the CEO of the Stroke Association, Juliet Bouverie. Following this, the NHS long-term plan will include a focus on cardiovascular disease and stroke, and is set to be published before the end of this year.

[Baroness Wheeler (Lab)]

I thank the Minister for his response. While the promise of including the national stroke plan in the full NHS long-term plan is welcome, nevertheless publishing it in its own entity after the national strategy ran out last year would surely have helped to sustain the progress and momentum since 2010, particularly in the reconfiguration of stroke services. Instead, thousands of stroke survivors say that they feel abandoned after they come out of hospital: 70% of patients are not offered a personalised care plan for their ongoing treatment, care and support; only 30% of CCGs are commissioning the vital six-month reviews of their progress and problems; one in four hospitals does not have access to stroke specialist early supported discharge at home; and, on average, stroke survivors wait 10 weeks for urgent psychological support. What action are the Government taking to ensure that CCGs tackle these problems now?

[Lord O'Shaughnessy]

I understand the noble Baroness’s frustration about the gap between the strategy and the plan but it was right to include the work undertaken on the stroke plan within a long-term plan, because clearly that covers every aspect of how the NHS is working. In the meantime, I point out to her that the NHS RightCare programme for cardiovascular disease has been set up. It is aimed specifically at dealing with some of the variation in service that she talked about. But there is good news in stroke care: not only is there less incidence than 10 years ago but 30-day mortality rates have more than halved, so there is progress which we need to build on.

If the noble Baroness and the House will allow me, I would like to use this opportunity to pay tribute to my noble friend Lord Skelmersdale, who died very recently. He was a predecessor in this role and a great champion of stroke care, both as a Minister and as chair of the Stroke Association for 10 years. I am sure that everyone in the House would offer their sincere condolences to his family and friends.

[Baroness Finlay of Llandaff (CB)]

My Lords, will the Government outline the plans to roll out thrombectomy, which is sucking out the blood clot and is done under remote X-ray control? It has massively improved outcomes, even on thrombolysis, which tries to dissolve the clot. Such services need to be available across the UK on a 24/7 basis because stroke does not respect the clock or the calendar.

[Lord O’Shaughnessy]

The noble Baroness is absolutely right. In 2017, NHS England announced a rollout of the mechanical thrombectomy procedure to 24 centres across England. It is expected that 10% of stroke patients will be eligible. It leads to big reductions in disability after stroke, is now approved by NICE, and will be a significant part of the long-term plan which we will publish by the end of the year.

[Baroness Gardner of Parkes (Con)]

My Lords, my husband had a stroke and it was not recognised. It was a clot. He got to the hospital rather late and his arm was definitely damaged for ever more. He died 10 years ago; the stroke did not affect his continuing to live. The hospital in Newcastle was so far ahead in clot-busting that it was three years ahead of London. I remind the House of how much effort Lady Rendell, who is no longer with us, put into Act FAST, a campaign to let people know pretty quickly what the symptoms are and not to delay so that they have more hope of being successfully treated. We have made great progress, but there is a clearly a lot more to make.

[Lord O’Shaughnessy]

I did not know that my noble friend’s husband had had a stroke; I am grateful to her for sharing that with the House. She is right that the examples of Newcastle and Northumbria have shown that hyperacute stroke units—the centralisation of services—save lives. Closing hospitals or changing services can be controversial, but in stroke we know that it makes a big difference. It is a focus of what we need to do, and we need to take courage on that. The Act FAST campaign, which my noble friend mentioned, has been incredibly successful in making sure that we get fast action when people have a stroke. More than 5,000 fewer people have been disabled by stroke since that campaign started.

[Baroness Jolly (LD)]

My Lords, when the national stroke plan is finally published, we should expect clinical elements. I hope that we will see some lifestyle elements around protection from stroke and stroke prevention. What actions are being discussed with Public Health England on the prevention part of the plan? Can he guarantee sufficient funding for local authorities to deliver it?

[Lord O’Shaughnessy]

The noble Baroness is right about prevention. There are lots of ways that we can prevent stroke, including by reducing hypertension, obesity and other things. Of course that will be a big part of it. She will know that decisions about funding for Public Health England will be taken at the spending review.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, the Minister will be aware that one of the medical conditions that can lead to stroke is atrial fibrillation. The important thing is to treat the patient once it is discovered. Some time ago, I attended a demonstration in the Palace of Westminster where patients put their hand on to a machine which detected whether they had that problem so that they could be treated. The idea was that the machine would be rolled out into doctors’ surgeries so that people could use it while they were waiting. How is that scheme progressing?

[Lord O’Shaughnessy]

The noble Lord is quite right that patients with atrial fibrillation have a five times greater risk of stroke. Most patients are diagnosed but about 300,000 are not yet, so finding them is critical. The tests are available now not just in GPs’ surgeries but increasingly in pharmacies. I will write to him with specific details about the rollout.

[Baroness McIntosh of Hudnall (Lab)]

Of course the prevention and treatment of stroke is very important, but unfortunately some people have strokes and are incapacitated by them, sometimes physically but sometimes mentally as well. What work are the Government doing to ensure that as many people as possible register a lasting power of attorney so that, when that bad thing happens to them, a proper care plan is available?

[Lord O’Shaughnessy]

I will need to write to the noble Baroness with specific details on promoting lasting power of attorney. There has been an improvement in the availability of occupational therapy for those who suffer disabilities from stroke, but I do not know whether there is support in terms of planning ahead.