Health: Stroke Treatment

Baroness Pitkeathley Excerpts

Wednesday 30th June 2010 Lords Chamber

[Baroness Pitkeathley]

My Lords, I thank the noble Lord, Lord Rodgers, for securing the debate and I heartily endorse what he said about its importance vis-à-vis yesterday’s debate, notwithstanding the difference in attendance. I thank him, too, for his excellent exposition about the support services available to stroke sufferers and his concern about the services available to support them and their families, and especially the sustainability of such services.

I am as concerned as he is about these issues, and especially about the negative effects that some of these developments may have on families and carers. I have spoken many times in this House about carer issues and the House—and, indeed, the Minister—will be familiar with most of them. So far as stroke is concerned, carers have two difficulties which make their plight extremely serious. The first is the sudden onset of most strokes, with very little warning or time to prepare. This means that carers are even worse off than many others because they are trying to get information about help and support at a time when they and the sufferer are in most distress and most worried and are therefore less able to find the time or the attention to get in touch with helping agencies. Carers always find a difficulty with accessing information and in these circumstances it is even more of a problem.

The second major problem for carers is the length of time the caring process goes on. Unless you die during the stroke itself you are probably going to live quite a long time, sometimes with a great degree of disability and sometimes with your ability to communicate severely impaired. This means that all the problems of shortage of finance, the threat to their own health, both physical and mental, and the sheer emotional stress of caring for someone who is disabled, and sometimes suffering a change of personality into the bargain, are not only acute but chronic.

As the Public Accounts Committee report reminds us,

“it is in the months and years after discharge that … their families and carers will experience the full impact of the stroke”.

Add to that the fact that if the carer is a spouse, it is likely that they themselves are rather elderly and frail. We have to remember that as well. So support services are vital and frequently make the difference between the carer being able to continue and being unable to, however great their desire to do so.

I am the first to acknowledge that much progress has been made not only with the treatment of strokes, as the noble Lord has reminded us, but also with the support of the carers and families. The fact that there is a national strategy in position for carers as well as stroke sufferers and their families is only one aspect of the progress made. These are cross-party issues that are of concern to the whole of society. While I pay tribute to the previous Administration for the fact that carers can never any longer be ignored, as was once the case, I acknowledge too the commitment of other political parties and of individuals such as the Minister himself.

I want my intervention today to focus on two particular issues because of my experience with carers when funding was not ring-fenced and my experience of the community, charitable and voluntary sector in the provision of services. I remind your Lordships that as part of the national carers strategy £150 million was allocated to primary care trusts to provide respite care for carers. Everyone rejoiced; this was a way of getting health professionals—especially GPs, who are so important to carers—to take their responsibilities seriously and to have money specifically allocated to them to help carers. However, the money was not ring-fenced. As a consequence, only 10 per cent of that money was ever spent on respite for carers. The rest disappeared into the black holes of PCT deficits and budget problems. This is what happens if you do not ring-fence money, and it will happen to the money for stroke as well—of that there is no doubt.

In the light of that, I wonder what assurances the Minister can give that stroke support services developed by local authorities in response to the national stroke strategy will be sustained this year and in the future, now that that ring-fencing has been removed. Does he feel that the ending of ring-fencing for stroke grants sends a rather unfortunate message to local authorities—that this kind of support is no longer a top priority?

In view of that, do we need to worry about other forms of support that are made available to those in need? For example, is the £200 million given to local authorities under the local authority settlement to support carers also under threat? I would be pleased to hear the Minister’s reaction to that.

As with carers, much progress has been made with support services for stroke sufferers. Much of the improvement and innovation in these services has been spearheaded by the voluntary and community sector, such as the Stroke Association, at both local and national level. Many of these services have been funded under contract from local authorities with the ring-fenced allocation. Noble Lords will know that local authorities are under considerable pressure at present, and this is likely to get worse in the next year. If the money is not ring-fenced, the likely outcome is that services will wither on the vine. The services that you get from the voluntary and community sector are extremely good value but they are not cost-free, and unless they have that kind of support they will not go on being provided.

Let us not forget that carers often require only a very small amount of support, provided that it is given at the right time. Two hours’ respite given to a carer in a week—that is often all that they ask for, in spite of what people fear they are going to demand—will often result in the carer giving not an extra week or month but extra years of support in return. The return on a comparatively small investment is very great indeed. I have often reminded the House that it makes good economic as well as moral sense to support the families who provide the majority of our health and social care willingly and over long periods. At a time of economic stringency it is even more important to remember that, and I hope that the coalition Government will do so.