Health: Stroke Treatment

Baroness Thornton Excerpts

Wednesday 30th June 2010 Lords Chamber

[Baroness Thornton]

My Lords, I start by thanking the noble Lord, Lord Rodgers, for bringing forward this debate. It is almost exactly a year since we had a debate in your Lordships’ House in which the noble Lord mentioned stroke and, indeed, his questions were answered by me. I do not expect that the noble Lord imagined that he would be addressing his questions to a Minister who, one year on, is now his noble friend. I hope that the noble Lord, Lord Rodgers, is not going to let up on his consistent holding of the Government to account for what is going to happen to stroke services and the stroke strategy.

It is not often that I do this, but I intend now to quote myself from 25 June last year. In that debate, I said:

“The noble Lord, Lord Rodgers, raised the issue of stroke, as did several other noble Lords including the noble Lord, Lord Walton of Detchant”—

whose debate it indeed was. I continued:

“He was right to point out that we have a new national framework for stroke and we are endeavouring to give it the right kind of emphasis and prioritisation that stroke requires. I can confirm that the 10-year plan is on track, that the stroke strategy acknowledges that the networks are of great benefit and that all the stroke services in England now fall within one of the 28 networks. The work of the stroke improvement programme, including the networks, will be evaluated over the next year, after which future work plans will be considered”.—[Official Report, 25/6/09; col. 1750.]

There is no question that the Labour Government took the issue of stroke very seriously, for all the reasons that have been eloquently described by noble Lords today. I think particularly of the very fair summary of the history of this issue which the noble Lord, Lord Rodgers, gave.

I suppose, then, that my first questions to the Minister are: has the review been finished, what is its outcome and what are the government plans for taking forward the strategy? Indeed, will the coalition Government be following the stroke strategy, or will they be junking it to start all over again in a year’s time? Personally, I would counsel against such a course of action, given the widespread support that the strategy has across a whole range of medical and voluntary organisations and, indeed, the involvement of many of those organisations in the creation and continued monitoring of the strategy.

However, there are some worrying signs, to which other noble Lords have already referred. On the recent decision by the coalition Government, on 10 June, to remove ring-fencing conditions from the £15 million 2010-11 revenue grant to local authorities for implementing the stroke strategy, I can only quote the excellent briefing, for which I am very grateful, from the Stroke Association. It says that in its opinion this,

“makes the risk of cuts to current support service levels even more pronounced and in need of urgent attention”.

I agree with it and would really like to know how the strategy will now be delivered at local level.

The NAO and the PAC, which noble Lords have also mentioned, recognise the risk posed to improvements in the longer-term stroke strategy services by the end of additional funding for the implementation of the national stroke strategy after 2010-11 and the current financial pressures facing the NHS and local authorities. Under these circumstances, we need a commitment from the department that these improvements will continue in the long run. Indeed, as has already been mentioned, the PAC makes a number of key recommendations on how the department can sustain and improve further the standards of service for all stroke patients across the whole care pathway, and asks for reports on progress in areas within 12 months. I agree with that and would like to hear a commitment from the Minister to that course of action. Indeed, when we were in government we regarded the work of the PAC as extremely important in helping us to deliver the stroke strategy.

However, I am alarmed at the current risks to services. The NAO report shows that 76 per cent of local authorities surveyed have used the Department of Health’s ring-fenced funding to develop services with the Stroke Association. As mentioned by my noble friend Lady Pitkeathley, the number of contracts with local authorities to provide information and support has increased from 164 in 2005 to 268 in 2009. It seems that, at current levels, one in every two patients is able to access them. Around half the local authorities have also used the funding to establish their own dedicated stroke-related jobs, such as stroke care co-ordinators, stroke-specific social workers and occupational therapists, and a quarter have used some of the grant to fund breaks for carers.

We know that there is also still an unmet need. It would seem that, at the moment, an estimated 50 to 60 services around the country could be under threat of not having their contracts renewed. This is a very serious issue. Some local authorities have already put recruitment on hold for vacant positions. I am concerned that the message being sent from the department is that this is no longer a priority for local authorities. How will the coalition Government re-establish the priority that we gave stroke, and how will they re-establish those networks that have been so important in improving the treatment of stroke across the country and for the future?

I have several other questions which the Government need to address. They relate to the issue of funding at local level. Do the Government have plans to monitor and evaluate the use of the ring-fenced funds to ensure that they continue to be a priority? Does the Minister feel that the premature ending of ring-fencing sends the message that I have already outlined—that this is no longer a priority? What on earth will they do about that? The Stroke Association and the voluntary sector have a right to be very concerned.

The Minister would expect me also to refer to FAST. The previous Government invested £10 million between 2008 and 2010 in awareness-raising activity around strokes, centred on the highly visible Act FAST campaign, which I demonstrated to your Lordships’ House twice last year. The PAC report describes this campaign as “excellent” and concluded that it,

“had improved public awareness of stroke and the responsiveness of ambulance and hospital staff”.

Given that the mantra we keep hearing is that the Government want an evidence base for the decisions that they take, I hope they will take on board the NAO’s public survey, which gives the evidence that this campaign has worked. Will the Minister confirm that the funding allocated for the continuation of the excellent Act FAST campaign will be spent? What plans does the department have to continue funding the excellent campaign to improve awareness of stroke over the medium to long term?

I am proud to have been part of the Government who transformed the treatment of stroke in this country. We made the National Stroke Strategy a priority and gave additional funding to strategic health authorities for its implementation. We ensured strong leadership at a national level with a national clinical director for stroke and the new NHS Stroke Improvement Programme. Progress was aided by the inclusion of implementation of the National Stroke Strategy of the NHS operating framework as a tier-1 “must do” national requirement. I am pleased that the tier-1 status continues to be there in the revised operating framework that this Government have just published. I hope that that is not just for this year, but for the duration of the strategy. Is that the case?

We know that the best way to reduce the human and economic cost of stroke is through prevention. I put it on record that I remain to be convinced that the coalition Government are taking seriously their commitment to issues of public health. The prevention of stroke is key to the whole of the Government’s public health drive. Smoking cessation, obesity campaigns and swimming are all linked to how we prevent stroke in the future. How will the Government’s work to prevent stroke happen in the current financial climate and given the freeze in advertising? Having a policy which just says that we are going to prevent stroke by doing the following things, but are cutting the budget that allows us to communicate that, makes it not at all a useful commitment. It is meaningless. It is important that we hear what the Minister has to say on that.

Finally, what does the moratorium on reconfigurations mean for stroke services? Following consultation, Healthcare for London planned to introduce eight hyper-acute stroke units, all of which it hoped would be up and running by April 2011. However, I have to ask, what is the future for these centres? The Secretary of State has said:

“I am fulfilling the pledge I made before the election to put an end to the imposition of top-down reconfigurations in the NHS … As part of this, I want NHS London to lead the way in working with GP commissioners in their reconfiguration of NHS services. A top-down, one-size fits all approach will be replaced with the devolution of responsibility”.

We have heard this many times before. However, this has potentially extremely serious implications for stroke services in London, which are beginning to deliver an absolutely excellent first-rate service which is saving the lives of Londoners. As someone who lives in London during the working week, I would like to know what would happen to me now if I had a stroke. Would I end up at one of these centres or have they now been reconfigured out of existence? I suggest that we probably need to keep a very vigilant eye on the future of stroke services.

[Lord Clinton-Davis]

I apologise for speaking in the gap. I did not know whether I could be here. However, it would be remiss if I were not to mention the debt that some stroke sufferers owe to the authorities of this place. I am one of them.