National Stroke Strategy

Baroness Walmsley Excerpts

Wednesday 18th November 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I start by congratulating all those who lobbied for the 10-year national strategy and all those who have made it work so well. If it had not been for the vision behind its establishment, and the hard work and co-operation of all those who have made it work, many more people would have died of stroke and many more survivors would have struggled with inadequate services.

Clearly, the additional specialist services and the community stroke teams have been a great success. However, every plan of this nature, especially those starting from a low base, has to be seen as a work in progress. The national stroke strategy is one of those for several reasons.

Medical research has, of course, moved on over the eight years of the strategy so far, and new ways of preventing stroke and treating and supporting people who have a stroke have emerged. In addition, because of the lowered mortality rate, there are now more people living with the consequences of stroke, and they require support. Add to that the changes in the structure of the NHS and commissioning since the strategy began, and the further pressures on the NHS which we have debated many times in your Lordships’ House, and we find ourselves looking at a strategy that needs updating, even though it has not yet reached its nominal sell-by date. So I am most grateful to the noble Baroness, Lady Wheeler, for giving us this opportunity to take a long, hard look at it.

It is clear from the briefings we have received that the scope of the strategy needs to be wider to include vascular dementia, a set of conditions that are closely linked to what we normally think of as stroke because they affect the delivery of blood to the brain. It is also clear to me that we need to invest in the wonderful new methods of prevention that have been mentioned.

Many of today’s speakers will, like me, have attended the walk-in briefing and testing session about atrial fibrillation last week—I was delighted to get a big green tick. I was impressed by the modest cost and ease of use of the kit, which can identify atrial fibrillation, and its potential for preventing strokes before they happen. I look forward to the analysis of the pilot scheme, which is putting 200 units into GP practices. Prevention is always better than cure, especially when action can be taken to prevent a serious condition such as stroke. I hope that the Minister’s department will look carefully at the cost-effectiveness of this initiative. Combine this screening with access to the NOAC drugs mentioned by the noble Lord, Lord Colwyn, and we have a formula for saving lives and saving money.

We know that strokes kill about a quarter of sufferers outright, as I know from personal experience in my family. When I listened to the noble Lord, Lord Kakkar, I thought, “Well, if you’re going to have a stroke, the best place to have it is in London”. But 20 years ago, when my late husband had a massive stroke, it was in Brussels. He was picked up by an ambulance in minutes, and within half an hour of collapsing in our hotel room was in a scanner being screened. That is why I think that four hours is an awfully long time.

We know a great deal about the lifestyle changes that can help to prevent strokes, but successive Governments have struggled to persuade the population to take these known preventive measures. Perhaps we need another public information campaign. I think that the public still lack knowledge of how to recognise when someone is having a stroke, as the noble Baroness, Lady Hodgson, outlined. Having taken an interest in the matter, I think that I know what to look for, but many people do not. Go out on to the street and ask people—despite the public information campaigns that we have already had, I think at least half of people would not know what to look for. We have to keep on telling them.

Given that successful outcomes depend a great deal on rapid diagnosis and access to treatment, it is vital that we have regular public information campaigns as part of the new stroke strategy. I suggest that such campaigns combine information on how to avoid having a stroke yourself alongside the messages about how to recognise it in others. If those around you recognise that you are having a stroke and call for help quickly, you have a much better chance of survival—and survival without serious disability.

The other thing that has been criticised in the briefings and by some noble Lords tonight is the patchiness of services for stroke survivors. This can only get worse, unless local commissioners are on the ball. We have learned from the briefings about the economic and lifestyle benefits of speech and language assessment and therapies for stroke patients, but not all patients have access to adequate amounts of these. They are clearly services which need to move seamlessly from hospital into the community, but they vary a lot from place to place. As a lay person, I have long been aware of the need for physiotherapy for legs and arms that have been damaged by stroke and for help with speech problems, but I was not aware, before I read the briefing, of how widespread swallowing difficulties are. Apparently, 40% of stroke victims have difficulty swallowing and a third have communication problems. What can the department can do to ensure, first, that there is an adequate supply of speech and language therapists—I believe there is a shortage—and, secondly, that CCGs are aware of the benefits of providing the services that have been discussed this evening?

Finally, do we really have to wait another two years to amend the national stroke strategy? The evidence is there. Why can we not start now?