National Stroke Strategy

Lord Kakkar Excerpts

Wednesday 18th November 2015 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I, too, congratulate the noble Baroness, Lady Wheeler, on having secured this important debate, and I thank her for it. In so doing, I declare my own interests as chairman of University College London Partners and my own specific research interests in the area of cardiovascular disease, including those of stroke.

We have heard already in this important debate that stroke represents a substantial burden of disease. It is still the fourth commonest cause of death in our country, with an increase in prevalence of some 26% over recent years. This is because we have a growing and ageing population who are living as a result of successes in other areas in the practice of medicine, and are therefore susceptible to cardiovascular diseases. The lifestyle of much of our population, with increasing obesity, diabetes and other important cardiovascular risk factors, also heightens the risk of stroke. That means within the coming five years we would expect to see an increase in the number of deaths attributable to stroke in our country to some 22,000 extra deaths a year by 2020. This is an important increase in the burden of the disease.

Beyond the physical burden, of course, there is the economic burden. The management of stroke costs us some £9 billion a year. Half that sum is due to health and social care costs and the remainder to informal care costs, costs associated with the loss of productivity in the economy and of course the benefits that need to be paid to those who, regrettably, have sustained a stroke.

Of course there is good news. We have heard from the noble Baroness about the success of the national stroke strategy, an important development in the mid-2000s, which has resulted in increased awareness among the public about the importance of understanding the symptoms of stroke and responding to them early, thereby improving early attendance at hospital. Over the period of time of the stroke strategy, we have also seen that now, at some point in the course of the management of their illness, some 95% of patients who suffer a stroke are managed in a dedicated stroke unit.

However, while we have seen from the Sentinel Stroke National Audit Programme some interesting and exciting data on improvements in practice, we have also seen some very serious variations in practice. For instance, the audit shows us that when process and outcomes relating to practice in stroke units are graded, some two-thirds of them get the lowest possible grades, grade D or E, with only 2% of units achieving the highest grade, grade A. We see important variation in the most important feature of acute stroke management: timely intervention by way of radiological assessment of the nature of stroke, and intervention with regard to thrombolytic therapy to dissolve the blood clot responsible for the stroke or indeed more advanced interventions such as thrombectomy to remove the clot itself using interventional radiological techniques. The reality of that situation is that, although 60% of patients suffering a stroke are transferred from A&E to a stroke unit within four hours, the variation is from around 20% of patients in some hospitals to over 80% in others. That fourfold variation is clearly not appropriate, so we have to do more to improve acute stroke management.

I remind noble Lords of my declaration as chairman of University College London Partners. Our academic health science system has been at the forefront of moving forward the stroke treatment strategy in London, along with the other academic health science centres. This particular model has landed upon the development of eight hyper-acute stroke units in London that bring together expertise in radiology and acute intervention. Patients are taken directly by ambulance to the hyper-acute stroke unit, managed there for 72 hours and then transferred to one of 24 stroke units in London for their further management. That model has been shown to save 96 lives per year in London, providing a saving to the NHS in London of some £5 million a year in treatment costs. What plans are there to ensure that the experience in London, now extended to Manchester, can be assessed for its value and utility in other urban areas in our country? Clearly it may not be suitable for all rural areas.

Indeed, how will the national stroke strategy be built on in future to address questions of better prevention, better identification of high-risk populations and the further extension of successful models at scale and pace to improve clinical outcomes?