National Stroke Strategy

Lord Lansley Excerpts

Wednesday 18th November 2015 Lords Chamber

[Lord Lansley (Con)]

My Lords, I join other noble Lords in thanking the noble Baroness, Lady Wheeler, for securing this debate and for the chance for me, early in my opportunity to contribute to debates in this House, to talk about an issue that is close to my heart.

The noble Baroness and some Members of the House may recall that I was chair of the All-Party Parliamentary Group on Stroke for seven years, before the 2010 election. The noble Baroness is quite right—it was a very important time for the development of stroke services, and Members of both Houses, as well as the Stroke Association, can take some credit for keeping a consistent focus on the treatment of stroke as a medical emergency. It has dramatically shifted over that decade from being thought of as a condition which people suffered—they had a stroke and then nothing much happened—to something that was treated as an emergency. Now, increasingly, we are beginning to see the development of more effective pathways for treatment that follow the acute emergency care, which is very important. It all goes back to the National Audit Office report back in 2005—so much of it flowed from that. We should not forget the critical role that should be played by the constructive but critical scrutiny that can be placed upon the service.

We have done a great deal but, as they say, there is more to do. We now know from the evidence, which the noble Lord, Lord Kakkar, eloquently set out, that a significant proportion of patients who are admitted as a medical emergency can benefit from acute care for ischemic stroke. One day I hope that the research will enable us to do something for patients who suffer a haemorrhagic stroke. However, the point is that making that very early diagnosis is absolutely critical to get patients on the right path.

We know that if patients are admitted to a specialist stroke unit rapidly, receive intensive therapy in the early stages after their stroke, and are discharged relatively early with support, all of those actions will have a significant impact upon their outcomes and, as a consequence, from the health service’s point of view, will be a major benefit as regards the reduction of long-term disability. The NHS, I hope—that was my intention—should be focused on outcomes and focused for the benefit of patients on reducing the disability consequences of stroke. We will have more patients with stroke to deal with—the noble Lord is quite right about that—but that does not mean that we should not be relentlessly focused on trying to increase consistently the proportion of those patients who suffer a stroke but who avoid mortality in the 30 days after that stroke and whose long-term level of disability is reduced. I should declare an interest as a stroke survivor myself. I had my stroke 23 years ago or so, in a very different age. We can do much more for stroke patients today.

There is a need in the midst of that for the department to act as steward of the system. For the NHS, through NHS England and the commissioners, there is a responsibility to secure the best possible outcomes. There is a need to commission for the best care to meet those quality standards; I was privileged to launch the first quality standards that NICE produced, which were on stroke. However, through the stewardship of the system, the Department of Health and Ministers are able to tie together the public health activity, and we here can hold the system to account. In his reference to screening for AF my noble friend made it clear how there is a public health benefit and activity to be determined there. The social care support that follows discharge of patients in the long term is of critical importance, as, of course, is the research activity. There is now ample evidence that more research activity on stroke can pay enormous dividends as regards securing the best pathway for treatment.

In the midst of that, I will make a plea. The better care fund is a large NHS fund, whose purpose is to enable patients to leave hospital and be looked after in the community with their social care much better adapted in the future, relieving burdens on the social care system in the long run using NHS resources. There would be no better place to focus some of this better care fund than on the support of stroke patients to receive early supported discharge after they have had a stroke.