Health: Stroke

Lord Patel Excerpts

Wednesday 23rd July 2014 Grand Committee

[Lord Patel (CB)]

My Lords, it is a pleasure to take part in this debate. I declare an interest: at one time I was a council member of the Stroke Association and I chaired Stroke Scotland for a while. After the noble Baroness, Lady Wheeler, sat down I decided that my speech was not much good, so I will take a different approach to today’s debate.

I want to look at what an ideal service for children with stroke might look like. The ideal service would be when both parents and GPs are aware that children might have a stroke, but especially when paramedics and medical staff in accident and emergency departments have the knowledge that stroke is one of the differential diagnoses to consider for children with particular symptoms. These children should have rapid access to MRI scanning; currently that is not happening. They should have access to specialist staff to inform early acute intervention, either on-site or known at tertiary level centres for district-level medical professionals to contact for advice; a multidisciplinary team experienced in early sub-acute neurorehabilitation to commence the child on a pathway of care, including parent support and guidance from day one after diagnosis; supported transition into a rehabilitation setting, with in-patient beds for children and young people available equitably nationally; tertiary level out-patient services to support and guide local teams in their management and support of children and families; and flexibility in service delivery to work around the family, for example being able to respond when a new issue arises in the longer term around school, socialising, mobility and so on. A family support worker with experience of stroke should be available to the families from diagnosis through to long-term recovery, to signpost families to services across the NHS, social, education and charitable sectors. I know that that is a long list; but that is what an ideal service would deliver for the best outcome for children.

We can begin by in the first instance—as the noble Baroness, Lady Wheeler, mentioned—getting the guidelines updated, this time from the Royal College of Paediatrics and Child Health, with the help of NICE, which would possibly set the standards, which would then improve the commissioning process. We will have to go further than that. One other way would be to carry out in the first instance a national audit of stroke in children, as that would inform us how the services perform.

I will briefly address research areas that might be useful to improve the services in future. Currently we do not know much about interventions at the early stage—even, for instance, when anti-coagulation or blood-clotting drugs should be used. Research might be in areas such as what therapeutic interventions work and the type of intervention and dosage of drugs that will be required, in particular in motor/movement interventions for preschoolers and infants, and social, emotional and behavioural input for adolescents.

Intervention effects could be evaluated at the level of neural pathways through innovations and MRI imaging. For instance, I know that two centres in the United States are currently carrying out research into MRI imaging through neural pathways—as well as clinical evaluation of functional change. Questions that could be answered, but realistically only through multicentre studies to support a large sample size, include, when is the optimal time after diagnosis to intervene? How old should a child be to gain maximum effect? How intensive a dose of intervention should there be? What models of remote access to intervention are effective, such as telehealth, for parents and for children and young people, to support parents in managing stress, build resilience in young people to manage daily life challenges, and enable people to meet each other and provide mutual support? Those are some of the key areas of research that are required and should be supported.

In conclusion, the current service is not ideal, but we can begin to make it ideal. We have, even in this city, the Evelina Children’s Hospital and Great Ormond Street, which will match up pretty closely to this ideal service. They could be used as good practice places which other units can learn from. I hope that we might hear some positive answers from the noble Earl; I have no questions for him.