Stroke Services

3rd June 2009

Brooks Newmark highlights the need for a three-pronged approach: the urgency of immediate health care; the long-term nature of recovery; and the opportunity to prevent strokes in future.


Mr. Brooks Newmark (Braintree) (Con): I am delighted to follow the hon. Member for Wyre Forest (Dr. Taylor). I want to begin my speech on a personal note. My father-in-law, Sir John Keegan, had a stroke four weeks ago. He survived due to the swift response of his local ambulance service and the immediate care that he received at Salisbury district hospital in the critical first three hours following his stroke. I want to thank the doctors and nurses in the Farley unit at Salisbury district hospital for all their after-care in the past four weeks. In particular, my mother-in-law, Susanne, my wife, Lucy, my brothers-in-law, Tom and Matthew, and my sister-in-law, Rose, share my gratitude.

As we have heard from my hon. Friend the Member for Westbury (Dr. Murrison)-in whose constituency my in-laws live-stroke is the country's third largest killer. It is also the single largest cause of adult disability, a point made by my hon. Friend the Member for Buckingham (John Bercow) at the beginning of the debate. We all have constituents who have been affected and I suspect that most of us may have experienced a stroke within our own families, as I did recently. Yet for too long, strokes have been the poor relation in the NHS, so I welcome the long overdue national stroke strategy of 2007, which finally prioritised stroke care for health and social care providers. Our response needs to be commensurate with the sheer size of the problem.

The strategy has undoubtedly brought progress, but we must not stand still on the issue. Not enough patients are receiving the treatment and care that they need quickly enough and too many are subject to a dangerous postcode lottery. Inequalities in access to stroke units and long-term care all too often mean that where people live can dramatically affect the length of recovery from a stroke-or even whether they recover at all.

If we want to improve stroke services, we must focus essentially on three elements: first, saving lives in hospital; secondly, reducing disabilities and long-term damage; and, thirdly, preventing strokes altogether. Speed is of the essence with a stroke. A scan and early treatment within the first three hours can, as we have heard, make the difference between complete recovery, a lifelong disability or even life at all. For example, a brain scan will crucially confirm the diagnosis of someone admitted to hospital. For people with ischaemic strokes, swift thrombolysis or treatment with clot-busting drugs within three hours will significantly reduce the chances of dying, yet last year, only 0.8 per cent. of patients received thrombolysis.

I know that having a specialist stroke unit can do much to improve survival rates and recovery times for stroke patients. Commendably, early access to a stroke unit has improved significantly since 2006. However, in 2008, one quarter of patients were still not being offered this service-a service that I know, through personal experience, really can make a difference. As our population ages, the demand for these specialist units can only grow, so we must ensure that we can cope.

Having swift and high-quality stroke services from day one makes sense for our country's financial health, too. Caring for stroke patients currently costs the UK about £7 billion each year because of the long-term implications of a stroke and the detrimental effects of delays in treatment. Given that about a third of stroke survivors will be left with a moderate to severe disability, long-term social care is often a necessity, not a luxury. However, the Stroke Association says that rehabilitation and long-term care in the community is one of the weakest elements of a stroke survivor's pathway. Only around half of those who have experienced a stroke receive the necessary rehabilitation in the first six months following discharge from hospital, which falls to a fifth in the following six months.

The transition from hospital back to the community can also be extremely difficult. Not only do about a third of stroke survivors have communication difficulties-including, as highlighted in the Stroke Association's recent "Lost without Words" campaign, aphasia and speech impacts-but many experience a loss of confidence and independence as they struggle to regain their basic capabilities and rebuild their lives.

I am pleased that as part of the national stroke strategy, every local authority now receives a ring-fenced grant of around £100,000 a year for stroke services. However, I believe that the scheme is currently intended for only three years, so just as services are really starting to make a difference, I fear they may be shut down for lack of long-term financial support.

Finally, it is not enough to just to treat the symptom of the problem, as its cause is also important. We can reduce the likelihood of a stroke through preventive work on high blood pressure, irregular heartbeats and smoking, for example. That alone could prevent thousands of strokes each year, saving not only many families from having to watch a loved one suffer, but millions of pounds each year in care costs. For progress on stroke services, we must look carefully at three elements: the urgency of immediate health care; the long-term nature of recovery; and the opportunity to prevent strokes in future. Only if we can weave those into a more seamless approach, applied evenly regardless of where the patient lives, can we say that we are doing the best for the thousands of stroke sufferers each and every year.


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