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7.24 pm

Mrs. Claire Curtis-Thomas (Crosby): I start by offering warm congratulations to my hon. Friend the Member for Coventry, South (Mr. Cunningham) on securing this important debate. As he said, stroke affects thousands of people in this country every year and affects some families more than others. I welcome his support for the Stroke Association, which does a great job in my community and in communities throughout the United Kingdom, not least in providing sometimes very distressed family members with vital information when they need it most, sometimes when consultants are too busy or no specific consultant is available to advise on stroke. The association is there to help people and to guide them through a very troubling time.

Difficulties sometimes start in hospitals where patients are not placed in appropriate facilities—a stroke unit is not available and they have to go into general wards—and may continue long after the patient is discharged, sometimes into communities without appropriate facilities for people with stroke and perhaps an absence of physiotherapy services as well. In our community in the north-west, care is sporadic. I endorse the sentiments expressed by my hon. Friend and ask the Minister to reassure us about the implementation of the stroke plan, with particular reference to hospitals and stroke units.

Some hospitals are engaging in research activity on stroke. That is welcome. A local hospital, Aintree university hospital, has such a research facility. I recently visited it, and was delighted to hear that the stroke unit had received £1 million for research. I thought that that was rather a small amount of money for one year, and asked how it had been spent over the course of the year. I was told that it had been spent over a period of six years. One million pounds over six years does not a lot of research make. There is a desperate need to do far more research, because intervention and good management can lead to a good prognosis for many people who endure a stroke.

However, the argument is not just about money—it is far more complex than that. There is an acute shortage of appropriately qualified and motivated individuals who want to embark on work on this condition. Will the Minister touch on the initiatives that her Department is engaged in, first, to make more research funding available for people interested in stroke and in developing good outcomes for stroke victims and, secondly, to stimulate the clinical world's interest in stroke?

I want to say a few words about educating the public on what they can do to minimise susceptibility to stroke. Far too few people understand that salt is a significant factor in stroke, as is hypertension. Although we have started to educate the public on both those factors, far more work remains to be done. Unfortunately, it is often

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only when people have suffered a stroke that they discover that they could have taken several simple measures to reduce their risk. Will the Minister tell me what has been done to improve the information available?

7.28 pm

The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I commend my hon. Friends the Members for Coventry, South (Mr. Cunningham) and for Crosby (Mrs. Curtis-Thomas) for securing and contributing to this important debate. The management of stroke is an important aspect of health care, and I welcome the debate, not least because it gives me an opportunity clearly to explain the Government's policy and how we are helping to make progress in this crucial area.

Stroke is an illness in which part of the brain is suddenly severely damaged or destroyed. The result is loss of function of the affected part of the brain. It usually causes weakness and paralysis of parts of the body, and in some cases, disturbance of vision and of speech. Stroke is the United Kingdom's third biggest killer and largest cause of serious disability.

During the 1990s, death rates from stroke fell by just over a third, having been falling continuously since the 1960s. However, although the figures have been coming down for several years, in 2000 the figure still stood at 19.9 deaths per 100,000. Although the majority of strokes affect older people, they can affect people at any age, and the consequences of a stroke for a young person are especially devastating.

My hon. Friend the Member for Coventry, South asked what was happening about strokes and young people. The standards set out in the national service framework for older people apply equally to services for young people. They are not exclusively for older people. It is the responsibility of each coronary heart disease team and primary care trust to work together to ensure that they develop services that are appropriate to younger people. Involving patients in designing those services will help to make them more accessible and responsive. The health service often puts people into categories, such as older people or younger people, and the right services are not always available. That is particularly true of adolescents, who find that the services available are often not appropriate to their needs. Involving those patients will be a key consideration.

The Government are committed to reducing the number of disabilities and deaths that result from strokes. We are making changes and improvements in access to, and delivery of, effective care and treatment. That includes the key priorities of prevention and education about risk factors. It also relates to the care and rehabilitation services that people receive immediately following a stroke, which make a difference to the quality of life that stroke victims experience.

On funding, substantial new investment in health and social care services was announced in the Budget. The NHS will receive an annual average increase of 7.5 per cent. above inflation over the next five years. That represents an increase of about £34 billion and is the highest sustained growth in funding that the NHS has ever received. There will be a similar increase over the next three years of 6 per cent. in real terms for social services, which are just as important to people who suffer strokes as acute medical services.

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My hon. Friend the Member for Crosby made the important point that the problem is not just one of investment; we also have to consider the capacity of the staff who work in the system. We are acutely aware that we need to boost the number of staff who are available to treat people in the NHS. The NHS plan makes it clear that we need a huge increase in consultants across the board if we want to have a consultant-led service. The target was initially set at 7,500 extra consultants by 2004. The recent Budget announcements have allowed us to roll that target forward and we now want to recruit at least 15,000 more doctors—consultants and GPs—over the 2000 baseline by 2005.

We are not just providing more doctors. Between September 2000 and September 2001, the number of qualified nurses employed in the NHS increased by 14,400, which is about 4.3 per cent. However, the Budget has allowed us to forecast a further increase of 35,000 more nurses by 2008. Again, we are trying to get qualified staff into the system as soon as possible.

Therapists are particularly important for people who have suffered strokes because they help with their rehabilitation. There will be 6,500 more therapists and other health professionals working in the NHS by 2004. There will also be an extra 4,450 training places. In the past, we failed to invest in training people in the system or we cut training places. The therapists will include physiotherapists, occupational therapists and speech therapists, who are particularly important for stroke victims. Many of the stroke victims I met said that had they received speech therapy at an early stage in their treatment, their quality of life—in particular their communication with their families, friends and neighbours—would have been greatly enhanced.

I recently met an elderly lady who had recovered from a stroke. Before her stroke, she used to get a great deal of pleasure from completing crosswords, which formed a large part of her life. Following her stroke, she lost the ability to spell, which left a big hole in her leisure time. I managed to enrol her in classes for literacy and spelling, and she is well on the way to being able to complete crosswords again. The NHS would not necessarily have thought of providing her with educational support to ensure that her skills went back to the levels at which they were before she suffered her stroke. It is important that we are more imaginative about the services and links that we provide for rehabilitation.

We want to deliver a patient-centred service. That is a big challenge for us—nowhere more so than in services for people who have suffered strokes. We have a 10-year programme to provide extra investment and to reform the service. We need to increase capacity but we also need to look more creatively at the services that we provide. However, the extra funding will help us to deliver the national service framework for older people, on which clinical services for strokes will be centred.

We want to ensure that patients can return as far as possible to the lifestyle that they enjoyed before their stroke. Work on the national service framework will help us to achieve that. Many of the policies that we are developing, such as helping people to give up smoking, promoting healthy eating, encouraging people to increase their physical activity and reducing the number of overweight people, especially those who have problems with obesity, will help to reduce the incidence of stroke and to tackle heart disease.

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It is important to prevent and limit the burden that strokes impose on the people who suffer them and, crucially, their carers. A huge responsibility is put on the families and friends of those who have had a stroke. We recognise that in the White Paper "Saving Lives: Our Healthier Nation", in which we identify heart disease and stroke as priorities for positive action to improve prevention. We set a target to reduce stroke mortality by at least a further third by 2010, using 1996 as a baseline. We are trying to build on recent reductions in mortality from strokes, and we have set a challenging target to reduce that even further.

Although we might reduce the number of people who have strokes, we must not forget that stroke victims still need a wide variety of services. Some people need acute care immediately following their stroke. Depending on the severity of the stroke, they will need a programme of rehabilitation to help them optimise their independence afterwards. Services for older people, especially stroke victims, were not always the most attractive parts of the health service and did not necessarily draw in clinicians. I am pleased to say that that is changing and we are developing good doctors, consultants, nurses and therapists who are committed to team working when helping stroke victims. I have seen evidence showing that when rehabilitation services work together, they have a huge impact on someone's quality of life in years to come. That intervention has to be at the earliest possible opportunity. If we leave problems for a long time, there is a corresponding reduction in the quality of life. Ensuring that different members of the team work together, and work quickly, is a priority.

Clearly, stroke is a medical emergency. The majority of patients are admitted to acute medical wards from accident and emergency departments. The aim of initial treatment is to stabilise the patient and reduce the risk of fatality; to reduce the prospect of major disability; and to prevent secondary strokes, which happen far too often and affect someone's quality of life enormously. The development of stroke services—the team working—has brought about an enormous change in the care of stroke patients. There is growing evidence that dedicated care improves outcome, reduces mortality and is cost-effective. Specialisation of nursing staff is a key factor in a successful stroke unit.

The latest development of stroke care was contained in the national service framework for older people, published in March last year. That sets specific standards and milestones, to which my hon. Friend the Member for Coventry, South referred. It establishes the development of integrated stroke services and improvements in the delivery of stroke care as a priority. I am pleased to say that the NHS priorities and planning framework for 2002–03 reinforces the high priority given to delivery of the milestones set in the national service framework. The health service used to have a wide range of priorities—probably far too many, in fact. Having a smaller number of priorities should enable the NHS to deliver better on the targets that we set, and stroke care is one of those high-priority targets.


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