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Mr. Jim Cunningham: Will my hon. Friend say more about numbers of social workers? How many specialist

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units have been established and where are they? My hon. Friend knows that provision throughout the country is patchy.

Ms Blears: I understand my hon. Friend's concern about the inconsistency in the way in which the units have been established. I understand that the results of monitoring will be available later this summer, so in the next couple of months we should get a clear picture of where services have been established, where they are planned but not yet up and running, and where we need to ensure that they are provided.

I know that the way in which monitoring will be carried out in future is a particular concern. In future, strategic health authorities will monitor the performance of acute trusts and primary care trusts in delivering the national planning priorities. Therefore, there will be a performance management route through the system, so that we can see where things are happening, and, where nothing is happening, take action through investment and creation of services on the ground. In future, the levers will be at strategic health authority level, rather than in the centre at the Department of Health. That is part of our drive to ensure that while the Department does not micro-manage the service, the service is managed according to the national standards and frameworks that we set. I assure both my hon. Friends that the matter is covered in the national priorities and planning framework and that it will be performance-managed to ensure proper performance in every community.

The aim of the stroke standard is to reduce the incidence of stroke in the population; to ensure that those who have had a stroke have prompt access to integrated stroke care; and to take action to prevent strokes, working in partnership with other agencies where that is appropriate. We are determined to ensure that people who have had a stroke have prompt access to diagnostic services; that they are treated appropriately by a specialist stroke service; and that subsequently they, with their carers, participate in a multidisciplinary programme of secondary prevention and rehabilitation.

Recently, I visited a beacon stroke service in the south-west which is attended by people who have had a stroke and their carers, so that they can learn together about the action that they can take to maximise the extent of rehabilitation and the mobility, speech and basic skills regained by the person who has had the stroke. I met an incredibly impressive husband-and-wife team who, as a result of their involvement with the stroke service in their area, resolved to set up a self-help group in their community. The stroke service was able to help them to set up this entirely new group, which could go on to help others in the community. I was impressed by that close collaboration between people who had had strokes, their carers and their wider family. That provides a good model for us.

The standards in the national service framework will be supported by wider action and development work on the elimination of age discrimination; the delivery of person-centred care through the single assessment process, which will apply to older people across health and social care, so that in future those involved in social care are involved in assessment as well as the NHS; the delivery of intermediate care services to promote faster recovery from illness and to prevent acute hospital admissions; and improving access to appropriate specialist

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care in the best hospital environments. Each of those standards has a contribution to make to the care of stroke patients.

Mr. Cunningham: Does my hon. Friend intend to speak about the Afro-Caribbean community—an issue that was drawn to my attention a couple of weeks ago? I am sure that she is aware that the Esaba Afro-Caribbean women's group in Coventry was involved in a pilot scheme during stroke week, which was last week.

Ms Blears: I am aware that certain groups in our community are particularly susceptible to certain conditions. A challenge facing all of us—not only those involved in stroke services but everyone involved in NHS provision—is to make sure that services are accessible, responsive and appropriate to the needs of a far more diverse and varied community than before.

The constituency group my hon. Friend mentions provides evidence of the way in which dramatic changes to services can be achieved when patients, their carers and their families are involved. The people with the best ideas for change are usually those who are at the sharp end—they know their illness better than any expert specialist, because they live with it every day. My Department is developing the expert patient programme, which covers a wide range of conditions including arthritis, diabetes and stroke. That programme will help to develop patients' skills in helping themselves and others. My hon. Friend's constituency group provides an excellent illustration of the way in which local people can influence the shape of health services in their community. I undertake to find out details of that project and to feed them into the development of policies within the Department.

The milestones for action were set from April this year. They are being monitored now and we should have the results very soon, which will enable us to see where specialised stroke services have been established. By April next year, all hospitals will have to have established clinical audit systems that ensure delivery of the Royal College of Physicians clinical guidelines for stroke care. By April 2004, PCTs will have to have linked with local specialist stroke services to ensure that general practices can identify, manage, treat and refer through agreed protocols. In that way, we will establish services at all levels—primary care, secondary care, and rehabilitation and community care—thus providing a seamless service for people with stroke.

Mrs. Curtis-Thomas: Recently, and to his great misfortune, a member of my staff succumbed to a second stroke, having had his first four years ago. Unfortunately, his prognosis is extremely grim. The problems he has experienced are familiar to me because this awful affliction has affected several members of my family.

From meeting this man's family and others, I have become concerned about the fact that when stroke strikes, people who have never been in that position before have no idea what type of services they can expect. This dear man is expected to leave hospital very shortly—the hospital can do no more for him, nor can physiotherapy—and his wife feels that she has been abandoned. She

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desperately wants to look after him at home, even though that will be extremely difficult, but she believes that social services are likely to tell her, "We're terribly sorry, but that's not an option. Your husband has to go into care because we're not prepared to fund the support that you need at home."

What can I say to that woman? Can I say, "If you want to nurse your husband—our dear friend—at home, you can do so and you will have the support of social services", or is there a class of individual who will invariably be consigned to a nursing home—

Mr. Deputy Speaker (Sir Alan Haselhurst): Order. The hon. Lady cannot make a second speech during an intervention.

Mrs. Curtis-Thomas: I apologise, Mr. Deputy Speaker. I hope that my hon. Friend the Minister is able to respond to the case that I have outlined.

Ms Blears: My hon. Friend gives a poignant illustration of the difficulties that people experience when seeking post-hospital care. The introduction through the national service framework of the single assessment process, which involves the NHS and social care, should ensure that people do not fall through the net. Closer integration and working between those two arms of the service will be key. In some circumstances, the assessment may indicate that residential care is the appropriate course of action. I have no knowledge of the personal circumstances of those involved in the case my hon. Friend describes, but in some cases residential care is appropriate. What is important is that the family, the carers and the person who has had the stroke are involved as far as possible in reaching what are extremely difficult and important decisions.

The involvement of specialist nurses is also important, as experience of other conditions such as cancer has shown. Macmillan nurses are able to assist people with home care, and the principles that govern their activities are equally applicable to a range of different conditions. Specialist help from people who have a wide range of knowledge and previous experience can help to guide and shape the services that should be established. Certainly, stroke services are not as well developed as cancer services, which have been in place for many years, so we need to look at developing them.

We have just embarked on a 10-year programme on the national service framework stroke standard. As it develops, I hope that fewer people will have a first or repeat stroke because there will be early identification and preventive action, and that there will be general advice and support on how to reduce risks; access to specialist stroke services, based on best evidence; better care and better outcomes to reduce death and disability from stroke; co-ordinated rehabilitation to improve people's chance of regaining independence; and support for carers.

As I said, it is important that standards in the national service framework for older people inform services provided for younger people in an age-appropriate setting.

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We are acutely aware that the organisation of stroke care across the country remains variable, and there is still much to do to ensure that services are consistent and that people can access them. In Coventry, there are 10 beds in a dedicated stroke unit at University Hospitals Coventry and Warwickshire NHS trust, supported by a stroke co-ordinator, a consultant leader and a professor of age-related medicine, which represents good progress.

Approximately 1,000 patients a year are admitted to that hospital with stroke-related disease, but only 30 to 40 per cent. of them go through the dedicated unit, which has a very high occupancy rate. It is recognised that that low coverage of at-risk patients is not desirable, so more efficient use of beds is being examined. However, the stroke co-ordinator's role ensures that all patients admitted to hospital with stroke-related disease receive appropriate care, although there is more work to be done on getting people into the specialist unit. The primary care trust in the area is running an experimental national programme for stroke care called Smartcare, which aims to smooth out the early identification of stroke and the management of treatment across primary and secondary care. It tries to make those processes seamless so that people do not fall through the net. The two-year programme has already begun and we hope to learn national lessons from it.

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I hope that my hon. Friends the Members for Coventry, South and for Crosby agree that the Government are committed to improving services for all NHS patients, including those who have had strokes. We have invested substantial extra funds in the NHS and intend to invest even more over the next five years. For people with stroke, initiatives such as the national service framework will do much to drive up standards of care. The improved standards will apply to stroke patients across the country, whatever their age.

I am delighted that my hon. Friends have raised this issue, which is of great concern to patients and their families. As I said, we have made progress, but we have a long way to go before we can be proud of services in every part of the country. However, shining a light on something which, in the past, may have been a Cinderella service is welcome; it can do nothing but good, draw clinicians and researchers together, and help to make the service a priority. When good teamwork and specialist clinicians are involved, there is evidence that the outcomes for people who have suffered a stroke are a lot better than many of us may expect in the early days. I am therefore delighted that my hon. Friends have participated in our debate, and I hope that they accept that we are making progress on aims that we all share.

Question put and agreed to.

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