Stroke Units (Hansard, 25 May 1982)

§ Lord Segal
My Lords, I beg leave to ask the Question which stands in my name on the Order Paper.

§ Lord Trefgarne
My Lords, no central record is kept of the number of wards which may have been designated locally as "stroke units". We are, however, aware of growing interest in them among the professions. The decision to set up such units is a matter for local professional and management discretion.

§ Lord Segal
My Lords, I thank the Minister for that reply. Is he aware that stroke units offer by far the speediest and most efficient form of treatment of the condition, and that no extra financial commitments need necessarily be involved? Is he further aware that several London hospitals, notably the new Charing Cross Hospital, already have the full facilities for a stroke unit? Will he undertake to look into the matter in rather greater depth than he has done hitherto?

§ Lord Trefgarne
My Lords, we want to provide the best facilities we can, within the limits of our resources, for stroke patients. I must say, however, that it is not yet proved that the units to which the noble Lord refers are necessarily the best way of doing it. A number of studies have been carried out into the matter—two in particular in 1980, of which I have the results with me—which tend to show that in certain ways, at least, it is better to treat patients in the general wards of hospitals. But the Government do not have a closed mind on the matter, and if further evidence becomes available or studies are made we shall be very willing to look into the matter further, but in the end it is a subject for the local area health authorities.

§ Baroness Trumpington
My Lords, is my noble friend aware that I am surprised at his last answer, that cures for stroke patients in general hospitals work as well, because a great deal of time has to be spent on stroke patients, which is not available in general hospitals?

§ Lord Trefgarne
My Lords, I am of course aware that there are some stroke units already in existence which are doing an admirable job, but in general, as I say, the case for them is not as clear-cut as some have had us imagine. The Government do not have a closed mind on the matter, and if further evidence comes to light, or if further experience of the existing units is more favourable, we shall be happy to consider the matter further.

§ Baroness Masham of Ilon
My Lords, may I ask the Minister whether he is aware that very often stroke patients take a long time to rehabilitate fully? Is he also aware that after they have been in hospital they have to return to the community, and will he ensure that the support services for rehabilitation in the community are available? These are therapists and community nurses.

§ Lord Trefgarne
Yes, my Lords, certainly in recent years there has been a significant increase in the number of expert therapists of different kinds available to patients, and perhaps I may write to the noble Baroness with the details. There are also the stroke clubs, in which I know the noble Baroness has an interest. Many of them are under the auspices of the Chest, Heart and Stroke Association, for which my department provides financial support.

§ Lord Harmar-Nicholls
My Lords, is my noble friend aware that many people will be surprised to read his reply that this is a matter which should be left to the area health committees? If there is any point behind this Question, surely it is a national problem, not an area one, and one would have thought that guidance or suggestions ought to come from the centre, in order to be country-wide, and not be left to area decisions, as his answer seemed to suggest.

§ Lord Trefgarne
My Lords, the point is that circumstances vary from hospital to hospital and from district to district, and that is why it is better for local people to take decisions of this kind on the spot. If I may say so, the Health Service is not a puppet con- 1072 trolled with strings by my right honourable friend from the Elephant and Castle. It is much more an organisation with local roots for local people.

§ Baroness Masham of Ilton
My Lords, may I ask another supplementary question? I should like to ask the Minister whether he will arrange for his department to undertake some screened controls on preventing strokes, such as checking for high blood pressure?

§ Lord Trefgarne
Yes, my Lords. I understand that hypertension and high blood pressure are an important cause of strokes, and that is why research into the matter is going on, I think by the Medical Research Council, again with my department's financial support.

§ Lord Segal
My Lords, will the noble Lord undertake to see that arrangements are made for a hospital consultant to be available for domiciliary visits in the early stages of an attack, since much research into this condition is still needed?

§ Lord Trefgarne
My Lords, I agree that more research into this matter is necessary. There might be difficulties in proceeding along the lines which the noble Lord suggests of having specialists visit patients in their homes at an early stage, if only because of the problem of determining when that should be. However, what the noble Lord says will certainly be borne in mind.