§ Mr. PikeTo ask the Secretary of State for Health (1) what research has been carried out to assess how many patients admitted to hospital as a stroke patient were admitted to the stroke unit during their stay at any time in(a) the UK, (b) England and (c) the Lancashire and Cumbria Strategic Health Authority; and if he will make a statement; [97864]
(2) what plans he has to expand follow-up treatment to help increase the numbers of stroke patients who have a return to normal blood pressure six months after discharge; and if he will make a statement. [97853]
(3) what research has been carried out to assess the number of stroke patients for whom it would be appropriate to be assessed in their own home prior to discharge that undergo such assessment in (a) the UK, (b) England and (c) Lancashire and Cumbria Strategic Health Authority; and if he will make a statement; [97857]
378W(4) what research has been carried out to assess (a) the number of stroke patients discharged into residential or nursing home care, having been previously independent, in (i) the UK, (ii) England and (iii) Lancashire and Cumbria Strategic Health Authority and (b) the reasons for most patients being discharged into such residential or nursing home care; and if he will make a statement; [97856]
(5) what plans he has to increase the aftercare and secondary prevention on stroke patients following their discharge to include (a) hypertension management, (b) lipid lowering and (c) modification of behavioural risk factors; and if he will make a statement; [97863]
(6) what assessment has been made of the change in the numbers of stroke patients who have brain imaging within the two day target of the National Service Framework for Older People; what plans he has to (a) increase these numbers and (b) achieve a 100 per cent. target rate; and if he will make a statement; [97855]
(7) what research has been carried out to identify the reasons for the number of stroke patients for whom it would be appropriate to be assessed in their own home prior to discharge that do not undergo such an assessment; and if he will make a statement; [97851]
(8) what plans he has to increase the number of stroke physicians in hospital trusts; and if he will make a statement; [97899]
(9) what targets the Department sets for assessment of stroke victims by (a) swallowing assessment within 24 hours, (b) visual fields recorded within 24 hours, (c) weighing the patient and (d) brain imaging assessment criteria; and if he will make a statement; [97862]
(10) what research has been carried out to assess the number of patients admitted to hospital as a stroke patient who (a) spend no time within the stroke unit during their stay and (b) are admitted to the stroke unit during their stay and who receive 50 per cent.or more of their treatment within the unit in (i) the UK, (ii) England and (iii) Lancashire and Cumbria Strategic Health Authority; and if he will make a statement; [97854]
(11) what research has been carried out to assess the numbers of stroke patients who have a return to normal blood pressure six months after discharge in (a) the UK, (b) England and (c) Lancashire and Cumbria; and if he will make a statement; [97852]
(12) what plans he has to improve the effectiveness of stroke units and to increase the capacity of units; and if he will make a statement. [97898]
§ Jacqui SmithWe do not collect routinely information on stroke services at the level of detail requested in these questions. The most comprehensive source of information is the National Sentinel Stroke Audit, carried out by the Royal College of Physicians. The audit was commissioned by the National Health Service in 1998 and was last updated in 2002. The results can be found at http://www.rcplondon.ac.uk/pubs/strokeauditQl-02.pdf.
379WThe audit contains information covering discharge arrangements, and clinical assessments including swallowing assessments and visual fields. The 2002 audit shows that 73 per cent. of trusts who participated had a stroke unit, compared to 56 per cent, three years earlier. In addition, 83 per cent, of patients receive brain imaging—the highest ever level. The audit shows that 80 per cent, of trusts that participated have a consultant physician with specialist knowledge of stroke who is formally recognised as having principal responsibility for stroke services. While it is recognised that some services need to increase their capacity, the audit notes that very significant improvements have already been made.
Our major vehicle for further improving standards for stroke services is through the older people's national service framework (NSF), which sets specific milestones for improvement by 2004 of stroke services in primary care trusts (PCTs), specialist services and general hospitals that care for people suffering from a stroke. Our document, Improvement, Expansion and Reform, which sets for the NHS a priorities and planning framework for 2003–6, makes clear that implementation of the older people's NSF is a top priority and that the 2004 milestone around specialist stroke services is a key target.
We monitor progress against the key milestones in the NSF. From the information gathered so far, we know that 83 per cent, of the hospitals who have replied now have plans to have a specialist stroke service in place by April 2004.
Under the NSF, PCTs will need to ensure that every general practice can identify and treat patients identified as being at risk of stroke because of high blood pressure, atrial fibrillation or other risk factors by April 2004. To help ensure that the treatment they receive is of a consistent standard, the National Institute of Clinical Excellence is developing guidelines for the management of hypertension in primary care. The Institute's report is expected next year.
Implementation of the NSF for older people is leading to real improvements in stroke services and making a difference to people's lives. The development of better services and improved standards in stroke care requires the right balance between national standards, provided by the NSF, national clinical guidelines and local control. It will be important to ensure that stroke care services are co-ordinated and fully integrated within a full range of other relevant local services.
§ Mr. AllenTo ask the Secretary of State for Health what monitoring has taken place against the April 2002 milestone contained in Standard Five of the National380W Health Service Framework for Older People, for every general hospital treating stroke patients to have a plan to introduce a specialised stroke unit by April 2004; and what proportion of hospitals have met the milestone. [945791
§ Jacqui SmithAn exercise conducted in autumn 2002 concluded that 83 per cent. of hospitals have plans in place to introduce a specialist stroke service from 2004.