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Speech by the Rt Hon Alan Johnson MP, Secretary of State for Health, 5 December 2007: Launch of the Stroke Strategy for England

Let me start by thanking all those who have worked together to contribute to our new stroke strategy most of whom are in this room today.

In July, I launched a consultation on our national stroke services and in five months, Professor Boyle, his team and the six working groups have engaged with NHS and social care staff, the voluntary sector and stroke survivors from across the country to produce a comprehensive plan for stroke care in England.

Over the last decade, we have made tremendous progress on cancer and heart disease, two of the country’s biggest killers and some progress on stroke. We now have to turn our full attention to third major cause of morality.

One of my first hospital visits as Health Secretary was to Kings in London where  I was joined by Roger Boyle.  Two things quickly became clear: Firstly, that Roger is a legend in the world of stroke services; and secondly that stroke had to be one of the top priorities in my period as Secretary of State for Health. That’s not to deny the advances made since 1997.

Our efforts to improve public health –cutting smoking rates, improving fitness and tackling obesity – have played a major role in reducing the number of strokes each year. 

In 14 years, deaths from strokes have fallen by 36% for over 65 year olds, and are down 27% for those under the age of 65.

There has also been extraordinary progress in our knowledge of stroke care.  Thirty years ago, a stroke was usually fatal; fifteen years ago, it was regularly debilitating; today, we know that if a stroke patient is treated quickly, and the simple things are done right, death rates can be halved and outcomes can be substantially improved. That’s something that many of you have been saying evangelically for years.

But our increase in knowledge has not been matched sufficiently by resultant improvements in care, as highlighted by the national Audit Office and the Public Accounts Committee. 

Stroke remains a major problem. 110,000 people suffer a stroke each year.  300 families a day rely on our services to help them through one of the most difficult periods they will face in their lives.  The physical and psychological consequences can be devastating.

So we have two clear aims in this strategy: to reduce the number of strokes experienced each year and to ensure that we provide effective acute and follow up care when strokes happen.

Stroke care is difficult; it requires early diagnosis, immediate intervention, highly specialised care facilities and comprehensive follow up action. So it’s difficult, but essential - we know that appropriate and timely care can make a dramatic difference in survival rates.

Right now, less than one percent of people who have a stroke are receiving thrombolysis.  If we can get that number up to 10%, 1000 people a year would regain their independence, rather than die or be disabled for life.  By following the guidelines set out in this strategy, 1600 potential strokes can be averted through preventive work and a further 6,800 deaths and disabilities can be avoided. 

This is the prize on offer. The question is  what do we need to do to claim it?

At root, we need care to be more integrated. We need to knit together education, prevention, early diagnosis and rapid treatment with access to rehabilitation services, and social and psychological support.

There are five specific aspects to this strategy.

First, there is a very clear need to improve public and professional awareness about the risks and symptoms of stroke.

A 2005 poll by MORI indicated that 60% of the public cannot name 3 symptoms of a stroke – they have no idea about the Face Arm Speech Test; only a third of the public would call an ambulance or go to hospital; and just half of GPs said they would refer a person with stroke symptoms to hospital immediately. 

We know that early intervention is vital.  This means families being absolutely clear about when to call for help.  It means providers offering greater support for healthier lifestyles and being aware of stroke risk factors such as high blood pressure and high cholesterol.  It means equipping ambulance crews with the skills to be able to diagnose a stroke and transport patients to the appropriate facilities.

The strategy includes the availability of £12m over 3 years specifically to improve national awareness of stroke. 

Second, early warning signs such as Transient Ischemic Attacks must receive sufficient attention.

Right now, just over a third of patients with a TIA are seen within a week; this number needs to be far higher.  Good care requires that higher risk patients receive a scan within 24 hours; and lower risk patients within 72 hours. 

The returns will be spectacular: if higher risk patients with TIA get scanned and cared for within 24 hours, we can lower the number of people who go on to have a full stroke by 80%.

Under the third aspect of the strategy, patients must be taken to hospitals where they can be seen by stroke specialists who can provide immediate clinical attention and imaging within 3 hours of admission to determine if thrombolysis is appropriate. 

This will require ingenuity and a fundamental change in where the first diagnosis of a stroke is made. Paramedics need to carry out  assessments in the field and determine which patients are suffering from stroke, and take those people directly to a hospital with a specialist stroke centre. 

Not every hospital can or should be equipped to handle a stroke 24 hours a day, 7 days a week.  The details must be determined locally, but it may mean a hub and spoke model, with stroke centres providing care during the day, and hubs proving hyper acute facilities on a 24-hour basis. 

This will require paramedics to work even more closely with hospitals.  Right now, only 12% of hospitals have protocols in place with ambulance services for rapid referrals.  This needs to be much higher.  Ambulance crews need to be aware of likely destinations before they get to their patients; hospitals need to know that there is a stroke patient on the way before the arrival in the ambulance bay. 

The fourth, aspect of the strategy is that stroke specific rehabilitation must be geared to each individual’s needs.  Thrombolysis is an excellent treatment, but it needs to be matched by immediate follow up rehabilitation that lessens disability, gets people home as soon as possible and lowers the chances of a repeat stroke. 

While most stroke survivors tell us they want to return home as soon as possible, we know that when they get home, they feel the full impact of their stroke; so our long-term care must ensure that we give the right practical, psychological and emotional support not just for the stroke survivor, but also for their carers whose lives are also transformed by the illness.

This will require radicalism: we are piloting individual budgets, which put the stroke survivor in control with more say, greater influence and the ability to seek out the services that are consistent with their unique requirements.

Finally, this renaissance of stroke care is going to require specially trained doctors, nurses and allied health professionals.  I have no doubt that every staff member, whether a clinician, a nurse, or a therapist comes to work each day with the principle objective of providing the best care possible to each person they treat.  It is our task to give staff the training and equipment they need to meet their aspirations. 

This will require earmarking central funding to increase the number of stroke specific physician training posts, creating training programmes for specialist nurses and allied health professions and developing demonstration sites that showcase best-practice.  We need leaders, whether nurses, doctors or others who care, to step forward and galvanise support for more integrated care, share and communicate with other local providers radiate innovative solutions.  We will put clinical networks in place, with national support, that will allow experienced clinicians and managers to work with staff to make this change happen.

This national strategy sets out an ambitious agenda that can yield extraordinary results through local cooperation, rather than central mandate. There will be enough money in next year’s allocations for the NHS to make the changes we need. At a national level we will provide funding to the tune of £105 million over three years and offer guidance and evidence, but genuine progress will come from the workforce, researchers and the voluntary sector. 

What sets this strategy apart from other clinical strategies is that you shaped it; you own it.  It has been created by health professionals for health professionals and it will need absolute clinical ownership if it’s to succeed.

The staff in this room, and across the country should not see this strategy as an edict.  If it is to succeed, if we’re going to reduce the impact of strokes across the country, it will need to be taken up by staff who feel that it is their function, their responsibility and their duty as providers to see it through.  And this ownership cannot come from doctors alone; everyone involved in the day-to-day care of people who have had a stroke need to feel they have a stroke. 

Stroke is devastating, but it is a condition that, as you know only too well,  we can tackle.  We have set out a vision, we have pledged support and we are working at ministerial level to clear the way for local progress.  This type of strategy together with clinical leadership and local ownership is at the core of a 21st century vision for the NHS. 

Progress is not accidental; the type of change which we need to see in stroke care is only going to come when staff are the catalysts for progress; when individuals’ needs are paramount; and when clinical staff have the resources at their disposal to provide world class care.

I have every confidence that this strategy will work and will be a huge success.  This strategy is the next step in a very powerful mood for change sweeping across the NHS and I look forward to working with you to help it flourish and grow and to help the strategy go through the difficult transition from document to reality. 

Thank you.