Inquiry into Stroke Risk Reduction

 Mark Drakeford: Cynigiaf y cynnig.

Rwyf yn ddiolchgar iawn am y cyfle hwn i gyflwyno dadl ynghylch adroddiad y Pwyllgor Iechyd a Gofal Cymdeithasol ar wasanaethau sy’n gallu helpu i leihau’r risg o strôc yng Nghymru. Dyma’r ddadl gyntaf sydd wedi cael ei chynnig gan bwyllgor yn y Siambr ers etholiadau mis Mai. Hoffwn ddiolch i aelodau’r pwyllgor iechyd am eu gwaith caled yn cwblhau’r adroddiad mewn pryd i’w gyhoeddi cyn y Nadolig. Hoffwn hefyd ddiolch i’r unigolion a’r cyrff a roddodd tystiolaeth i’r ymchwiliad ac a fu o gymorth yn canfod yr achosion a materion allweddol.

Yn yr adroddiad, mae’r dudalen flaen yn nodi’n prif gasgliadau a’n prif argymhellion. Mae’r adroddiad, wrth gwrs, yn cynnwys amrywiaeth o faterion ychwanegol rydym yn tynnu sylw Llywodraeth Cymru atynt, ond mae’r materion pwysicaf i gyd yn ymddangos ar y dudalen flaen. Roedd hynny’n ddisgyblaeth i ni, fel aelodau’r pwyllgor, a, gobeithio, bu’n gyfrwng i’r Gweinidog hefyd ganolbwyntio ar y camau y mae angen eu cymryd i wella gwasanaethau i leihau’r risg o strôc yn y dyfodol. Yn sicr, gwyddom fod y fformat hwn wedi caniatáu i’r rhan honno o’r adroddiad gael ei dosbarthu’n eang iawn i gyrff ac unigolion sydd â diddordeb yn y maes. Hefyd, mae’n ei wneud yn haws i’r rheiny sy’n ymddiddori yn y maes i weld gwaith y Cynulliad Cenedlaethol.

Mae’r Pwyllgor Iechyd a Gofal Cymdeithasol yn ffodus i gael uwch swyddogion profiadol o bob plaid ymhlith ei aelodau. Fel pob un ohonom, maent wedi bod yn benderfynol o ddatblygu’n gwaith mewn ffordd sy’n gwneud yn fawr o bob cyfle i sicrhau y bydd ei ganlyniadau’n gwella gwasanaethau i gleifion a’u teuluoedd. Rwy’n credu bod yr adroddiad ac ymateb cadarnhaol Llywodraeth Cymru iddo yn dangos rhywfaint o lwyddiant cynnar o ran gweithredu’r uchelgais hwnnw. Trof yn awr at brif bwyntiau’r adroddiad.

[I move the motion

I am very grateful for this opportunity to introduce a debate on the Health and Social Care Committee’s report on services that can help to reduce the risk of stroke in Wales. This is the first debate proposed by a committee to be held in the Chamber since last May’s elections. I would like to thank members of the health committee for their hard work in bringing the report to a conclusion in time for publication before Christmas. I would also like to thank the individuals and organisations that gave evidence to the inquiry and helped to identify the key cases and issues.

In the report, the front page notes our key conclusions and key recommendations. The report, of course, does include a range of additional matters that we draw to the attention of the Welsh Government, but the most important matters all appear on the front page. That was a discipline for us, as committee members, and, we hope that it helped the Minister to focus on the most urgent steps that need to be taken to improve stroke reduction services for the future. We are certainly aware that this format allowed that part of the report to be distributed very widely to interested organisations and individuals. It also makes it easier for those who have an interest in this field to see the work of the National Assembly.

The Health and Social Care Committee is fortunate to have senior and experienced representative from all parties among its membership. Like each and every one of us, they have been determined to develop our work in a way that maximises the opportunities to ensure that its outcomes might improve services for patients and their families. I think that the report and the Welsh Government’s positive response to it demonstrate a certain amount of early success in terms of achieving that ambition. I now turn to some of the main points.]

I wish to begin with a few facts about stroke. Care of people who have experienced a stroke consumes 5% of all health care resources each year. Around a third of all strokes are fatal. A similar proportion leaves stroke victims permanently and significantly disabled. Nearly a quarter of people who suffer a stroke are unable to walk thereafter. Nearly a third suffer from clinical depression. Between a quarter and a half are left dependent on carers. For every minute that an acute ischaemic stroke goes untreated, 1.9 million neurons, 14 billion synapses and 7.5 miles of myelinated nerve fibres in the brain are destroyed. For every hour the treatment is delayed, the ischaemic brain ages 3.6 years. It is little wonder, therefore, that the Health and Social Care Committee chose, as its first inquiry, an investigation into how all of this damage and suffering might better be avoided in the future.

We have found that there is a cause for optimism, because the evidence presented to us demonstrated that new forms of treatment and intervention exist, which can make a real difference to reducing the risk of strokes in Wales.
Our recommendations begin by urging the Minister to ensure that actions already agreed are in place reliably and routinely across Wales. There is already a stroke-risk reduction plan. We call for its robust evaluation. Our evidence emphasised the importance of local, professional, ownership of this agenda to avoid the danger that the plan becomes everybody’s responsibility and nobody’s. The Minister has accepted that recommendation in full and we will look forward to seeing its results.

There is also a set of clear guidance in place, issued to the NHS in Wales, which sets out best practice in relation to treatment of what are sometimes called ‘mini strokes’. We know a good deal more today than was once the case about the importance of responding quickly to these often very brief events. In evidence, we received assurances that the Welsh Government’s own policy would be in place, on the ground, throughout Wales, by April 2012. The Government’s response to our report is a little less categorical. I have no doubt that the Minister is determined to ensure that Welsh patients receive the best treatment, and I look forward to hearing what she has to say on that matter today.

Our two other major recommendations are for new services that could do more to prevent the risks of stroke in Wales. Any committee that hopes to be taken seriously, in current financial circumstances, knows that new services will have to pay their own way. The good news is that we were persuaded by some very convincing evidence that the services we are recommending are highly affordable and by being an effective way of reducing the incidence of strokes will more than pay for themselves, and will do so quickly, in the future. We concluded, for example, that a simple pulse check would do a great deal to identify and then to help to treat individuals who suffer from atrial fibrillation. We do not propose a national screening programme, although we know that this is currently being considered by the UK National Screening Committee. Rather, we preferred an opportunistic approach to pulse checking, because we know that many such opportunities exist. Our recommendation is that pulse checks should be offered as standard to all patients who are at risk of stroke, whenever they attend primary care. Thereafter, patients and healthcare workers should have the right information to make best decisions about treatment choices. That requires a greater clarity than was apparent in evidence concerning professional roles and responsibilities. Improvement in reducing the risk of strokes requires the right policy mix and clear political direction. However, it also requires effective professional leadership in which different groups come together, not to protect or preserve professional boundaries, but to agree on the best way in which these different professional responsibilities can be exercised to the benefit of patients.

Our report recommends that the Welsh Government develops clear guidance on the diagnosis, treatment and management of atrial fibrillation, but we are also clear that there is a professional obligation here as well to bring practice fully up to date and to make it fully effective, because, in that way, as many strokes as possible can be prevented in Wales.

I look forward to the debate. I am sure that other members of the health committee wish to draw attention to additional aspects of our report, and I am grateful to them for that. It is our clear message that more could, and should, be done to reduce the human and financial costs of strokes in Wales. We hope that our report will have made a contribution to making that happen.

Mark Drakeford: I apologise in advance to those Members who I might not be able to refer to by name in my reply. I thank all those who have taken part in the debate, particularly members of the Health and Social Care Committee, and I thank you for the kind words that have been expressed during the afternoon about the work that the committee has undertaken so far.

There are three common themes that have been echoed around the Chamber this afternoon in everything that we have heard. The first is to do with the prevalence of stroke. Right across the Chamber there are people whose lives, families and friends have been affected by this awful condition. We heard about the way that stroke not only touches your life, but can so profoundly make a difference to the futures of those who suffer a stroke and those who go on to care for them. We have heard about that from all around the Chamber this afternoon.

The second theme is one that Darren Millar mentioned in his contribution: that stroke prevention services is an area where we know what needs to be done. So many of the debates that we have in this Chamber are about intractable policy problems, where we are searching for something that we can do to make a difference. However, this is an area where we know what needs to be done, from the very beginning of the population-level issues that Julie Morgan referred to, through to the prevention of first strokes, which Kirsty spoke about, through to the prevention of further strokes in people who have already had them, which Joyce Watson and Vaughan Gething mentioned. That is why the third theme, evident in both the work of the committee, and from listening to people this afternoon, is the sense of frustration that Lindsay expressed that, while we know what needs to be done, we cannot be confident that everything that could be done is being done already in Wales. We are not even always sure what is being done already at LHB level.

I am grateful to the Minister for the positive way in which she has responded to the written report and for the extra assurances that she has given in the Chamber this afternoon. We say in our report that there is a golden opportunity for the Welsh Government in the development of the national delivery plan for stroke services. Some of what we have heard the Minister say this afternoon can help to give us confidence that some of what we know can be done will be done more extensively, more reliably and more routinely in the future.

I began this afternoon by explaining some of the new ways in which the Health and Social Care Committee is going about its work. I will end by returning to that theme, because another new way in which we hope to work during this fourth Assembly is through a commitment to return to any inquiry that we publish within the lifetime of this Assembly to see what has been done in relation to our recommendations. Therefore, Minister, we will be back. We will be back in 12 to 18 months’ time. We will be back to hear about how that national plan is being delivered and how the recommendations that we have made today are making a difference to the lives of people in Wales. Much has been achieved already and much continues to be achieved by some very dedicated clinicians in this field in Wales, but there is more again to be done. That is the purpose of our report and that is why we will be returning to it.
Wednesday, 22 February 2012.