National Stroke Strategy

Lord Colwyn Excerpts

Wednesday 18th November 2015 Lords Chamber

[Lord Colwyn (Con)]

My Lords, I am grateful to the noble Baroness, Lady Wheeler, for raising this important issue. I have read the report of her debate just over a year ago when she drew our attention to the incidence of stroke in children, and I reread her contribution to the debate on atrial fibrillation on 4 November, which set the scene for our debate today. I congratulate the noble Baroness on the brilliant way in which she and my noble friend Lord Black have stimulated interest in the national stroke strategy. They have organised demonstrations of the walk-in clinics with Anti- Coagulation Europe and have had discussions with the all-party groups for stroke and atrial fibrillation—both of which I am a member of—about what might be the likely successor to the strategy in 2017.

I shall confine my few remarks to the need for a focus on prevention, particularly in relation to atrial fibrillation. I declare an interest in that I have atrial fibrillation myself, which is anticoagulated. Since the strategy was published in 2007, there have been significant advances in the prevention of AF-related stroke, including the introduction of new clinical guidelines and treatment options, but there is still more for the NHS to do and it is essential that preventing AF-related stroke is at the forefront of any new stroke strategy.

In 2014-15, there were 14,979 strokes in people with known AF and 8,831 strokes in people with known AF who were not on anticoagulation. Some 25 % of people with AF who were not anticoagulated before their stroke died, and a further 11% were severely disabled, bed-bound and in need of constant nursing care and attention. Ensuring that patients with AF are identified and anticoagulated in line with NICE guidelines could save lives, prevent disability and save the NHS money.

On average, the healthcare costs associated with an AF-related stroke are £11,900 in the first year of care alone, and the overall cost to the NHS of AF and AF-related illness has been estimated at £2.2 billion each year. I am sure we all agree that there is an urgent need for an improvement in the diagnosis of AF. Estimates suggest that about half of people with AF are undiagnosed, and therefore are not anticoagulated and are at risk of having a stroke.

The diagnosis of AF could be improved through the introduction of a national screening programme for AF in people over 65 and the introduction of pulse checks for older people at seasonal flu clinics and other settings, such as the dental surgery, where most patients are examined for problems that are likely to show up in future. Dental check-ups are unique in that patients who are well arrange appointments to see if anything is wrong and could be prevented. Screening for AF is not currently recommended by the UK National Screening Committee. Would the Minister urge the committee to reconsider the evidence for the introduction of a national screening programme for people aged over 65?

There are now four non-vitamin K antagonist oral anticoagulants, called NOACs, recommended by NICE for the prevention of AF-related stroke. The NOACs were specifically designed to overcome the limitations of warfarin. They provide predictable, stable and reliable levels of anticoagulation and do not require routine monitoring, ongoing dose changes or dietary restrictions. All patients with AF should have access to the full range of NICE-recommended treatment options, and should have the opportunity to choose the treatment that is right for them in consultation with their doctor. At present, though, about 31% of eligible patients with AF receive no anticoagulation at all, and only 11% of anticoagulants prescribed are NOACs.

Will the Minister provide further information on what action the Government are taking to ensure that patients have access to the full range of NICE-recommended treatments? Would she consider providing specific support for clinical commissioning groups with the lowest rate of NOAC use to ensure that patients in those areas have better access to treatment?