'Alan Johnson is keen on neglected causes like stroke so his startling brevity in the debate implies no disrespect'

A busy start for health secretary Alan Johnson. Renewed publicity around the MMR vaccine, which experts fear will hit take-up, even though this week's disciplinary hearing is about medical ethics, not science. Our EU neighbours don't have this problem.

And high-profile publication of the Darzi report on London hospital reorganisation prompted David Cameron to taunt Gordon Brown that health minister Sir Ara means hospital 'closure'.

It is just possible that the jibe was prompted by that lively by-election in the London suburb of Southall. Mr Brown fought it off. 'Lord Darzi is not proposing closure of existing hospitals,' a claim he may regret. He's not Lord Darzi either yet, countered Dave, correctly. These Etonians are sticklers for protocol.

All the same, a new secretary of state doesn't want to draw too much of the boss's attention to himself, especially not this hands-on PM, one who is suspected of not loving London much - except as a tax base.

If that was not enough Mr Johnson and his new team had to cope with two Tory-led debates in successive weeks. Mr Johnson spoke for 33 minutes, as long as shadow health secretary Andrew Lansley had, on access to NHS services.

In sharp contrast he managed only 14 minutes in response to Mr Lansley's 33 on stroke services - or brain attacks as we are now advised to call them.

Mr Johnson is keen on neglected good causes like stroke, so this startling brevity implies no disrespect. One explanation is the publication of consultation document A New Ambition for Stroke. It pre-empted some opposition criticisms in addressing challenges raised by the National Audit Office in 2005.

The other is a consensus over stroke, evident in MPs' exchanges. Andrew Turner, conservative member for the Isle of Wight, even made a brief appearance in solidarity (MPs: 'Hear, hear') after his own December stroke.

Labour's Ian Gibson described the mini-stroke he suffered in the Gaza region in 2004: scary, but he was brilliantly treated in a Palestinian hospital under Israeli armed guard.

Yet I learned that this is an ailment the NHS spends more on -£2.8bn a year - than neighbouring EU healthcare systems, but still gets results 10-30 per cent worse.

One problem is ignorance among both doctors and the public. Patients do not address lifestyle issues - smoking or drinking, for instance - or recognise symptoms of stroke or its little brother, transient ischaemic attack (TIA), well enough. They do not realise that one stroke in four happens to those under 65.

They and the professions are traditionally fatalistic: wait until it happens. Yet 50,000 of us die each year of stroke - it is killer number three after cancer and heart disease - and 300,000 people suffer lasting disability. 'The whole stroke area is where heart disease was 10 years ago', 'heart czar' Professor Roger Boyle told the health secretary.

Mr Lansley remained impatient, as did Sandra Gidley, the pharmacist Lib Dem MP. We know what is needed, said Mr Lansley: faster diagnosis and treatment, followed by appropriate specialised treatment. Remedial action within three hours is deemed critical.

That requires CT scan services available 24/7 everywhere, not patchily. 'Don't have a stroke at the weekend' is still good advice. TIA should be followed up by clinical treatment to prevent full stroke.

Of course, the service is better than 10 years ago. But why do we need another consultation? Mr Lansley asked. It is, I fear, a New Labour weakness.

But his main point relates to the Darzi-ish issue of hospital organisation. Thus stroke suspects should go straight to specialist-staffed stroke units, not to accident and emergency. This has been policy since 2001, but is not happening everywhere. Early discharge and better rehabilitation are also needed. Currently discharge can be 'like falling over a cliff'.

Since stroke is killer number one in my family I must end on a positive note. My sister last week passed on a cousin's e-mail, a version of FAST - the face, arms, speak test - for checking whether someone has had a stroke. On my GP's prescription for my hypertension pills is scrawled: 'See practice nurse for check-up'. I will.

Michael White is assistant editor (politics) of The Guardian.