Presentation on theme: "Professor Roger Boyle March 2009"— Presentation transcript:
1 Professor Roger Boyle March 2009 The National Stroke Strategy - Direction of travel and quality markers for stroke rehabilitation service development in EnglandProfessor Roger BoyleMarch 2009
2 Why stroke matters Burden of disease Costs >110,000 strokes each year (rule of thirds)>20,000 Transient Ischaemic Attacks (TIAs or ‘mini strokes’)At least 300,000 living with significant post-stroke disability (single largest cause of adult disability)Third most common cause of death1 in 4 people affected are under 65People of South Asian and African Caribbean origin at significantly higher riskCosts£2.8 billion direct care costs£1.8 billion due to lost productivity and disability£2.4 billion informal care costs2.6 million bed days per year
3 Positioning Ministers (particularly Secretary of State) NHS Board NHS Chief ExecutiveDirectors of Commissioning and PerformanceChief Executives and medical directors of the Ambulance TrustsAll Party Parliamentary GroupStakeholdersNext Stage Review – High Quality Care for All
6 Working together Hyper-acute stroke service 24-hour cover by stroke specialists24-hour radiological supportNeuroscience centreLikely to benefit from interventionsLink to neighbouring networkTransfer to acute stroke unit after hoursLikely to benefit from specialist careAcute/Rehabilitation Unit CombinedAcute Stroke UnitEarly Supported Discharge TeamsStroke Rehabilitation UnitsCommunity Stroke Teams
7 11,000 people suffer a stroke each year In London stroke is:Second commonest cause of deathThe commonest cause of disability11,000 people suffer a stroke each yearOne person every hourOne in six die
9 Supporting the strategy Mandated for every PCT within the Operating Framework‘Tier 1’ priorityCentral finance over 3 years (£105 million)Training (£16 m)Raising awareness (£12 m)Developing innovative practice (£77 m)£32 m to the NHS£45 m to social care
10 Implementation agenda Money to SHAs (circa £2.4 million)Money to local authorities (circa £100k each year for three years)Problem solving small grants fundAwareness campaignNHS staff and the publicNational Training Forum (30 doctor training places)Communication planEvaluationDevelopment of the stroke networks and the stroke improvement programme
13 Publish quality performance Recognise and reward quality The Quality Framework in “High Quality Care for All”Bring clarityto qualityMeasure qualityPublish quality performanceRecognise and reward qualityRaise standardsSafeguard qualityStayaheadQuality StandardsNHS EvidenceMetrics – local, national, internationalQOF indicator developmentClinical dashboardsQuality accountsNHS ChoicesInternational measures and NQB reportCQC roleCQUINMulti-year and best practice tariff workCEAsQOFClinical voice at every level inc NQBSHAs – Medical Directors and CABsPCTs – WCC clinical engagementNICE fellowship programmeCQC roleRegulation extended to primary careNQBSHA duty to innovateInnovation funds and prizesAHSCsHIECs13
14 Vital Signs% stroke patients who spend 90% of their time in hospital in a stroke unit% of high risk TIA patients who are treated within 24 hours
15 Audit as a lever for change Sentinel Audit sets the standardExpansion to a ‘MINAP’ style process for acute care plannedExpansion for extension into primary and community care under consideration
19 Life after stroke - Key facts At present only around half of individuals who have experienced stroke receive the rehabilitation to meet their needs in the first six months after discharge from hospital, falling to around one fifth in the following six months
20 Life after stroke – Key facts Three- quarters of younger individuals want to return to workOne third of individuals develop depressionOne third of individuals experience communication difficultiesAbout one third of individuals will die of their stroke – not immediately but within three months
21 QM 10 High-quality specialist rehabilitation People who have had strokes access high-quality rehabilitation and, with their carer, receive support from stroke-skilled services as soon as possible after they have had a stroke, available in hospital, immediately after transfer from hospital and for as long as they need it.
22 Multi-faceted stroke rehabilitation Mobility and movementCommunicationEveryday activities, dressing, washing, meal preparationDepression and distressSwallowingNutritionCognitive difficultiesVisual disturbancesContinenceRelationships and sex
23 QM11 End-of-life carePeople who are not likely to recover from their stroke receive care at the end of their lives which takes account of their needs and choices, and is delivered by a workforce with appropriate skills and experience in all care settings
24 QM 12 Seamless transfer of care A workable, clear discharge plan that has fully involved the individual (and their family where appropriate) and responded to the individual's particular circumstances and aspirations is developed by health and social care services, together with other services such as transport and housing.
25 QM 13 Long-term care and support A range of services are in place and easily accessible to support the individual long-term needs of individuals and their carers.
26 QM 14 Assessment and review People who had strokes and their carers, either living at home or in care homes, are offered a review from primary care services of their health anc social care status and secondary prevention needs, typically within six weeks of discharge home or to a care home and again six months after leaving hospital.This is followed by an annual health and social care check, which facilitates a clear pathway back to further specialist review, advice, information, support and rehabilitation where required
27 QMs 15 and 16 Participation in community life Return to work People who have had a stroke, and their carers, are enabled to live a full life in the communityReturn to workPeople who have had a stroke, and their carers, are enabled to participate in paid supported and voluntary employment