1. Stroke,Past,Present, Future

2. Impact of stroke 1,2 Stroke has a major impact on people’s lives Stroke is the: –single most devastating effect of hypertension –third most common cause of death –largest single cause of severe disability The estimated annual cost of stroke to the NHS is over £2.3 billion

3. ACUTE STROKE UNIT OCTOBER 1 2006 WARDS REARRANGED JUN-AUG 2006 ASU REVAMPED SEPT 06 NURSING STAFF RECRUITED SEPT O6 2 ND CONSULTANT X SEPT 06

4. IMPACT CLOT-BUSTING OCT 06 ALL STROKE PATIENTS SEEN BY ACUTE STROKE TEAM ON ADMISSION ALL PATIENTS SCANNED ON ADMISSION

5. 0 no disability 100%80%60%40%20%0% Active Placebo 1 No significant disability 2-3 Slight or moderate disability 4-5 or dead Modified Rankin Scale at Day 90: general shift to the left NXY-059: mRS at day 90 Common odds ratio for improvement 1.20 (95% CI 1.01-1.42)

6. IGNORANCE Lancet 2001;358:683-4 ThrombolysisCCU30 per 1000 Thrombolysis ASU140 per 1000 Aspirin12 per 1000 ASU66 per 1000

7. RESULTS SOUTHEND 228 / 246 BOTTOM 15% for last 8 years No improvement in 4 years 0% for ASU 14% OT ASSESSMENT 21% AGREED REHAB GOALS 18% MOOD ASSESSED

8. COMMUNITY INTERMEDIATE CARE UNITS NURSING HOMES GENERAL PRACTICE AND STROKE WHEELCHAIR SCANDAL DEFICIENT PHYSIO AND OT FOLLOW-UP

9. WHAT DO WE NEED MONEY STAFF POLITICAL SUPPORT PUBLIC HEALTH INFORMATION PCT PROTOCOL FOR STROKE VOLUNTEERS PFI