London Strategy for Life after Stroke Tony Rudd
Story so far HASUs Stroke Units High quality inpatient rehabilitation New acute model of care 999 HASU SU Community Rehabilitation Services 30 min LAS journey* Discharge from acute phase After 72 hours HASUs Provide immediate response Specialist assessment on arrival CT and thrombolysis (if appropriate) within 30 minutes High dependency care and stabilisation Length of stay less than 72 hours Stroke Units High quality inpatient rehabilitation in local hospital Multi-therapy rehabilitation On-going medical supervision On-site TIA assessment services Length of stay variable
% of patients spending 90% of their time on a dedicated SU 1 year outcomes % of patients spending 90% of their time on a dedicated SU
1 year outcomes Average length of stay
1 year outcomes Thrombolysis rates Feb-July 2009 Aim Feb-July 2010 14% 12% 10% 3.5% Feb-July 2009 Aim Feb-July 2010 Jan-March 2011
Improvements in Community Services Many more areas now have early supported discharge teams Some increase in longer term stroke rehabilitation teams We are reviewing in-patient rehabilitation services
London Stroke Survival vs Rest of England Hazard ratio for survival in London 0.72 95%CI 0.67-0.77 p<0.001
The Stroke Association UK Stroke Survivor Needs Survey Christopher McKevitt Reader in Social Science & Health King’s College London
Aims To estimate levels of self reported long term need in stroke survivors (1-5 years) To compare levels of need between stroke survivors in England, Scotland, Wales & Northern Ireland
Results 51% reported having no unmet needs Of those reporting unmet needs, total number per respondent ranged from 1-13, median 3
Information 54%: more information about stroke No differences by age, gender, ethnicity, disability level or time since stroke Significantly different by nation (p=0.009): Northern Ireland=66% Wales=65% England=54% Scotland=49%
Unmet health needs N reporting problem (weighted %) Need unmet (%) Need met to some extent (%) Mobility 321 (58.4) 25 43 Falls 265 (43.9) 21 47 Incontinence 217 (37.2) 40 Pain 249 (39.5) 15 51 Emotional 244 (38.4) 39 34 Speech 194 (34.3) 28 33 Sight 212 (37.2) 26
Other unmet needs N reporting problem (weighted %) Need unmet (%) Need met to some extent (%) Fatigue 301 (51.7) 43 36 Concentration 260 (44.7) 41 Memory 260 (42.8) 59 25 Reading 148 (23.2) 34
Changes in social participation 52% unable to return to work or reduced hours Significantly higher in Black and other ethnic groups compared to Whites (p=0.006, population registers) 67% reported loss in leisure activities Significantly higher in Black and other ethnic groups compared to Whites (p=0.012, population registers)
Impact on finances 18% of those working at time of stroke reported a loss of income since stroke 31% reported increased expenses 16% (25% population registers) reported need for benefits advice
Family 42% reported a negative change in relationship with partner 26% reported negative changes in family relationships
Groups at higher risk? No differences by Higher unmet need: age gender time since stroke Higher unmet need: disability, including communication disability ethnic minority stroke survivors people living in poorest areas
Stroke survivors in London ‘denied recovery’ says new report calling for better coordination and support ‘Stroke survivors across London say they are being denied the chance to make their best recovery because of a lack of patchy post hospital care and confusion between health and social care services, states a new national report published today (Tuesday May 1st 2012) by the Stroke Association.’
Stroke Association Survey Findings 85% of stroke survivors say that the impact of stroke is not understood Six out of ten (59%) said that health and social care services did not work well together resulting in families and carers having to take responsibility for coordinating care. Almost a third (31%) reported services being reduced or withdrawn even though their needs had stayed the same or had increased.
Stroke Association Survey Findings 38% felt they did not receive enough support from NHS services Almost a third (31%) reported services being reduced or withdrawn even though their needs had stayed the same or had increased. 77% are unable to get out as much since they had their stroke.
Life After Stroke Commissioning Guide
London stroke strategy – where this fits Public consultation (2008/09) Rehab commissioning guide (2009) Life after stroke (2010)
Principles Active citizenship Quality of life Empowerment
Scale of need Sum of stroke and TIA patients in a GP register in 2008/9 Prevalence ranges from 1.6% to 0.8% of registered GP population 88,000 people across London on GP registers have had a stroke or TIA
Diverse needs 15% have on-going continence problems 25% of nursing home residents have had a stroke 33% of stroke survivors report depressive symptoms 20% “silent stroke” – underlying cognitive problems
Structured social group Regular review Needs change over time Recognise variability of needs and aspirations National guidance – 12 monthly review Structured social group Therapist Social care Stroke survivor GP Stroke navigator
Information Stroke care navigator London stroke directory Single point of contact Direct role in delivering care Coordinate care packages Training stroke survivors and carers Work across different sectors London stroke directory www.londonstrokedirectory.org.uk
Engaging with community life Stroke survivors do not get out of the home as much as they would like Building confidence Addressing practical issues Community/social groups have benefits beyond primary purpose
Peer support & peer-led services Improve emotional wellbeing Confidence Sense of purpose Peer support Build capacity Range of functions Source of information Improve functional status
Carers and families Carers have a right to their own needs review Training and education should be provided Local authority and charitable sector support is available
Conclusions Stroke care is better in London as a result of the stroke reorganisation BUT...... Still failing to meet longer terms needs of people after stroke There is no additional money for changing these services Need to persuade commissioners that these are services that are worth investing in for both clinical and economic reasons Major concerns that government cuts will negatively affect the resources available to people for longer term support