1. London Strategy for Life after Stroke
Tony Rudd

2. 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

3. % 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

4. 1 year outcomes
Average length of stay

5. 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

6. 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

7. London Stroke Survival vs Rest of England
Hazard ratio for survival in London
%CI p<0.001

8. The Stroke Association UK Stroke Survivor Needs Survey
Christopher McKevitt
Reader in Social Science & Health
King’s College London

9. 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

10. Results 51% reported having no unmet needs
Of those reporting unmet needs, total number per respondent ranged from 1-13, median 3

11. 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%

12. 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

13. 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

14. 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)

15. 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

16. Family 42% reported a negative change in relationship with partner
26% reported negative changes in family relationships

17. 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

18. 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.’

19. 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.

20. 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.

21. Life After Stroke Commissioning Guide

22. London stroke strategy – where this fits
Public consultation
(2008/09)
Rehab commissioning
guide (2009)
Life after stroke
(2010)

23. Principles
Active citizenship
Quality of life
Empowerment

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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