1. Supporting NHS Wales to Deliver World Class Healthcare All Wales Stroke Services Improvement Collaborative Learning Session One 21 st October 2009

2. Slide 2 All Wales Stroke Services Improvement Collaborative What’s all the fuss about? Dr Anne Freeman Consultant Physician RGH Clinical Advisor AWSSIC

3. Slide 3 All Wales Stroke Services Improvement Collaborative Past perceptions What it used to be like in the past 1950s 1970s 1980s Present day

4. Slide 4 All Wales Stroke Services Improvement Collaborative The perceptions of Stroke MYTH Stroke is not preventable Stroke cannot be treated Stroke only strikes the elderly Stroke happens in the heart Stroke recovery ends after 6 months REALITY Up to 80% of strokes are preventable Stroke requires emergency treatment Anyone can have a stroke Stroke is a “Brain attack” Stroke recovery can last a life time

5. Slide 5 All Wales Stroke Services Improvement Collaborative People don’t know ( awareness) That stroke can be preventable That stroke can be treatable What the symptoms of stroke are What to do if they suspect a stroke What the effects of stroke are What could easily be done with better organisation and resources to transform stroke care What the Stroke Association is for

6. Slide 6 All Wales Stroke Services Improvement Collaborative Stroke facts in UK Stroke is the third most common cause of death in England and Wales after heart disease and cancer Greatest cause of severe adult disability An estimated 150,000 people have a first stroke in UK each year. That’s 1 every 5 minutes. Most >65yrs – but 1000 <30 yrs. Many more second strokes, etc There are 67,000 deaths due to stroke in UK each year (many are preventable) Stroke patients occupy a significant number of all hospital acute beds and 25% of all long term (NH and NHS) beds Direct cost to NHS in UK– around £ 2.8 bn. Other costs about £6 bn

7. Slide 7 All Wales Stroke Services Improvement Collaborative Stroke incidence in Wales 7 500 in Wales first stroke 11 500 stroke events (incl recurrent stroke and TIA) Many thousands more are living with the long- term effects of stroke Mortality rate 17% (approx )

8. Slide 8 All Wales Stroke Services Improvement Collaborative Of the first strokes…………………. One-third die within 4 weeks One-third will be significantly disabled 5% of these will require long-term care The resulting long-term disability has significant cost to the individual, the NHS, and to social services

9. Slide 9 All Wales Stroke Services Improvement Collaborative

10. Slide 10 All Wales Stroke Services Improvement Collaborative

11. Slide 11 All Wales Stroke Services Improvement Collaborative

12. Slide 12 All Wales Stroke Services Improvement Collaborative Immediate Care All patients who may have a stroke will require admission to hospital and should be treated by a specialist stroke team in a designated stroke unit including a physician specialising in stroke medicine National Service Framework

13. Slide 13 All Wales Stroke Services Improvement Collaborative Immediate Management – first few days Access hospital Assessment in A and E or MAU (ROSIER) Admit to acute stroke unit (ASU) CT Scan as soon as possible – same day Shows if ischaemic or haemorrhagic Thrombolysis if appropriate Swallow screen – Oral, NG, PEG feeding Aspirin, statin, TEDS BP, Pulse, Temp, O2 levels, B Sugar ECG (AF), Carotid Dopplers Other procedures eg craniectomy Assessment of speech, cognition, mood Physio assessment and get out of bed OT assessment and ADLs Aim home or to rehab depending on initial outcome/response

14. Slide 14 All Wales Stroke Services Improvement Collaborative Recovery starts as people get better after the immediate effects of a stroke Over time other areas of the brain take over from the dead areas 1/3 of strokes are left with disabilities Rehabilitation is process of overcoming or learning to cope with the damage the stroke has caused. It is about getting back to normal life and achieving the best independence one can, by:

15. Slide 15 All Wales Stroke Services Improvement Collaborative Rehabilitation Getting back to a ‘normal’ life Learning to live with the long-term effects of stroke Relearning skills and abilities Learning new skills Adapting to some of the limitations caused by stroke Finding social, emotional, and practical support at home and in the community

16. Slide 16 All Wales Stroke Services Improvement Collaborative Rehab starts while you are still in the hospital and on the acute unit. After you leave the acute hospital, you can continue treatment at a rehab centre or at home. Most rehab programs offer at least 3 hours of therapy a day, 5 or 6 days a week. You have the greatest chance of regaining your abilities during the first few months after a stroke and especially in the first few weeks So it is important to start rehab as soon after a stroke as possible and do a little every day.

17. Slide 17 All Wales Stroke Services Improvement Collaborative Prevention Risk factors and awareness TIA

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19. Slide 19 All Wales Stroke Services Improvement Collaborative Financial burden of stroke in UK Direct costs to NHS£2.8 billion Wider economy £1.8b (lost productivity and disability) Informal care costs £2.4b (home nursing and care by families) Total cost in UK £7 billion 5% of total NHS bill

20. Slide 20 All Wales Stroke Services Improvement Collaborative Stroke patients who receive organised inpatient care in a stroke unit are more likely to be alive, independent, and living at home one year after the stroke. The benefits were most apparent in units based in a discrete ward. Cochrane database, 2006

21. Slide 21 All Wales Stroke Services Improvement Collaborative Financial burden of stroke in Wales pro-rata Direct costs to NHS £140 m Wider economy £90 m Informal care costs £230 m Total cost of stroke in Wales £360 million

22. Slide 22 All Wales Stroke Services Improvement Collaborative Money in HM gave £2.5m for investment in acute stroke Divided proportionately across the 3 regions Compare with money given in other 3 countries - England and NI No more additional funding for the foreseeable future

23. Slide 23 All Wales Stroke Services Improvement Collaborative Year Two Rehab TIA Intelligent Targets

24. Slide 24 All Wales Stroke Services Improvement Collaborative The Intervention