National Stroke Programme and aftercare and rehabilitation services for stroke patients

Summary

The NHS England stroke webpage states that stroke is the leading cause of disability and the fourth largest cause of death in the UK. It further explains that stroke is a serious life-threatening medical condition that occurs when the blood supply to part of the brain is cut off. The damage this causes can have physical, psychological and cognitive impacts. The NHS stroke webpages set out some of the cognitive functions can be disrupted by a stroke, including:

• communication
• spatial awareness – having a natural awareness of where your body is in relation to your immediate environment
• memory
• concentration
• executive function – the ability to plan, solve problems and reason about situations
• praxis – the ability to carry out skilled physical activities, such as getting dressed or making a cup of tea

NHS England note that around 85,000 people a year are admitted to hospital with a stroke, and there are over 1 million stroke survivors in England, more than half of whom have a disability resulting from their stroke. Information on the prevalence of stroke across the UK can also be found on the Stroke Association website.

The National Institute for Health and Care Excellence has published detailed guidance on the process of rehabilitation after stroke (Stroke rehabilitation in adults, CG162).

Further background on the effects of the condition and NHS support for recovery can be found on the Stroke Association website.

The National Stroke Programme

The NHS Long Term Plan (January 2019) included stroke as one of the ‘national priority’ areas for the NHS in England, and made a number of commitments to better prevention, treatment and care. To help delivery, NHS England and the Stroke Association have been developing the National Stroke Programme, in consultation with a wide range of clinical experts and people affected by stroke. The NHS England stroke webpage state that the programme aims to:

• Improve post-hospital stroke rehabilitation models for stroke survivors
• Deliver a ten-fold increase in the proportion of patients who receive a clot-removing thrombectomyto end their stroke so that each year 1,600 more people will be independent after their stroke
• Train more hospital consultants to offer thrombectomy in more sites, providing a national service
• Deliver clot-busting thrombolysisto twice as many patients, ensuring 20% of stroke patients receive it by 2025 – the best performance in Europe
• Enhance the Sentinel Stroke National Audit Programme (SSNAP)to identify further need and drive improvements across the stroke pathway, including rehabilitation
• Ensure three times as many patients receive 6 month reviews of their recovery and needs – from 29% today to 90%

This work will be led by new Integrated Stroke Delivery Networks.

Information on the programme’s actions and ambitions can be found on a FAQs webpage from the Stroke Association.

Stroke services and the impact of Covid-19

A new service set up during the coronavirus pandemic, Stroke Connect, in a partnership between the NHS and the Stroke Association, provides stroke survivors with support and advice in the early days following hospital discharge, without having to leave the house (see NHS England news release, NHS ‘lifeline’ for hundreds of stroke survivors, 31 August 2020).

The British Association of Stroke Physicians (BASP) provides information on the Restoration and recovery of stroke services during the COVID-19 pandemic.

UK Parliament Proceedings

Business of the House

04 Mar 2021 | 690 c403

Asked by: Sir Robert Neill

There are 1.2 million stroke survivors in the United Kingdom. It is the largest cause of adult disability in this country. Will my right hon. Friend the Leader of the House make time for a proper debate on the progress of the national stroke programme, because, two years on, the quality and availability of after-care and rehabilitation services, particularly specialist areas such as physio and speech therapy, remain very variable to the great concern of many families?

Answering member: Jacob Rees-Mogg

My hon. Friend raises a crucial point. The NHS long-term plan, published in January 2019, outlines commitments to improving stroke services, including better stroke rehabilitation services and increased access to specialist stroke units. Stroke services across England continue to provide rehabilitation and post-acute services to stroke survivors and their families and carers during the pandemic. In part, this has been helped by innovative methods of care delivery alongside face-to-face contact. Almost half of stroke survivors have had virtual care since covid began. More than 80% of them reported positive or very positive experiences. There are 20 integrated stroke delivery networks, giving full coverage across England. Integrated stroke delivery networks were established in shadow status in October 2020 and we expect them to be fully operational by spring 2021. Ninety per cent of stroke patients will receive care in a specialist stroke unit and more patients will have access to disability-reducing treatments of mechanical thrombectomy and thrombolysis. This combined with increased access to rehabilitation services will deliver improved long-term outcomes for stroke patients. I thank my hon. Friend for raising this very important issue.

Strokes: Health Services

24 Nov 2020 | 114895

Asked by: Jonathan Ashworth

To ask the Secretary of State for Health and Social Care, how the Government plans to continue delivering its commitments for stroke during the covid-19 outbreak.

Answering member: Jo Churchill | Department: Department of Health and Social Care (DHSC)

NHS England and NHS Improvement have ensured that stroke services across England continue to provide rehabilitation and post-acute services to stroke survivors and their families and carers during the COVID-19 pandemic.

NHS England and NHS Improvement have funded the Stroke Association over the last six months to provide Stroke Connect, which was developed in direct response to COVID-19 to ensure stroke survivors and their carers had support when discharged from hospital.

The Department has also funded the Stroke Association over the last six months for them to continue to provide frontline support to stroke survivors and others connected to stroke during the COVID-19 pandemic.

Strokes: Rehabilitation

04 Aug 2020 | HL5690

Asked by: Lord Lingfield

Her Majesty's Government what progress has been made on the commitments to improve stroke rehabilitation set out in the NHS Long Term Plan.

Answering member: Lord Bethell | Department: DHSC

NHS England and NHS Improvement continue to focus on the detection and management of risk factors including high blood pressure, raised cholesterol, atrial fibrillation and diabetes to improve diagnosis of silent strokes.

The NHS Long Term Plan highlighted that stroke community rehabilitation as an area with significant scope for improvement. NHS England and NHS Improvement are developing a service specification for an integrated community rehabilitation service in order to reduce variation in the provision of stroke rehabilitation across England.

Stroke rehabilitation pilot schemes from 2020 to 2022 will develop a best practice model for high intensity rehabilitation, to be rolled out nationally. Both the specification and the pilot schemes will incorporate learning and innovation within community stroke teams as a response to COVID-19, including virtual rehabilitation.

Additional Reading News Articles and Blogs

The following is a selection of news and media articles relevant to this debate.

Please note: the Library is not responsible for either the views or the accuracy of external content.

The Guardian, Covid disruption leaves thousands of UK stroke patients disabled, 17 September 2020

The Guardian, NHS failing stroke patients with 'postcode lottery rehabilitation', 26 February 2020

BBC, Stroke consultant shortage 'hurtling towards crisis', 17 January 2020

British Heart Foundation, Stroke rehabilitation needs radical overhaul, 22 May 2018