World Stroke Day
On Thursday 23 November 2023 there will be a Westminster Hall debate for World Stroke Day, which is marked on 29 October each year (the debate was originally scheduled to take place on 26 October). The debate will be opened by Sir Bob Neill MP.
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.
NHS England state that stroke is the leading cause of disability and the fourth largest cause of death in the UK. Around 100,000 people have strokes each year and there are 1.3 million stroke survivors in the UK, more than half of whom have a resulting disability (further information on prevalence across the UK can be found on the Stroke Association website).
The NHS website notes there are two main causes of strokes:
- ischaemic – where the blood supply is stopped because of a blood clot, accounting for 85% of all cases
- haemorrhagic – where a weakened blood vessel supplying the brain bursts
There's also a related condition called a transient ischaemic attack (TIA), where the blood supply to the brain is temporarily interrupted.
Further background on the causes and effects of the condition, and on prevention, treatment and support for recovery can be found on the NHS stroke webpages and the Stroke Association website.
The National Clinical Guideline for Stroke provides guidance to improve the quality of care in the UK and Ireland. The guideline is an initiative of the Intercollegiate Stroke Working Party and is endorsed for use in clinical practice by the Royal College of Physicians of London, the Scottish Intercollegiate Guidelines Network (SIGN) and the Royal College of Physicians of Ireland. The sixth edition of the guideline was published in April 2023.
Priorities and guidance for the NHS in England
The NHS Long Term Plan (January 2019) included stroke as one of the ‘national priority’ areas for the NHS in England. This led to the development of the National Stroke Programme by NHS England and the Stroke Association to support the NHS in England to improve prevention, treatment and care. This programme aims to increase the proportion of patients receiving clot-removing thrombectomy and clot-dissolving thrombolysis. It also aims to improve post-hospital rehabilitation and use the Sentinel Stroke National Audit Programme (SSNAP) to identify further improvements in treatment and care.
From 1 April 2021, 20 Integrated Stroke Delivery Networks (ISDNs) were established and NHS England published a National Stroke Service Model for these Networks in May 2021. The Government says “ISDNs are responsible for delivering optimal stroke pathways, based on best evidence, which ensures that more people who experience a stroke receive high-quality specialist care, from pre-hospital, through to rehabilitation and life after stroke.” (see PQ195988 [Strokes: Medical Treatments], 8 September 2023).
An Integrated Community Stroke Service (ICSS) model, was published by NHS England in February 2022 to help coordinate the transfer of care of stroke survivors from hospital to home-based stroke rehabilitation. An Integrated Life After Stroke Service (ILASS) Model (PDF) was also published in May 2023.
The National Institute for Health and Care Excellence (NICE) has published a range of detailed guidelines on stroke and TIAs, including:
- Stroke rehabilitation in adults (NG236)
- Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (NG128)
The NICE guidance on stroke rehabilitation (NG236) was published on 18 October 2023 and recommends an increase in rehabilitation compared with NICE’s original guideline from 2013.
The new guideline says that people who have had a stroke should be offered, needs-based rehabilitation for at least 3 hours a day on at least 5 days of the week covering a range of multidisciplinary therapy including physiotherapy, occupational therapy and speech and language therapy (see NICE, People who have had a stroke should be offered additional rehabilitation to help them recover NICE says in updated guidance, 18 October 2023).
The Act FAST stroke information campaign was relaunched in February 2023 and provide public awareness around common stroke symptoms.
There is also information on the NHS England website about its work on cardiovascular disease (CVD), including stroke, heart attack and cardiac arrest.
The Stroke Association website provides links to guidelines for other parts of the UK.
The Major Conditions Strategy
On 24 January 2023, the Government announced plans for a Major Conditions Strategy for England. The strategy will cover conditions that contribute most to morbidity and mortality across the population such as cardiovascular disease, including stroke. In a written statement to Parliament on 24 January 2023 (HCWS514), the Health Secretary Stephen Barclay said the strategy will set out a shift to integrated, whole-person care:
The strategy will set out a strong and coherent policy agenda that sets out a shift to integrated, whole-person care, building on measures that we have already taken forward through the NHS Long Term Plan. Interventions set out in the strategy will aim to alleviate pressure on the health system, as well as support the Government’s objective to increase healthy life expectancy and reduce ill health-related labour market inactivity.
Our approach will be rooted in the best understanding of the evidence to tackle the major conditions that contribute to the burden of disease in England, namely:
- Cancers
- Cardiovascular diseases, including stroke and diabetes
- Chronic respiratory diseases
- Dementia
- Mental ill health
- Musculoskeletal disorders
These areas account for around 60% of total disability adjusted life years in England. Tackling them is critical to achieving our manifesto commitment of gaining five extra years of healthy life expectancy by 2035, and our levelling up mission to narrow the gap in healthy life expectancy by 2030.
In May 2023, the Government published a Major conditions strategy: call for evidence to seek views on how best to prevent, diagnose, treat and manage the six major conditions.
In August 2023, the Government published the Major conditions strategy: case for change and our strategic framework. The final strategy is expected in early 2024.
Previous parliamentary debates on stroke services
There have been a number of previous parliamentary debates on stroke including a Westminster Hall debate on stroke aftercare on 21 April 2021. The House of Lords has debated stroke care on 24 July 2023, and stroke rehabilitation and community services on 22 March 2023.