Lincolnshire JSNA: Stroke

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1 Lincolnshire JSNA: Stroke What do we know? Summary Around 2% of the population in Lincolnshire live with the consequences of this disease (14, 280 people) in 2010 Over 1,200 people were admitted for stroke in the last year. The East Lindsey district appears to suffer from a higher prevalence and mortality from stroke. Facts and figures Use Ill Heath and Inequalities Dropdown. Trends The LRO website records three different data indicators for stroke prevalence in the County - estimated, actual and projected levels until Using the actual recorded prevalence for the disease, around 2.04% of the population (14,280 people based on a 700,000 population) are recorded as having had and are living with the disease by This prevalence figure has risen steadily year on year from around 1.9% (13,300) in 2005 This actual recorded prevalence from people who have had a stroke is still less than the estimated for this time period however. Modelled estimates suggest a slightly higher number of people should have had a stroke in the county (2.24%, 15,680) by 2010 Geographically, the highest prevalence of the disease is in East Lindsay (2.44% %) with the lowest prevalence in the district area of South Kesteven, 1.88% actual prevalence. This geographic split has remained constant over both time (since 2005) and in estimated modelled figures. By the year 2020, it is estimated that 3.10% or the population will have had a stroke, which with an estimated growing population in the County might equate to roughly 20,000 people living with the consequences of this disease. Using age standardised, data the admissions rates for Stroke in the County in was just 1.03 per 1,000, meaning approximately 1030 people were admitted for a stroke in the last year from the county's hospitals. The highest admissions rates were in the Boston and South Holland areas. When looking at mortality (i.e. deaths) from stroke. Using a yearly moving average in 2009 the directly age standardised death rate from stroke was 12.1 per 100,000 population. This would Lincolnshire JSNA: Stroke 1 of 5 May 2011 (v1)

2 equate to roughly 88 people dying from stroke from the county during these 12 months. The highest death rates (which will none the less be numerically small) are recorded in East Lindsey and Boston. Such data must be treated with caution however as this death rate seems abnormally low. Targets There are two 'vital signs' connected with stroke performance in Lincolnshire Proportion of people with high risk Transient Ischemic Attack (TIA) fully investigated and treated within 24 hours Proportion of patients spending 90% of the inpatient say on a stroke specialist unit Performance Achievement against the vital signs (above) has been poor in the County but is now expected to rapidly improve if the recently approved business case covering all aspects of stroke care in the County is fully implemented. Lincolnshire JSNA: Stroke 2 of 5 May 2011 (v1)

3 What is this telling us? Summary Since the publication of the national stroke strategy, a comprehensive review of stroke services in Lincolnshire has been undertaken. As a result many new services have been commissioned by both the NHS and also the County Council including an Assisted Discharge Service (ASD) and Family and Carer support services (run by the Stroke Association). Local views The stroke implementation group is a countywide stakeholder group which has been running for over 3 years. 2 stroke survivors sit on this group and their input has helped shape service planning and development. In addition, there is also the work of the Stroke Association, Different Strokes Group and the patient focus groups which are being established by the Assisted Discharge Service Recent service user views have been mainly positive with queries around numbers receiving thrombolysis clot busting drugs and a rapidly resolved question about cross-border flows of stroke patients. National and local strategies Published in December 2007, the National Stroke Strategy (NSS) is intended to provide a quality framework to secure improvements to stroke services, to provide guidance and support to commissioners and strategic health authorities and social care, and inform the expectations of patients and their families by providing a guide to high quality health/social care services. _ The NSS covers the whole stroke pathway with a strong emphasis on primary prevention of stroke through healthy living (e.g. quitting smoking, maintaining a healthy weight etc). Once a stroke is diagnosed, the NSS is clear that rapid and effective transfer, assessment and treatment is given through quick access to diagnostic tests and, if needs be, referral to a specialist 24/7 stroke unit. Further down the pathway, specific measures are also stated for back-to-work planning and endof-life care. Current activity and services Hyper acute stroke pathway in place Assisted Discharge service in place - The Assisted Discharge Service for Stroke (ADSS) is a community based, time limited (average 42 day length of stay) rehabilitation service for those recovering from a recent stroke and who meet the service access criteria. Access to the ADSS will be only via acute services referral to be professional to professional following an admission for stroke. The ADSS will in-reach into acute care stroke services and work with Multi Disciplinary Team (MDT) to identify, at the earliest point in the patients recovery, those who are able to safely benefit Lincolnshire JSNA: Stroke 3 of 5 May 2011 (v1)

4 from a transfer (step down) to intensive home based rehabilitation services (including in intermediate care / long term care setting). Family/Carer service in place. NHS Lincolnshire has commissioned The Stroke Association to organise and deliver the Family and Carer Support service to people diagnosed with stroke, their families and carers and will include: Recruitment and training of Family and Carer Support Co-ordinators (x5 0.8 WTE) to deliver the service. The establishment of local support groups for stroke survivors, and their carers. Each Family and Carer Co-ordinator will take referrals per year and hold a caseload of around 120 patients per year. Lincolnshire County Council has awarded a grant to 'Different Stroke' to run exercise groups and art therapy groups. Key inequalities Stroke is the third biggest cause of death in the UK and the largest single cause of severe disability. Each year over 110,000 people in England will have a stroke (with direct costs to the NHS of over 2.8 billion). Stroke causes disability in 250,000 people in the UK and contributes to wider costs of 7 billion (e.g. lost income, long term benefits and informal care costs). Key issues regarding stroke include: The risk of stroke increases with age most strokes occur in people aged 65 years and over. Men have a greater risk of premature mortality as a result of a stroke than women. Hypertension (high blood pressure) is the single most important risk factor for stroke. People with diabetes are 2 to 4 times more likely to die from a stroke. Smokers are 50% more likely to have a stroke than non-smokers; smokers are more likely to have a second stroke than non-smokers. Other risk factors include: obesity; excessive alcohol or binge drinking; poor diet with low consumption of fruit and vegetables; low levels of physical activity. In the year 2007/08 14,305 people were on the stroke register across Lincolnshire, accounting for 1.96% of the total population. Key gaps in knowledge and services Review taking place of the hospital element of the stroke pathway In addition, a lot of work is taking place on primary prevention of stroke. The national media 'FAST' campaign has already run twice in the County but more needs to be done in this area. Lincolnshire JSNA: Stroke 4 of 5 May 2011 (v1)

5 Risks of not doing something Patients will not achieve their optimum recovery and rehabilitation potential Without better primary prevention, the numbers of stroke sufferers is expected to rise in future years. What is coming on the horizon? The national public awareness campaign for stroke is being relaunched (the 'FAST' campaign). In addition, plans are being implemented to expand TIA clinics and scope and design atrial fibrillation (AF) pathways. What should we be doing next? Implementation of the redesigned stroke pathway for hospital care. Commissioning of 7 day a week TIA clinics. Lincolnshire JSNA: Stroke 5 of 5 May 2011 (v1)