Stroke

Background and policy context

StrokeNational Service Frameworks provide a systematic approach for improving standards and quality across health care sectors.

Stroke can occur at any age but it is more common in people over 55 and the risk rises with age. The standard for stroke services in Wales is contained in the National Service Framework for Older People.

The framework states that "The NHS, working in partnership with other agencies where appropriate, will take action to prevent strokes, and to ensure that those who do suffer a stroke have access to diagnostic services, are treated appropriately by a specialist stroke service, and subsequently, with their carers, participate in a multidisciplinary programme of secondary prevention and rehabilitation and appropriate longer term care."

Further guidance on implementing the Welsh Assembly Government's health policy for Stroke Services was given in the Welsh Health circulars:

  • Improving Stroke Services and
  • Implementation of National Standards for Stroke Services in Wales.

What is NHS Wales doing about stroke?

We have three main aims. Preventing stroke, improving stroke survival rates, and maximising post-stroke independent living and quality of life.
 

Ask FirstPreventing stroke

We aim to prevent stroke happening to people by providing advice and education on improving lifestyles to minimise the risk. Advice may be provided opportunistically by GPs and other members of the Primary Health Care team and education is provided through national campaigns and local initiatives centred around good diet, increasing physical activity, smoking cessation, and drinking alcohol moderately. Examples include:
 
 
Another key to stroke prevention is the effective management of those at risk. Primary care teams maintain patient registers for those with diabetes, obesity, hypertension, cardiac arrhythmias and high cholesterol levels - all factors which increase the likelihood of having a stroke. These conditions are then monitored, controlled and treated appropriately to reduce the risk.
Patients who are suspected of having suffered a Transient Ischaemic Attack or "mini-stroke" will be referred within 24 hours to hospital specialist teams for assessment and treatment.


Improving stroke survival rates

It is important that primary health care teams and members of the public recognise the symptoms of stroke and that suspected stroke is treated as a medical emergency to maximise outcomes. The Act FAST national stroke awareness campaign has this as its aim.
Evidence suggests that the effective and optimal acute care of suspected and confirmed stroke cases in discrete beds or specialist stroke units improves outcomes.
Ensuring stroke patients have access to thrombolysis - the so called "clot busting" drugs where they are appropriate can also help.
An example of a dedicated Stroke unit is:

Maximising post-stroke independent living and quality of life

Our aims here are to increase the numbers of stroke patients being discharged to 80% by 2011 and using hospital Quality of Life measures achieve comparable levels with the best in the world.

Continuation of physiotherapy and occupational therapy treatment, home exercise programmes, links with Social Services teams for home adaptations, referrals to other NHS services such as orthotics,speech and language therapy, wheelchair service as well as linking with voluntary agencies like the Stroke Association and the Dysphasia Support Group all have a part to play in promoting independent living and improving quality of life.

Resources