Stroke rehabilitation in coastal Eastern England: a qualitative study of intersectional inequalities

My conclusion is, YOU DON'T UNDERSTAND THE BASIC PROBLEM!

You don't have 100% recovery protocols and AREN'T EVEN WORKING TOWARDS THAT!

 Stroke rehabilitation in coastal Eastern England: aqualitative study of intersectional inequalities

Katie Chadd , Doofan Udendeh , Ahang Kareem , Julia Vlahovic & Reza Majdzadeh To cite this article: Katie Chadd , Doofan Udendeh , Ahang Kareem , Julia Vlahovic & Reza Majdzadeh (28 Apr 2026): Stroke rehabilitation in coastal Eastern England: a qualitative study of intersectional inequalities, Disability and Rehabilitation, DOI: 10.1080/09638288.2026.2659555 To link to this article: https://doi.org/10.1080/09638288.2026.265955

ABSTRACT 

Purpose: Disparities in stroke incidence, outcomes and access to healthcare are increasingly reported—including in relation coastal status—yet a health-systems perspective is rarely applied to examine root causes. This study utilises a health-systems approach to explore how rehabilitation models of care may exacerbate or mitigate health inequalities, in an organisation serving rural and coastal communities in England. 

Methods: A multi-faceted theoretical framework drawing on seminal health-systems concepts was derived, to guide this qualitative study. Focus group discussions with stroke professionals were conducted. Data were analysed thematically, and iteratively, via operationalisation of the theoretical framework. 

Results: Rehabilitation systems exacerbated health inequalities, which was related to unresponsiveness to personal and social determinants, geographical factors and system-level factors. Bottlenecks were identified in accessibility and effective health coverage, which were associated with multiple aspects of a health system, including service delivery, financing, workforce, health information systems and leadership/ governance. Four recurrent intersectional high-risk profiles emerged. 

Conclusion: There are significant, system-derived challenges in the current stroke rehabilitation and life-after-stroke provision in the region studied, which may exacerbate health inequalities for those who are already marginalised by society. Applying an intersectional framework to develop solutions for equality in rehabilitation systems is required. (Equality in failure to recover IS THE HEIGHT OF STUPIDITY! Solve the correct problem! 100% recovery!)

IMPLICATIONS FOR REHABILITATION • In England, stroke rehabilitation is delivered via the publicly funded national health service (NHS) which is mostly free at the point of use for all residents, centring equity. • Stroke rehabilitation systems should be commissioned, designed and implemented according to patient needs and local population characteristics, with explicit attention to the intersections of coastal and socio-economic deprivation and across multiple axes including, transport barriers, cultural and linguistic diversity and disability status across the lifespan. • Improving the quality and collection of patient data is an important step in enabling intersectional analyses for understanding interactions between patient and population characteristics, needs and outcomes which can inform the design of equitable systems. 

New Swim England fact sheet on swimming after a stroke

 Not very helpful, no instruction on swimming one-armed. In looking at videos side stroke might be possible.  I'd have to practice in 4-5 feet of water so I could stand if necessary. 

New Swim England fact sheet on swimming after a stroke

A new fact sheet which explains how people can benefit from swimming and aquatic activity after a stroke has been published by Swim England.

The Swimming after a Stroke fact sheet has been developed by the national governing body in conjunction with the University of Nottingham and the Stroke Association – and is aimed at helping more than 1.3 million stroke survivors in the country to get active.

Stroke can occur every five minutes in the UK, with 100,000 people experiencing one every year.

They can lead to long-term disability and people who have had a stroke may experience ongoing issues with their mobility and independence caused by pain, fatigue, cognitive and emotional problems.

Getting active after leaving hospital in the absence of, or with formal rehabilitation can provide a massive boost to their recovery, confidence and wellbeing, helping them to stay healthy in the future.

The fact sheet details what people after a stroke need to consider before, during and after a swimming session – and top tips on how aquatic activity can aid their recovery.

It has also been created in a format to help those who have aphasia – a common speech and language issue after a stroke.

More than 350,000 people in the UK have aphasia and this version of the fact sheet includes the use of clear illustrations and icons to support the context of the sentence.

It also contains simplified and short sentences, with bold key words based on the Stroke Association aphasia-friendly style and co-created from extensive testing with people with aphasia.

‘Allowing people to enjoy being active in the water’

Dr Fiona Moffatt, associate professor and director of professional development and wellbeing for the School of Health Sciences, University of Nottingham, and a member of Swim England’s Swimming and Health Commission, said: “Getting active again after a stroke can have numerous benefits, including lessening the risk of another stroke occurring.

“But we also know that swimming or aquatic activity can be of particular help, with a range of benefits not seen with land-based exercise

“This new fact sheet helps to explain some of those benefits and some of the approaches that will allow people to enjoy being active in water in a safe and enjoyable way.

“We were also aware however, that for those who have aphasia the standard fact sheet formats that have been so popular with other audiences might not be suitable.

“So, we developed an aphasia friendly version with the help of a specialist speech and language therapist, as part of a stakeholder group of people with lived experience of stroke and with input from the Stroke Association.”

Mike Hawkes, head of diversity and inclusion at Swim England, said: “Swim England is committed to tackling the inequalities which prevent sections of our communities from enjoying the benefits of swimming and aquatic activities in all its shapes and forms.

“We believe aquatic activities are uniquely placed to support those who may have experienced a stroke.

“By developing the aphasia friendly version of this fact sheet, we hope this opens up the opportunity to participate in aquatic activity for even more people.”

Juliet Bouverie, chief executive for the Stroke Association, added: “Getting active after stroke is incredibly important to recovering from the effects of stroke and reducing the risk of another stroke happening.

“It is brilliant to see that Swim England has developed a swimming after stroke information resource, to support stroke survivors to get back into the water or even start swimming for the first time.

“We are delighted to have been able to support the process of development. We hope that it will be used by healthcare professionals, leisure providers and people affected by stroke to encourage more stroke survivors to enjoy the benefits of being active in water.”

The new fact sheets follow 12 others developed, covering conditions such as asthma, cancer, dementia, diabetes, epilepsy, ear infection, glandular fever, mental health, musculoskeletal conditions, skin conditions, swimming before and after surgery and a fact sheet on swimming after Covid-19.

To date, more than 23,000 copies of the various fact sheets have been downloaded – with more than 275,000 visits to the fact sheet pages of the Just Swim website – since they were first developed.

Swim England will be continuing to develop new fact sheets for different conditions with support from the Swimming and Health Commission over the coming months, with a further fact sheet around swimming with multiple sclerosis and Parkinson’s also due to launch very soon.

For more information on this or other aspects of Swim England’s health and wellbeing work, please email health@swimming.org

Stroke patients face seven-hour waits for specialist care

 Which means your stroke hospital still has to to have 100% recovery protocols regardless of entry time. NO EXCUSES ALLOWED. Leaders prepare and deliver on challenges! Even getting them there in 4 hours is not enough; tPA full recovery is only 12% so your doctor and hospital still haveto have  protocols needed for 100% recovery post tPA or brain bleed stoppage.

 Stroke patients face seven-hour waits for specialist care

Waiting times for stroke patients have doubled, with average delays of seven hours for specialist care, official data show.

NHS England guidance states that every patient with acute stroke should be given access(NOT GOOD ENOUGH! Survivors still want full recovery! Don't shrink from your responsibility.) to a stroke unit within four hours.

The timeframe is considered critical because patients can be given only clot-busting drugs and treatments such as thrombectomy, which surgically removes a clot, within the first few hours of stroke onset.

But the figures for 2022-23 show it being hit in just four in 10 cases. Overall, patients in England were waiting an average of six hours 49 minutes to be admitted to a specialist unit in 2022-23, compared to three hours 32 minutes in 2019-20.

The analysis of NHS data by the Health Service Journal found University Hospitals Sussex had the longest average waits last year, of more than 14 hours, with just eight per cent of patients seen within four hours.

The trust said the service had since moved into a new £500 million hospital in Brighton which was helping to speed up care through an acute stroke assessment area.

Some trusts said ambulance handover delays appeared to be fuelling waiting times. Many of the worst-affected units were in areas with significant handover delay problems, particularly the South West.

The figures are for 2022-23, when many parts of the country saw the worst ambulance handover delays on record. But recent weeks have seen several areas with long delays.

Just before Christmas, the heads of the NHS trusts with the worst ambulance queues were hauled in front of Victoria Attkins, the Health Secretary, and ordered to “buck up their ideas”.

Juliet Bouverie, the chief executive of the Stroke Association, called for urgent action to tackle the problem, saying: “Stroke is a medical emergency and every minute is critical.

“We are very concerned to see that, far from improving over the past year, the proportion of stroke patients being admitted to a stroke ward within the timescale for thrombolysis has continued to decline. This is putting patient recoveries at risk and strain on the rest of the health system.”

She said stroke units needed more support from community teams to free up beds, with an expansion in the workforce for stroke care needed.

NHS England cited record demand for emergency care, adding that response times for category two 999 calls have improved since last year.

A spokesman for NHS England said: “Thanks to ongoing improvements in NHS stroke care, more people than ever are surviving a stroke.

“The NHS is committed to delivering the highest-quality stroke services possible by increasing the speed that people are seen and treated and increasing the number of patients accessing thrombectomy, thrombolysis and stroke rehabilitation.”

 

 

 

Quality and performance ‘National improvement board’ to be set up by NHS England

YOU need to get involved so when they start discussing stroke you can DEMAND 100% RECOVERY. Don't you  dare get bamboozled by medical staff and researchers that say it can't be done.  Send them to me.

Oops, I'm not playing by the polite rules of Dale Carnegie;  'How to Win Friends and Influence People'. 

Telling supposedly smart stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful, I look forward to that day.

‘National improvement board’ to be set up by NHS England

NHS England has launched a new framework for quality improvement and delivery, including a national board that will pick a ‘small number of shared national priorities’.

The new document, announced to NHS chairs and chief executives this week, says NHSE will “establish a national improvement board, to agree the small number of shared national priorities on which NHSE, with providers and systems, will focus our improvement-led delivery work”.

It follows a review, led by South East regional director and former trust chief Anne Eden, which found NHSE’s “structures and governance do not yet optimise our ability to focus on a small number of shared national priorities effectively”.

The review says NHSE will, among other actions: 

• Create a “national improvement board” to “agree a small number of shared national priorities and oversee the development and quality assure the impact of the NHS improvement approach”; 
• “Set an expectation that all NHS providers, working in partnership with integrated care boards, will embed a quality improvement method aligned with the NHS improvement approach”;
• “Incentivise a universal focus on embedding and sustaining improvement practice”, including with “regulatory incentives alongside clearer and more timely offers of support”; and
• “Work with the [Care Quality Commission] to align the revised CQC well-led [inspection method] with the improvement approach”.

National management of NHS improvement work has been through several reorganisations in recent years, with Hugh McCaughey, the most recent national director of improvement in NHSE, leaving last year. Improvement functions were moved into the NHSE transformation directorate led by Tim Ferris. 

The review says NHSE will “consolidate capability and expertise into a national priority improvement function, whose role is to co-ordinate action”, but does not state where this will sit in its new structure, or who it will be led by.

It highlights how several trusts, including Leeds Teaching Hospitals Trust, Surrey and Sussex Healthcare Trust, and East London Foundation Trust, have used improvement methods to achieve better performance as well as morale. 

The review also looked at how NHSE works with poorly performing organisations. 

It found: “There are further opportunities to support our most challenged organisations and systems more consistently and effectively…

“People told us that NHS England’s recovery support programme works well and marks a positive shift from the previous special measures regime. We increasingly need to focus on earlier intervention for support and sustainable improvement.”

It says NHSE’s “support for challenged systems team” will work with its regional teams to ”more consistently co-ordinate intensive support”, including “collaboration with other regulators and royal colleges to ensure consistent support and no duplication”.

It will review its oversight framework – under which systems and trusts are rated from 1 (best) to 4 (worst) according to a range of measures – including “how national and regional teams more consistently support organisations in segment 3 and offer longer-term support to organisations exiting segment 4”.

New dedicated stroke and neurological rehab unit for Dorset, England

 You'll have to ask what the goals are for stroke survivors. If not 100% recovery, YOU need to replace the complete management team because they don't deserve to be there.

New dedicated stroke and neurological rehab unit for Dorset,England

Dorset County Hospital (DCH) and Dorset HealthCare are jointly providing a new dedicated rehabilitation unit for people recovering from stroke and neurological illnesses or injuries.

The 10-bed unit based at the Yeatman Hospital in Sherborne opened its doors to patients on the 4 August.

The service will initially run as a pilot until March next year, and patient feedback and engagement will shape how the service develops after the pilot period.

The unit will be led by a Consultant Therapist working alongside a specialist rehabilitation team and hospital nursing staff. 

image by sharon mccutcheon from pixabay

The unit’s approach will also encourage active participation from nominated rehab companions, who can be friends or family members.

Rehab companions can take part in therapy sessions and ward rounds, and are encouraged to support practice between therapy sessions.

Louise Clark, DCH’s Head of Occupational Therapy and Allied Health Professional Lead for Stroke Services, said:

“This is an exciting and positive step. Rehabilitation was prioritised in the NHS Long Term Plan published last year and, in the wake of COVID-19, has never been more important.

(Your long term plan is worthless.

Lousy plan for stroke. NOTHING on 100% recovery just 'care' and 'services'.  Whomever wrote this up didn't talk to stroke survivors and did no planning on how to solve all the problems in stroke. They assumed the status quo will continue and nothing new will be found. That way there will be no hard and difficult work to be done. In other words there are NO LEADERS to be found.)

 

“Both our trusts are committed to ensuring the delivery of high quality rehabilitation services – both in an inpatient setting, and through on-going rehab support in the community as soon as care needs can be safely met outside of the hospital.

“Moving rehabilitation beds from DCH also supports the development of ‘hyper acute’ stroke services there, which is a priority for Dorset. It is imperative that only people with the most serious medical needs remain on the acute site, to ensure that people suffering a stroke have rapid access to the required level of care.”

pixabay

The new unit forms part of the Dorset Vision for Stroke and Neuro rehabilitation approved by all four Dorset NHS trusts and the Dorset Clinical Commissioning Group last year. And feedback from patients and their families will help to evaluate and develop the service in future.

Interim Matron of the Yeatman Hospital, Helen Hunt, said:

“This is a very exciting initiative for us at Sherborne. We already care for patients with rehabilitation goals but this opportunity will enhance our nursing skills further in the field of stroke and neurological illnesses.

“This joint venture is a positive step for the future of the Yeatman, and will make a real difference to patients in our community.”

An extended stroke rehabilitation service for people who have had a stroke: the EXTRAS RCT

How do you reconcile these two conflicting results?   

did not improve stroke survivors' performance in extended activities of daily living but did improve their overall satisfaction with services. Your stroke team was excellent at getting you to accept the tyranny of low expectations but didn't deliver actual results? Not my idea of excellence.  

An extended stroke rehabilitation service for people who have had a stroke: the EXTRAS RCT

Shaw L¹,

Bhattarai N²,

Cant R³,

Drummond A⁴,

Ford GA¹,

Forster A⁵,

Francis R¹,

Hills K¹,

Howel D²,

Laverty AM⁶,

McKevitt C⁷,

McMeekin P⁸,

Price C¹,

Stamp E²,

Stevens E⁷,

Vale L²,

Rodgers H¹

Author information

Health Technology Assessment (Winchester, England), 30 Apr 2020, 24(24):1-202
PMID: 32468989 

Abstract 

---

BACKGROUND:

There is limited evidence about the effectiveness of rehabilitation in meeting the longer-term needs of stroke patients and their carers. 

OBJECTIVE:

To determine the clinical effectiveness and cost-effectiveness of an extended stroke rehabilitation service (EXTRAS). DESIGN:A pragmatic, observer-blind, parallel-group, multicentre randomised controlled trial with embedded health economic and process evaluations. Participants were randomised (1 : 1) to receive EXTRAS or usual care. SETTING:Nineteen NHS study centres.  

PARTICIPANTS:

Patients with a new stroke who received early supported discharge and their informal carers.  

INTERVENTIONS:

Five EXTRAS reviews provided by an early supported discharge team member between 1 and 18 months post early supported discharge, usually over the telephone. Reviewers assessed rehabilitation needs, with goal-setting and action-planning. Control treatment was usual care post early supported discharge. 

MAIN OUTCOME MEASURES:

The primary outcome was performance in extended activities of daily living (Nottingham Extended Activities of Daily Living Scale) at 24 months post randomisation. Secondary outcomes at 12 and 24 months included patient mood (Hospital Anxiety and Depression Scale), health status (Oxford Handicap Scale), experience of services and adverse events. For carers, secondary outcomes included carers' strain (Caregiver Strain Index) and experience of services. Cost-effectiveness was estimated using resource utilisation costs (adaptation of the Client Service Receipt Inventory) and quality-adjusted life-years. 

RESULTS:

A total of 573 patients (EXTRAS, n = 285; usual care, n = 288) with 194 carers (EXTRAS, n = 103; usual care, n = 91) were randomised. Mean 24-month Nottingham Extended Activities of Daily Living Scale scores were 40.0 (standard deviation 18.1) for EXTRAS (n = 219) and 37.2 (standard deviation 18.5) for usual care (n = 231), giving an adjusted mean difference of 1.8 (95% confidence interval -0.7 to 4.2). The mean intervention group Hospital Anxiety and Depression Scale scores were not significantly different at 12 and 24 months. The intervention did not improve patient health status or carer strain. EXTRAS patients and carers reported greater satisfaction with some aspects of care. The mean cost of resource utilisation was lower in the intervention group: -£311 (95% confidence interval -£3292 to £2787), with a 68% chance of EXTRAS being cost-saving. EXTRAS was associated with 0.07 (95% confidence interval 0.01 to 0.12) additional quality-adjusted life-years. At current conventional thresholds of willingness to pay for a quality-adjusted life-year, there is a 90% chance that EXTRAS is cost-effective. 

CONCLUSIONS:

EXTRAS did not improve stroke survivors' performance in extended activities of daily living but did improve their overall satisfaction with services. Given the impact on costs and quality-adjusted life-years, there is a high chance that EXTRAS could be considered cost-effective. FUTURE WORK:Further research is required to identify whether or not community-based interventions can improve performance of extended activities of daily living, and to understand the improvements in health-related quality of life and costs seen by provision of intermittent longer-term specialist review. TRIAL REGISTRATION:Current Controlled Trials ISRCTN45203373. FUNDING:This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 24. See the NIHR Journals Library website for further project information.

Stockport stroke unit rated best in England for 3rd time

Nothing here tells me if they are any good at all.

Three measurements will tell me if the stroke hospital is possibly not completely incompetent; DO YOU MEASURE ANYTHING?

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?
3. rehab full recovery? Better than 10%?

I absolutely hate invalid chest thumping like this.

 You can see the audit questions here:

Sentinel Stroke National. Audit Programme (SSNAP)  

This statement means they 'care' but not enough to tell us exact recovery results.

10 domains covering key aspects of the process of stroke care.   

Stockport stroke unit rated best in England for 3rd time

The quarterly Sentinel Stroke National Audit Programme (SSNAP) report is compiled by the Royal College of Physicians, rating the quality and performance of services for every stroke patient, from treatment to recovery.
In the latest report, covering July to September 2019, Stepping Hill Hospital came top in England, Wales and NI out of a total of 224 routinely admitting acute stroke teams.  Stepping Hill Hospital Stoke Unit had previously been rated best in the SSNAP report in December 2018, maintained 2nd position until July 2019, and now the Stockport team have returned to the top position once again.
Strokes are the fourth biggest killer in the UK, and a leading cause of disability – but swift, specialist treatment can make a significant difference in recovery. People are most likely to have a stroke over the age of 55, but around a quarter of strokes happen in people of working age, with the unit in Stockport treating patients as young as 21.
One current patient on the unit is Mrs Ann Moss, 78, from Macclesfield. Ann had a stroke at home in November last year and was taken by ambulance to receive emergency stroke care at the Stockport unit. She has since been recovering on the unit. Ann says:

I’ve received marvellous care here at Stepping Hill. It’s a very friendly and light-hearted atmosphere here on the ward, which really helps. I used to do Tai Chi exercise before my stroke, and they’ve been helping me to do that again as part of my recovery. I’m very thankful to them all.”

Thankfully Ann is recovering well, and it is believed she will soon be ready for discharge to go home. The average patient stays on the unit for 22 days.
Dr Srinath Meadipudi, Clinical Director for stroke services at Stockport’s Stepping Hill Hospital said:

We’re absolutely delighted to be recognised as top stroke unit from the Sentinel Stroke National Audit Programme once more. This achievement is very much a team effort and everyone who works on the wards, including nursing, medical, therapists, domestic staff and many others all contribute towards providing the best possible care and experience for our stroke patients.  I’d like to thank them all and I look forward to us continuing to provide top class care and treatment, giving our patients the best chance of recovery that we can.”

Stockport’s stroke unit assesses over 5000 patients with suspected stroke and treats over 1200 inpatient strokes a year. It is one of only three specialist units in Greater Manchester, and also treats patients from Eastern Cheshire, Trafford, Tameside and North Derbyshire. 
The centre includes a dedicated assessment unit for stroke patients in the emergency department, Hyperacute Stroke Unit (HASU) , Acute Stroke Unit with  physiotherapy gym, sensory garden therapy rooms and a specialist unit specifically for the rapid assessment of TIAs (or ‘mini strokes’).  Facilities at Stockport’s Stepping Hill Hospital also provide stroke patients with a full rehabilitation programme, with a team of physiotherapists, occupational therapists and speech and language therapists working alongside stroke doctors and nurses at the unit.

Details announced of how to put the NHS long term plan for England into effect

You can look at the four milestones for stroke here and see that they are completely worthless for getting survivors to 100% recovery. So YOU have a lot of work to do to change the strategy that NHS has for stroke. First by removing all stroke medical personnel from any decision making and putting survivors in charge.  The word 'care' is a dead giveaway that survivors weren't consulted or listened to.

 

 

 

 

 

 

NHS long term plan for Stroke

 

Details announced of how to put the NHS long term plan for England into effect

 

Specialist stroke units could save thousands of lives, England’s top doctor claims

Well your definition of thriving leaves one hell of a lot to be desired. Only a

10% chance of full recovery. 

tPA full recovery only 12%.

You will need a lot of followup to solve all these problems in stroke. Better get cracking, assuming you even know of these problems.

Specialist stroke units could save thousands of lives, England’s top doctor claims

• Nick McDermott, Health Editor

• 20 Jun 2019, 0:01
• Updated: 20 Jun 2019, 3:34

THOUSANDS of lives could be saved by specialist stroke centres, it is claimed.

England’s top doc says 170 extra victims a year survive because of new units in London and Manchester.

2

New specialist stroke centres could save thousands of lives a year, it's claimedCredit: Getty - Contributor

2

Professor Stephen Powis claims rolling out specialist units nationally will ensure more stroke victims survive

In both cities, local stroke wards were controversially closed.
But health bosses say when patients do arrive at hospital, they now get faster specialist diagnosis and treatment.
They plan to expand the centres across England and stop emergency stroke care at smaller hospitals.
NHS national medical director Prof Stephen Powis, believes it will ensure thousands more “survive and thrive”.

Stroke deaths halved in England over ten years, study shows

If you really were concerned about cost, you would do the smart thing and stop the 5 causes of the neuronal cascade of death in the first week that would result in vastly less dead and damaged neurons.

But that will never occur, stroke leaders have no clue how to solve stroke, and why should they? They get paid regardless of lack of recovery of stroke patients.

Stroke deaths halved in England over ten years, study shows

Improvements in survival offset by 'concerning' rise in stroke rate among under 55s 

• Alex Matthews-King Health Correspondent
• 15 hours ago

Click to follow
The Independent

Strokes occur when the blood supply to part of the brain is stopped and the neurons rapidly begin to die ( iStock )

Stroke deaths in England halved in the decade up to 2010 as a result of overhauls which saw more patients taken to specialist centres, a review has found.
There was a 55 per cent drop in the death rates for strokes, caused when the blood supply to parts of the brain is cut off by a clot or bleed, according to the study published in the British Medical Journal (BMJ).

While the number of strokes occurring fell by around 20 per cent, the major driver of was that more people were surviving, the University of Oxford researchers said - however this can be costly.
"Acute and long-term management of such patients is expensive, and the NHS is already spending about 5 per cent of its budget on stroke care," the authors said.

"By focusing on prevention and reducing the occurrence of stroke, major resources can be conserved."(Notice the wrong focus, the idiocy of stroke leaders on display.)

Factors, trends, and long-term outcomes for stroke patients returning to work: The South London Stroke Register

The takeaway from this should be a commitment to get stroke survivors 100% recovered so they can return to work. 

Factors, trends, and long-term outcomes for stroke patients returning to work: The South London Stroke Register 

Show all authors

Arup Sen*, Alessandra Bisquera*, Yanzhong Wang, ...

First Published March 15, 2019 Research Article

https://doi.org/10.1177/1747493019832997

Article information

Abstract

Background and purpose

There is limited information on factors, trends, and outcomes in return to work at different time-points post-stroke; this study aims to identify these in a multi-ethnic urban population.

Methods

Patterns of return to work were identified in individuals in paid work prior to first-ever stroke in the population-based South London Stroke Register (SLSR) between 1995 and 2014. Multivariable logistic regression examined associations between patient characteristics and return to work at 1 year (1 y), 5 years (5 y) and 10 years (10 y) post-stroke.

Results

Among 5609 patients, 940 (17%) were working prior to their stroke, of whom 177 (19%) were working 3 months post-stroke, declining to 172 (18%) at 1 y, 113 (12%) at 5 y, and 27 (3%) at 10 y. Factors associated with return to work within 1 y, after logistic regression, included functional independence (BI ≥ 19; p < 0.01) and shorter length of stay (p < 0.05). Younger age (p < 0.01) was associated with return to work at 5 y and 10 y post-stroke. Non-manual occupation (p < 0.05) was associated with return to work at 10 y post-stroke. Return to work within 1 y increased the likelihood of working at 5 y (OR: 13.68; 95% CI 5.03–37.24) and 10 y (9.07; 2.07–39.8). Of those who were independent at follow-up (BI ≥ 19), 48% were working at 1 y, 42% at 5 y, and 28% at 10 y. Lower rates of anxiety and depression and higher self-rated health were associated with return to work at 1 y (p < 0.01).

Conclusion

Although functionally independent stroke survivors are more likely to return to work long-term, a large proportion do not return to work despite functional independence. Return to work post-stroke is associated with improved long-term psychological outcomes and quality of life.

Keywords Stroke, return to work, outcome

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We’re looking for a Director of Stroke Support to provide strategic direction to our work in England.

YOU have to get involved in this. Otherwise the strategy created and followed will not include 100% recovery. Conquering stroke is nothing less than 100% recovery. Hold their feet to the fire to accomplish that goal. Otherwise they will allow the tyranny of low expectations creep in. Ideally this should be a stroke survivor, I don't trust currently abled people to have the drive and passion to complete that 100% goal, they haven't in the past.

We’re looking for a Director of Stroke Support to provide strategic direction to our work in England. 

Region: 

Nationwide

Salary: 

Competitive

Closing date: 

Sunday, 24 February, 2019

Job type: 

Full time

Ref:S495 | National (Office or home-based) | 35 hours per week

We’re looking for an exceptional individual to provide strategic direction to our work in England. You’ll develop partnerships to ensure all affected by stroke get the help they need to live the best life they can. Leading and inspiring your team of staff and volunteers, you’ll ensure we deliver excellence in all we do. And you’ll be passionate about ensuring all affected by stroke have a strong and influential voice.
Reporting to the UK Executive Director of Stroke Support, you’ll be joining the UK senior leadership team at a really exciting time as we take forward our new strategy. With proven influencing and negotiation skills, you will actively develop positive, credible relationships with all stakeholders to grow our work. You’ll be innovative in contributing to support and policy development and skilled in driving change.
Significant senior management or executive level experience in the third, social or health sectors is required, to help us make stroke the priority it needs to be and grow access to our support offerings.
It is optional for this role to be homebased, please see our homeworking agreement for full details.
This is an exciting time to join the Stroke Association. Join us and together we can conquer stroke.

Applying

We want to make the process of applying for this role as straightforward as possible. To this end, we ask that your application consist of the following three documents:

• A supporting statement, no more than two pages in length, which addresses and provides evidence against the criteria set out in the Person Specification in the Role Profile section below. The covering letter provides you with the opportunity to explain your motivation for applying, as well as highlighting how your experience and achievements fit with the requirements of the role. As such, it is an important part of the application process.
• A comprehensive CV.
• Your completed Equal Opportunities Form - The information you provide in this form will not be shown to the Selection Panel and will play no part in the assessment of your application. The Stroke Association is an equal opportunities employer, to fulfil our responsibilities please email it to equalops@stroke.org.uk which is managed by our HR team.

For more information on how we use the information you have provided and the legal basis upon which we rely to process the personal information you have provided in this form, please see our job applicant privacy notice which can be viewed by clicking here
Email the completed supporting statement and CV to recruitment@stroke.org.uk by the closing date 24 February 2019. 1 stage interview to be held on 6 March 2019, London. 2 stage interview to be confirmed.
If you have any queries please email the HR team at recruitment@stroke.org.uk
If you’re still unsure about applying for a role with us or just want to get an idea of the benefits of doing so please visit the benefits page or see what we do.

Role profile

Download the role profile for the Director of Stroke Support England role.

About Us

We are the UK’s leading charity dedicated to conquering stroke.
There are over 1.2 million stroke survivors in the UK. Almost two thirds have a disability and one third rely on others for help, making stroke one of the biggest causes of disability.
We are continually working to improve the lives of stroke survivors and their families who deserve the very best treatment and care. We deliver amazing, life-changing support to over 60,000 stroke survivors and their families each year. We also fund research to find better treatments, campaign for better stroke care and help people understand how to spot and prevent stroke. This work is made possible by more than 4,000 talented volunteers and staff, our fantastic supporters and our strong relationships with the stroke clinical and research community.
We work with integrity, demonstrating our values as one combined passionate, innovative, respectful and professional team.
Together we can conquer stroke.

Ambitions set to address major causes of cardiovascular disease - Public Health England and NHS England

Oh well, lazy prevention press releases rather than actually tackling the hard work of actually getting stroke survivors 100% recovered. But that is what you get when survivors are not in charge. 

Ambitions set to address major causes of cardiovascular disease - Public Health England and NHS England

A new coalition led by Public Health England (PHE) and NHS England has announced the first ever national ambitions to improve the detection and treatment of atrial fibrillation, high blood pressure and high cholesterol (A-B-C) – the major causes of cardiovascular disease (CVD).
Detecting and treating these conditions can prevent or delay the onset of CVD, but they often carry no symptoms meaning millions are unaware they are at risk and in need of treatment. Over 5 million people are currently living with high blood pressure undiagnosed in England alone. By 2029, PHE and NHS England want:

• to detect and treat millions more people living with high blood pressure who are currently undiagnosed; currently, just over half (57%) of those with high blood pressure have been detected (6.8 million people) – the ambition is to increase this to 4 in 5 people (80%)
• to ensure three quarters (75%) of 40- to 74-year-olds have received a formal CVD risk check and have had their cholesterol levels recorded; currently fewer than half (49%) of those eligible for a formal check have received one (7.6 million people)
• to increase from 35% to 45% the proportion of 40 to 74 year olds at high risk of developing CVD who are treated with statins

The A-B-C conditions can be detected through routine checks across community and healthcare settings. The ambitions include recommendations for decision makers and frontline professionals on getting more people checked and best practice for identifying and treating those already at risk. People aged between 40 and 74 are also being urged to get their free NHS Health Check, which helps detect the early warning signs of CVD.
Duncan Selbie, Chief Executive, Public Health England, said:

Know your numbers and save your life. We know our PIN numbers but not the numbers that save our lives. Thousands of heart attacks and strokes can be prevented by more people knowing their blood pressure and cholesterol numbers and by seeking help early. Prevention is always better than cure.

CVD is the leading cause of premature death and disability in England, causing a death every 4 minutes. Achieving the national ambitions would help meet the long term plan target to prevent 150,000 heart attacks, strokes and cases of dementia within a decade.
Professor Stephen Powis, NHS Medical Director, said:

This shows the fantastic commitment being made by this coalition to identify and treat heart disease and stroke which are top priorities in the NHS Long Term Plan. These ambitions will save thousands of lives by identifying and targeting people most at risk of these preventable conditions.

The ambitions also commit to reducing the health inequalities associated with CVD, with people in the most deprived communities four-times more likely to die prematurely from CVD than those in the least deprived. Health inequality data on each of the high risk conditions and tailored plans to address them will be published by 2021.
Health Secretary Matt Hancock said:

Prevention is at the heart of our vision for improving the health of the nation, empowering people to stay healthy, not just treating them when they’re ill. Almost half of those with high blood pressure are going about their daily lives without it being detected or treated. Millions of people are needlessly at risk of heart attacks or strokes when it could be prevented. So I want to help more people take the time out to protect their future health and get checked.

The NHS Long Term Plan has a target to prevent 150,000 heart attacks, strokes and cases of dementia within 10 years. By coming together across the system to agree these ambitions, we have set the goal posts for how we will achieve this target and continue our fight against the nation’s biggest killer.

To see the ambitions in full read the CVD edition of Health Matters and download the infographics.

Background

Additional quotes

Professor Jamie Waterall, National Lead for Cardiovascular Disease at Public Health England and Chair of CVD Prevention Forum, said:

Millions are unaware that they are living with these serious but treatable conditions. Detecting them early will help avoid thousands of heart attacks and strokes, the majority of which are preventable. If you’re between 40 and 74, get your free NHS Health Check to find out if you’re at risk and how this can be lowered.

Simon Gillespie, Chief Executive of the British Heart Foundation, said:

Heart and circulatory diseases are responsible for one in four deaths in this country, so improved detection of the major risk factors will play a critical role in the fight to save lives. If these ambitions are made a reality, the prospects of millions of at-risk people will be transformed.

For this to happen we must embrace innovative approaches so those at greatest risk of developing these conditions are identified at an early stage – making it as routine to know your numbers as it is to know your bank PIN number or weight. This means taking detection out into the community, making sure those with atrial fibrillation, high blood pressure or raised cholesterol have access to testing in local settings such as a supermarket or pharmacy. Those who do have one of these conditions will then able to get the treatment they need, and can be supported to self-manage on an ongoing basis.

Juliet Bouverie, Chief Executive of the Stroke Association, said:

We know that 9 in 10 strokes can, and should, be prevented. However, our research shows that if we don’t act now, then we can expect the number of strokes to increase by 44% in the next 20 years.

Every 5 minutes, stroke destroys lives. It can strike anyone – young or old. In England alone, there are around 5.5 million people with undiagnosed high blood pressure – ticking time bombs for stroke. Tackling this and atrial fibrillation (AF) would see the biggest drop in the number of strokes every year. We urge people to get their free NHS Health Check to test for these high risk conditions, prevent the devastation and disability that stroke causes, and avoid unnecessary cost to the NHS.

There are a number of ways people can take action to find out if they’re at risk:

• if you’re between 40 and 74, take up your offer of a free NHS Health Check, which will help you find out if you’re at risk of CVD and the support that is available to lower this risk
• if you’re over 30, take the Heart Age Test to find out more about the factors that affect your heart health; those under-30 can take the How Are You quiz for easy tips on healthy living
• everyone can find out about the different ways to maintain good cardiovascular health, such as eating well, staying active and cutting back on alcohol; free advice is available through PHE’s OneYou campaign

The National CVD Prevention System Leadership Forum is made up of over 40 member organisations covering government, NHS England, other arm’s length bodies, the third sector, Royal Colleges, clinicians and academia.

Public Health England press office

Email phe-pressoffice@phe.gov.uk

Telephone 020 7654 8400

Out of hours telephone 020 8200 4400

Gloucestershire hospital opens new rehab unit to benefit stroke patients

Notice they tell you nothing on the results they expect to achieve or the protocols they will be using. So status quo, meaning 90% failure rate to get to full recovery, NSA statistic. And a 88% failure rate on full recovery using tPA. 

Makes you feel tingly and wonderful all over, doesn't it? But they will take care of you. 

Gloucestershire hospital opens new rehab unit to benefit stroke patients

7th February 2019 Gloucestershire hospital opens new rehab unit to benefit stroke patients2019-02-07T14:04:14+00:00 Charities & organisations, Newsroom, NHS

Credit: The Gazette

Launched on the 4^th of February, a new specialist stroke rehabilitation is now open at the Vale Community Hospital in Dursley, Gloucestershire.
Located within the Peak View Ward at the Hospital, the special inpatient unit aims to bridge the current gap in post-stroke care in Gloucestershire, allowing people who have suffered a stroke to have the best possible recovery.
The rehabilitation unit has been set up for for patients who no longer need specialist medical care at the Gloucestershire Royal Hospital but still require stroke rehabilitation that cannot be delivered at home.
Featuring 14 specialist stroke beds and six general community beds, the unit is staffed by a multidisciplinary team including doctors, nurses, physiotherapists, speech and language therapists, occupational therapists (OTs), rehabilitation assistants and hotel services.
Professional Head of Adult Physiotherapy in Gloucestershire Care Services Sarah Morton told the Gazette: “The Specialist Stroke Rehabilitation Unit came about following the findings of an NHS Gloucestershire Clinical Commissioning Group review, which examined the stroke rehabilitation pathways in Gloucestershire.
“The report concluded that although there were lots of elements of really good service provision within the county, there wasn’t a seamless pathway for stroke rehabilitation.
“The stroke unit at The Vale is a centralised, co-ordinated unit where we can focus our resources. The development of this unit has been a result of collaborative partnership working between commissioners and clinicians from Gloucestershire Hospitals NHS Foundation Trust, community organisations, patient representatives and a range of key stakeholders.
“By providing a community bed-based service here at Vale Community Hospital, we aim to continue the rehabilitation journey for patients following a stroke in a suitable, fit-for-purpose environment.
“When patients no longer need inpatient specialist stroke rehabilitation, and if it is safe and effective for them to have rehabilitation in their own home, they will receive ongoing support from community stroke specialist nurses or the early supported discharge (ESD) community team, including community stroke specialist nurses, specialist therapists and rehabilitation assistants.”