Do Stroke Victims in the UK Receive the Rehabilitation and Care They Need?

Despite strokes being one of the leading causes of death in the UK, many survivors feel that they are not receiving enough specialist stroke rehabilitation and support to enable them to function in day to day life.

Despite the NHS Constitution pledging its support for a more comprehensive and universal healthcare system, community rehabilitation is still patchy. Experts claim that stroke victims in the UK are still not receiving the rehabilitation they require after being discharged from hospital. This inequality of service has been found to contribute to the poor health outcomes and disability in deprived areas of the UK1.  Lack of funding is also an issue with the UK appearing in the lower percentiles of OECD countries in terms of health spending invested in meeting long-term needs2.

The Government recognised the situation and in a 2018 report produced by the UK All-Party Parliamentary Group on Acquired Brain Injury (APPG-ABI) 3, noted that a better link between acute and post-acute care is required and made a series of recommendations about other policy areas that need to be addressed.

Strokes: A Leading Cause of Disability and Death in the UK

An Acquired Brain Injury (ABI) is any injury to the brain which has occurred following birth. It includes Traumatic Brain Injuries (TBIs), such as those caused by trauma e.g. from a road traffic accident, fall or assault, and non-TBIs related to other medical conditions, e.g. encephalitis, meningitis, stroke, substance abuse, brain tumour and oxygen deprivation resulting from a cardiac arrest or other causes.

Acquired Brain Injury (ABI) is a leading cause of death and disability in the United Kingdom (UK). It is a chronic condition with ‘hidden’ disabilities and life-long consequences.”

Source: United Kingdom Acquired Brain Injury Forum

UK and Worldwide Stroke Statistics

In February 2018, Stroke.org.uk published statistics on the occurrence of strokes throughout the UK. According to this report4:

  • There are more than 100,000 strokes in the UK each year5.
  • The rate of first-time strokes in people aged 45 and over is expected to increase by 59% in the next 20 years (between now and 2035).In the same period, it’s estimated that the number of stroke survivors, aged 45 and over, living in the UK is expected to rise by 123%6
  • There are over 1.2 million stroke survivors in the UK7.
  • Stroke is the fourth biggest killer in the in the UK. Fourth in England and Wales, and the third biggest killer in Scotland and Northern Ireland8,9,10.
  • More than 400 children have a stroke every year in the UK11.
  • 1 in 14 deaths are caused by stroke in the UK. This is equivalent to 6% of all deaths in men, and 7% of all deaths in women.8,9,10,12
  • Stroke is the second leading cause of death worldwide.13

The nature of stroke and the potential consequences

A stroke is a medical condition that occurs after blood supply is cut off to parts of the brain. They can be life-threatening, so it is vital to seek urgent treatment as soon as possible. The sooner treatment is administered, the less damage is likely to occur.

The body’s organs require oxygen to function. This is also true for the brain. When blood supply – and therefore oxygen, is disrupted it can cause brain cells to die and if allowed to persist this could lead to disability, brain damage, and even death. Because of the serious brain damage which can result from a stroke, a patient may require short or long-term therapy and rehabilitation to improve co-ordination, mobility and control of functions.

The common causes of strokes are:

  • Haemorrhagic: Blood vessels that supply the brain become weakened and burst.
  • Ischaemic: A blood clot causes blood supply to become cut off. This type accounts for 85% of strokes.
  • Transient Ischaemic Attack (TIA): The brain’s blood supply is temporarily disrupted. This condition causes a “mini-stroke”, and can last for several minutes or up to 24 hours.

Some medical conditions can increase the risk of suffering a stroke. These conditions include:

  • Diabetes
  • High Cholesterol
  • High Blood Pressure
  • Irregular Heart Beat

If a stroke is misdiagnosed or diagnosed late this could delay life-saving treatment and potentially result in devastating consequences tissue damage, brain damage and even death.

Why community rehabilitation is important for stroke victims

Once a stroke patient is discharged, community rehabilitation should take over to provide short or long-term support and therapy to help the victim live life to their potential.

The benefits of community rehabilitation for stroke victims are many:

  • It reduces demand on the most expensive parts of the NHS, freeing up capacity to deal with emergency care. As most emergency admissions are of people with long term health conditions, making community rehabilitation available to people before they are in crisis reduces demands on emergency care14.
  • It saves the NHS money. People with traumatic brain injuries who receive rehabilitation once they have left an acute hospital ward cost the NHS and social care £27,800 less a year than those who don’t.15
  • Neurorehabilitation improves functional independence and reduces the burden on carers which may lead to a decreased requirement for residential and nursing care and a lower risk of falls in the elderly.

Rehabilitation for stroke victims: The treatment plan

Depending on the severity of your stroke, you may be required to stay in the hospital from a few  days to a few months. The damage caused by the lack of oxygen to the brain and subsequent organs will require time for recovery as well  as short or long term rehabilitation if the brain damage is significant and affects mobility, co-ordination and speech.

Before being given a rehabilitation plan therapists will need to assess the following:

  • How you swallow. You will need to be checked for any problems swallowing as this ensures safety while eating and drinking.
  • What your mobility is like. The therapists will need to fully understand how you were affected physically after the stroke. They will need to determine if you need help moving or being positioned.
  • Are there any problems with incontinence? If they find that you have issues with continence you’ll need a plan to manage this.
  • Do you have cognitive or communication problems? Strokes commonly cause lasting problems with cognition and communication, so the team will assess you and develop a plan if you need it.
  • What’s your hydration and nutritional status? You’ll need to be assessed to ensure you’re getting the right amount of nutrition and are not dehydrated.

 Your Team of Stroke Professionals

Your stroke team (often referred to as your multidisciplinary team (MDT) will consist of many health professionals who have received specialised training in assisting with stroke victims. The members of the team include:

  •  Doctors and Nurses
  • Language and speech therapists
  • Physiotherapists
  • Occupational therapists
  • Dietitians
  • Clinical psychologists
  • Ophthalmologists
  • Pharmacists
  • Rehabilitation assistants
  • Social workers

During your hospital stay, the daily rehabilitation sessions will often focus on:

  • Setting small goals that are broken down and manageable for you.
  • Activities and exercises to help re-learn skills that were affected by the stroke.
  • They will also show you different ways to do things. One example is dressing yourself with one arm rather than two.

Your exact rehabilitation therapy plan will depend on the severity of the brain damage and your personal requirements.

Stroke victims are not receiving enough rehabilitation after leaving hospital

Statistics noted in the February 2018, Stroke.org.uk4 report noted:

  • Only half of the stroke survivors in England, Wales, and Northern Ireland are discharged from hospital having been assessed for all appropriate therapies and with agreed goals for their rehabilitation16.
  • In England, Wales and Northern Ireland, only 3 out of 10 stroke survivors who need a six month assessment receive one17.
  • 1 in 5 stroke survivors in England Wales and Northern Ireland ask for psychological support at their six month review. However, stroke survivors wait an average of 10 weeks after referral to receive psychological treatment.18,19
  • Only 15% of post-acute services in England, Wales and Northern Ireland have the resources to help people return to work after their stroke.19
  • 1 in 3 areas in England, Wales and Northern Ireland do not provide support to the carers and families of stroke survivors.19
  • 1 in 5 commissioning areas in England, Wales and Northern Ireland do not offer access to speech and language therapy for stroke survivors.19

A 2019 report published by Manifesto For Community Rehabilitation (MCR) described access to rehabilitation as a “postcode lottery”. The MCR, a collective of 20 charities, trade unions and professional bodies came together to call on all political parties to ensure equal access to high-quality community rehabilitation services.


According to the MCR’s report:

  • Only 15% of people suffering from lung problems and considered eligible for pulmonary rehabilitation are referred for it.20
  • Only 50% of those who have suffered stroke or heart attack are provided cardiac rehabilitation after discharge from the hospital.21
  • 44% of people with neurological conditions don’t have access to community rehabilitation for their condition: 22% would like psychological therapy and 13% would like physiotherapy but can’t get it22.

The report provided an example of one such patient. Elizabeth Printer a mother of two and a judge whose life dramatically changed when she had a brain hemorrhage at the age of 46. She waited seven months for community rehabilitation through the NHS before deciding to pay privately for therapy to learn to walk again.

Now aged 54, Ms Pinter credits the NHS for saving her life during a medical emergency, but she said:

“The NHS saved my life in an emergency but then failed to help me recover any of the life I once had”

 “I had to teach myself to walk again. I wanted to get well for my daughters but there was no support or guidance about how I could do this.

“I just needed to have the right rehab, treatment, and love and care, but it was never there.”

The head of policy for the Stroke Association, Charlotte Nicholls, explained “there are thousands of stroke survivors being let down by the health and social care system” after they leave the hospital due to the discrepancies in local rehabilitation and physiotherapy services.

She added that she hears many stories of stroke survivors who were told they’d never feed themselves, walk, or even hold a pencil again and yet they were able to achieve significant milestones after being offered specialist stroke recovery programs.   

Karen Middleton, the Chief Executive of the Chartered Society of Physiotherapy (CSP), said “it’s horrifying to see so many lives changed forever because the excellent care they receive in hospital is not continued once they are discharged”.

Compensation for the misdiagnosis of a stroke

If you are unsure if what happened to you was an act of medical negligence, contact our stroke misdiagnosis claims team who will take the time to listen with empathy and advise if you have a valid compensation claim.

Devonshires Claims’ highly experienced experts will support you through the whole process of obtaining compensation if you have experienced negligent care or treatment relating to your stroke.  For more information or to start your free case evaluation, contact our ‘No Win No Fee’ medical negligence solicitors today on  0333 577 9444, email cn@devonshires.co.uk or complete our online form.

References

  1. Vos T, Barber RM, Bell B, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2015;386(9995):743-800
  2. Organisation for Economic Co-operation and Development. Health at a Glance 2017. Paris: OECD Publishing; 2017.
  3. https://www.bsrm.org.uk/downloads/appg-on-abireporttime-for-change2018.pdf
  4. Stroke statistics February 2018, stroke.org.uk, https://www.stroke.org.uk/sites/default/files/state_of_the_nation_2018.pdf
  5. Royal College of Physicians Sentinel Stroke National Audit Programme (SSNAP). National clinical audit annual results portfolio March 2016-April 2017. Available: http://bit.ly/1NHYlqH Last accessed 24 October 2017
  6. S. Seshadri, A. Wolf (2017 Lifetime risk of stroke and dementia: current concepts, and estimates from the Framingham Study. The Lancet Neurology , Volume 6 , Issue 12 , 1106 – 1114
  7. NHS Digital. (2017). Quality Outcomes Framework (QOF) – 2016-17. Available http://bit. ly/2gC6LWb Last accessed 26 October 2017
  8. Office for National Statistics. (2016). Deaths registered in England and Wales: 2015. http://bit. ly/2h7Om7P Last accessed 20 December 2016.
  9. National Records of Scotland. (2016). Deaths by sex, age and cause, Scotland, 2015. http://bit. ly/2h671Pu Last accessed 20 December 2016.
  10. Northern Ireland Statistics and Research Agency (NISRA). (2016). Deaths, by sex, age and cause, 2015. http://bit.ly/29ffuON Last accessed 20 December 2016.
  11. Mallick A, O’Callaghan FJ (2009). The epidemiology of childhood stroke. Eur J Paediatr Neurol. 2010 May;14(3):197-205
  12. Harvard Medical School (2014). “Heart attack and stroke:Men vs Women” Available at: http:// bit.ly/2z3KNag. Last accessed 30 October 2017
  13. World Heath Organisation. (2017) The top 10 causes of death. Available at: http://www.who. int/mediacentre/factsheets/fs310/en/. Last accessed 10 January 2018
  14. Deeny S, Thorlby R, Steventon A. Briefing: Reducing emergency admissions: unlocking the potential of people to better manage their long-term conditions. London: Health Foundation; 2018.
  15. National Clinical Audit of Specialist Rehabilitation following Major Injury (NCASRI) Project Operational Team. Specialist rehabilitation for patients with complex needs following major injury: clinical audit. London: Healthcare Quality Improvement Partnership; 2016.
  16. Royal College of Physicians Sentinel Stroke National Audit Programme (SSNAP). National clinical audit annual results portfolio March 2016-April 2017. Available: http://bit.ly/1NHYlqH Last accessed 24 October 2017)
  17. Royal College of Physicians Sentinel Stroke National Audit Programme (SSNAP). National clinical audit annual results portfolio March 2016-April 2017. Available: http://bit.ly/1NHYlqH Last accessed 24 October 2017.
  18. (Emberson et al. (2014) Effect oftreatment delay, age, and stroke severity on the effectiveness of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised controltrials. Lancet. doi: 10.1016/S0140- 6736(14)60584-5
  19. (NICE (2015). Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing. Available: http://bit.ly/2hppxC7 Last accessed: 31 October 2017
  20. (Royal College of Physicians, British Thoracic Society. Pulmonary rehabilitation: steps to breathe better. London: Royal College of Physicians; 2016.
  21. British Heart Foundation. National Audit of Cardiac Rehabilitation (NACR) Quality and Outcomes Report 2018. London: British Heart Foundation; 2018
  22. Neurological Alliance. Neuro Patience: still waiting for improvements in treatment and care. London: Neurological Alliance; 2019.

 

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