A stroke is a “brain attack” caused by a disturbance to the blood supply to the brain (Alzheimer Society). There are two main types of stroke:
- Ischaemic: Caused by a blockage cutting off the blood supply to the brain.
- Haemorrhagic: Due to a bleed on the brain.
Transient ischaemic attacks (TIA) are minor strokes where stroke symptoms resolve themselves within 24 hours. TIAs needs to be regarded as an emergency because the time necessary for effective prevention of a more serious stroke is extremely short.
Having a stroke is a long term condition - which means that survivors, their families and carers will continue to experience changes in their needs over time.
Stroke is the fourth largest cause of death in England and over 100,000 people have a stroke each year. The economic cost of stroke to the UK society is estimated at £26 billion per year.
Cost of strokes by sector (incidence)
- 29% NHS
- 11% Social care
- 57% Informal care
- 3% Lost productivity
Statistics suggest almost two thirds of people who have had a stroke are left with a long term disability, this could include physical disability, loss of cognitive and communication skills as well as depression and other mental health problems (Stroke Association, 2017).
Key lifestyle risk factors
Lifestyle risk factors such as;
- tobacco use and smoking,
- alcohol use,
- diet and nutrition and
- physical activity
are part of controllable risk factors. Lifestyle risk factors are habits or behaviours people choose to engage in. If changed, they can directly affect some medical risk factors by improving them.
The local picture
There were 4,004 recorded strokes or transient ischaemic attacks (TIA) during 2016/17 (QOF, 2017) in Calderdale.
There are two measures used to give an indication of the size of the issue in Calderdale; these are emergency hospital admissions and deaths as a result of a stroke.
The rate of emergency hospital admissions in Calderdale in 87.4 (per 100,000 population, all ages) the chart below breaks the results down by ward, rates are highest in Park ward, 64% of the population in Park ward identify as Asian, risk factors are higher among those from South Asian origins so this would be expected. Rates were lowest in Calder.
Emergency hospital admissions for stroke, standardised admission ratio, 2011/12 – 2015/16

Source: Public Health England, 2017
Between 2011 and 2015 there were 557 deaths in Calderdale as a result of a stroke. The rate of deaths (per 100,000 population) during the same time period is 91.4 which is significantly better than the England average. The following chart shows the rates at ward level in Calderdale. Highest rates were in Park and Rastrick with the lowest rates in Brighouse and Calder.

Source: Public Health England, 2017
Inequalities
Stroke is one of the greatest health challenges of our time. More than 100,000 strokes occur in the UK each year killing 50,000 people. As a result stroke is the leading cause of adult disability in the UK. More than 1,170 people in Calderdale are living with a long term disability after a stroke, which is predicted to rise to 1,361 by 2020. The cost of stroke to society is around £26 billion a year.
There is considerable scope for preventing stroke by addressing modifiable risk factors such as poor diet, smoking, obesity, excessive alcohol intake (these are aspects of people’s lifestyle that can be changed through their own behaviour). By managing and improving lifestyles other risk factors such as high blood pressure and diabetes can help to reduce the risk of stroke.
In England people are most likely to have a stroke after the age of 55. The average age for women to have a stroke is 78 and men 72, but strokes can affect people of any age, including children.
Men tend to be at a higher risk of having a stroke at a younger age compared to women. This is mainly due to a combination of lifestyle and medical factors. Diabetes and heart disease are more common amongst men and are both risk factors for stroke. More women die of stroke this is because women tend to live longer than men and the risk of stroke increases with age.
Generally people from more deprived areas have an increased risk of stroke due to underlying socioeconomic, behaviour and lifestyle factors (including obesity and alcohol consumption) related to health.
Above referenced from stroke.org.
The Stroke Association continue to work with BME communities and groups across Calderdale to promote awareness, provide advice and guidance to support people with lifestyle changes based on identified factors.
Predicted number of people with a longstanding health condition caused by a stroke in Calderdale.
2019 | 2020 | 2025 | 2030 | 2035 | |
---|---|---|---|---|---|
Females aged 18 and over | 514 | 518 | 553 | 589 | 625 |
Males aged 18 and over | 821 | 831 | 909 | 991 | 1061 |
Total | 1334 | 1349 | 1463 | 1580 | 1686 |

Figures are from Projecting Older People Population Information and Projecting Adult Needs and Service Information.
There are inequalities among different ethnic groups and social deprivation.
Black people are twice as likely to have a stroke compared to white people. This is due to other risk factors including high blood pressure and diabetes which can contribute to a higher risk factor of stroke. Conversely white people are more likely to have an irregular heart beat as a result of poor lifestyle choices for example smoking and drinking alcohol. People from South Asian origins are more likely to have high blood pressure; diabetes and high cholesterol in comparison to white people which increases their risk of having a stroke.
People from more deprived areas have an increased risk of stroke, and are likely to experience more severe strokes. (Stroke association, 2017).
Current provision
Accident and Emergency
Stroke patients are referred by the Accident and Emergency (A&E) department to the stroke team at Calderdale Royal Hospital. There are specialist nurses present 24/7 and they attend A&E to assess patients on arrival. There is a pre alert by the ambulance service and the Consultant (8-5) and the thrombolysis nurses 24/7 meet the patients and take straight for CT scan and then return to ED to complete their care.
Secondary in-patient care
There are 6 HASU beds, 8 ASU BEDS, 38 Rehab beds. There is a 15 bedded Acute Stroke Unit, a 34 bedded in patient Stroke Rehab Unit and an Early Discharge service to support people back home. These services are supported by physiotherapists, occupational therapists, speech and language therapists and dieticians.
The Trust has an End of Life pathway in place with guidance for staff on hydration/nutrition, medication, pain management and on-going patient needs assessment.
Stroke Buddies
These are volunteers who have survived a stroke and go onto the Stroke Rehab Unit to talk to people about the support that is available to them when they leave hospital and offer an important peer support role at the very early stages of recovery.
The Stroke Association
This organisation is jointly contracted by the Council and CCG to deliver a community based service, the aim of the service is to improve health and social care outcomes for adults who have survived a stroke, to maximise independence and enhance quality of life of the Individual, their family and carers. Specifically, they:
- Provide advice and information in a variety of settings;
- Provide a link from hospital to the community with follow up calls when people return home;
- Complete six month reviews and provide the data for the SSNAP reports;
- Provide ongoing 1:1 support when needed;
- Run a range of groups for peer support, carers and communication;
- Provide appropriate support, information and signposting to stroke survivors, their family and carers at different times in their recovery whether living in their own home or in long term care;
- Raise awareness in the wider community of the risk factors associated with stroke and what to do if you suspect someone of having a stroke;
- Encourage user involvement in service design and delivery;
- Manage the Stroke Buddies;
- Produce ‘My Stroke Guide’ – A web based solution for advice information and a forum for connecting with other stroke survivors, support workers and therapists.
Know Your Blood Pressure Scheme
The scheme raises awareness of stroke in the wider community and specifically with groups identified as high risk of having a stroke. Through ongoing events such as ‘Know Your Blood Pressure’ the scheme highlights the risk factors associated with stroke and offers advice on a healthy lifestyle. Significant savings are being made by ensuring members of the public at risk of stroke, seek intervention to prevent stroke.
Carers Corner Drop-In - Ward 7BC, Calderdale Royal Hospital
The Carer’s pop-up stand at Calderdale Royal Hospital provides carers and family members of stroke survivors the chance to speak with a Coordinator, to answer any questions they have about life after stroke. Between January – March 2018 9 x sessions were held and approximately 122 people were supported.
The Carers Corner is held every Thursday afternoon on Ward 7 at Calderdale Royal Hospital and has been exceptionally successful providing vital information and advice to many carers of stroke survivors. Carers visit the dedicated Stroke Association corner to discuss the various support services available pertaining to their particular needs including discussions on further rehabilitation and support post discharge.
The Better Living Team
This service offers 1:1 (for a period of up to 12 weeks) for people recovering from a stroke who wish to pursue some form of physical exercise as part of their recovery and builds on progress begun in Community Rehabilitation. The aim is to re-enable the person to maximise their independence and it is open to adults over 18 living in Calderdale who are recovering from stroke.
At the end of the 12 week programme the person is linked in to continuing support/physical activity/health promotion service options through the community/voluntary sector or similar service provider. Chair based exercise sessions for service users referred to the service that do not require specific one to one support, but are unable to attend a mainstream class, commenced at the end of July 2017 at North Bridge Leisure Centre. The class has been successful as a further option within the pathway for stroke patients. Patients are able to access the class for 12 weeks free. There is an option to continue in the class on a fee paying basis after 12 weeks.
Unmet needs
The Stroke Association, NHS England and other partners, are working together to develop a national 10 year plan for stroke in England. The Stroke Association plan to build on the successes of the current National Stroke Strategy, which ends in 2018 and hope the new plan will tackle the big issues in stroke treatment and care which stroke survivors and clinicians tell us need to be sorted out.
The Calderdale & Huddersfield NHS Foundation Trust had identified in their Annual Report some areas that need to be strengthened. In particular a key issue identified was Psychology and the action plan from ISR, SALT, assessment area near ED to see more patients with minor neurological symptoms so minor strokes are not missed.
Psychology services
These would support the stroke unit.
- A third (33%) of stroke survivors experience post-stroke depression;
- Approximately 20% of stroke survivors experience emotionalism in the first six months. This decreases to 10% in 12 months;
- There is currently no psychology service provided in the stroke unit.
Projected future need
The risk of a stroke increases with age however people are having strokes earlier in their lives (Stroke Association, 2018):
- Around 1 in 4 strokes happen to people of working age,
- The average age for men to have a stroke is 72 and 78 for women.
The population is aging with currently 18% of people in Calderdale estimated to be over the age of 65. The Office of National Statistics (ONS) estimates that by 2035 that figure will rise to 25% with the prevalence rate of having a stroke being directly linked to age the number of people having a stroke is due to rise substantially (POPPI, 2018).
In 2017 877 of the population aged 65 and over were predicted to have a longstanding health condition caused by a stroke this is expected to increase to 1,339 by 2035.
The following areas need to be considered in future work to try to reduce the risk of stroke:
- Improved lifestyle services;
- Earlier detection and better management by general practice of people with hypertension;
- Work with vulnerable and high-risk groups to reduce inequalities, specifically people living in the most deprived areas and South Asian populations;
- Improved self-care support, both before and following a stroke.
Key considerations linked to the known evidence base (what works?)
The National Stroke Strategy (Department of Health (DoH) 2007) set out 20 Quality Markers summarised into a Ten-Point Plan for Action covering the following areas:
- awareness;
- preventing stroke;
- involvement;
- acting on the warnings;
- stroke as a medical emergency;
- stroke unit quality;
- rehabilitation & community support;
- participation;
- workforce;
- and service improvement.
These markers were set out to improve the support available to individuals and their families following a stroke and progress against them to be evaluated.
NICE guidance CMG45 (2012) Services for the prevention of cardiovascular disease recommends that commissioners consider the following components of a high-quality service:
NICE guidance (CG162) Stroke Rehabilitation for Adults (2013):
1.1 Organising health and social care for people needing rehabilitation after stroke
1.2 Planning and delivering stroke rehabilitation
1.3 Providing support and information
1.4 Cognitive functioning
1.5 Emotional functioning
1.6 Vision
1.7 Swallowing
1.8 Communication
1.9 Movement
1.10 Self-care
Education
Recognising the signs of stroke or mini-stroke (TIA) and calling 999 for an ambulance is crucial. The quicker a patient arrives at a specialist stroke unit, the quicker they will receive appropriate treatment and the more likely they are to make a better recovery. The FAST test can help you to recognise some of the most common symptoms of a stroke:
- Facial weakness: Can the person smile? Has their face fallen on one side?
- Arm weakness: Can the person raise both arms and keep them there?
- Speech problems: Can the person speak clearly and understand what you say? Is their speech slurred?
- Time: If you see any one of these three signs, it’s TIME to call 999. Stroke is always a medical emergency that requires immediate medical attention.
References
References
- Stroke Association Strategy ‘Together we can conquer Stroke’ April 2017 – March 2019.
- Calderdale Council, 2013: Calderdale Adult Social Care Vision.
- Calderdale Council, 2015: Locally calculated from ONS births and deaths data.
- Calderdale and Huddersfield Foundation Trust, 2015: Annual Report for Calderdale and Huddersfield NHS Foundation Trust 1st January 2015 – 31st December 2015 , Yorkshire and the Humber Strategic Clinical Networks.
- Department of Health, 2007: The National Stroke Strategy.
- Stroke Association: FAST - recognise the signs of stroke (Accessed on 15th January 2015).
- Hackett ML, et al. 2005: Frequency of Depression After Stroke A Systematic Review of Observational Studies , Stroke. 2005;36:1330-1340.
- Hackett ML. et al. 2010: Pharmaceutical interventions for emotionalism after stroke , Cochrane Database of Systematic Reviews.
- NHS, 2014: NHS Choices: Stroke.
- NICE, 2013: Guidance (CG162), Stroke rehabilitation in adults (Accessed on 15th January 2015).
- ONS, 2014: Available from Sub-national Population Projections.
- Projecting Older People Population Information and Projecting Adult Needs and Service Information (Accessed 24th May 2019).
- Stroke Association, 2016: State of the Nation (Accessed on 15th January 2015).
- State of the Nation Stroke Statistics, January 2017.