business combination with cliffstar corporation

The Stroke Association Annual Review 2005

The Stroke Journey

10 things you should know about stroke

1. Every five minutes someone in the UK has a stroke.

2. A stroke is a brain attack. A stroke happens due to a clot or bleed in the brain, which causes brain cells to die.

3. The signs of a stroke are: • Facial weakness• Arm or leg weakness• Speech problems• Loss of sight in one eyeThese signs may only last a few hours (called a TransientIschaemic Attack – TIA) but must not be ignored.

4. A stroke is an emergency. If you see the signs of a stroke act FAST and call 999. Early treatment saves lives andincreases the chance of making a better recovery.

5. Stroke is the third biggest killer and the leading cause ofsevere disability in the UK.

6. Almost one in four men and one in five women aged 45 canexpect to have a stroke if they live to 85.

7. More than three times as many women die from stroke thanbreast cancer in the UK.

8. Unacceptable inadequacies in stroke care and research exist.For every £50 spent on cancer research and £20 on heartdisease research, only £1 is spent on stroke research.

9. Eating healthily, taking more exercise, not smoking and ensuring blood pressure is normal, can all help to prevent stroke.

10. The Stroke Association is working to create a world wherethere are fewer strokes and all those touched by stroke getthe help they need.

Thanks to Andrea Elson for sharing her stroke journey in this Annual Review.

Medical Charity of the Year 2004 – 2005 (Medical Journalists’ Association Awards 2005)

Contents

Introduction

Stroke prevention

When a stroke happens

Stroke treatment and care

Stroke rehabilitation

Andrea’s stroke journey

Getting involved

Funding research

The future

Finance

Thank you

How to contact us

Committee members

Professor Averil Mansfield, Chairman of Council

Introduction from the Chairman and Chief Executive

In the next hour 12 people in the UK will have astroke. Four of those people will recover, four willhave permanent disabilities and four will die.

However, there is much that can be done to improvethis situation, in order to reducethe number of deaths andincrease recovery.

The Stroke Association isworking to ensure that peopleon the journey through strokeprevention, treatment andrehabilitation, have access tothe best possible services andcare. We are also working toraise awareness of the fact thatmany strokes can be preventedaltogether. In the last year wehave made big steps forward infacing these challenges and it isinspiring to see how many morestroke survivors, families andcarers we have helped.

During the year we developed a new five-year strategy for theorganisation, which outlinesour plans for delivering moreservices to people affected by stroke; funding morestroke research; and buildingon our campaigning work. This includes a clear vision,

mission and set of objectives to work to (you can read moreabout these objectives on page20). We have also improved ourorganisational structure so thatit aligns with the Government’sVoluntary Sector CompactRegions. This means that wewill be able to communicatemuch more effectively withHealth and Social Services inthe regions and to build betterrelationships with them.

We have strengthened ourrelationship with parliamentariansthrough the All PartyParliamentary Group on Strokeand an event at the House ofCommons to raise awareness ofstroke. We have also partneredthe Food Standards Agency inits important campaign to reducethe nation’s salt consumption.

Funding from The StrokeAssociation has resulted in anumber of key achievements in stroke research over the year. In particular there havebeen developments in stroke

02 | The Stroke Association

In 2005 stroke continues to have a serious impact onhealth. It is the third biggestkiller in the UK and the leadingcause of severe disability.

Annual Review 2005 | 03

prevention, identification andtreatment. Another developmenthas been the formation of theUK Stroke Forum, which ishosted by The StrokeAssociation. The Forum willhave a significant impact on thesharing of research between theclinical and scientific disciplineswhich have an interest in stroke.

We are dedicated to improvingcommunications with everyonewho has an interest in our work.For this reason we launched our new website –www.stroke.org.uk – at theend of 2004. The websiteprovides clear and accessibleinformation about stroke for allour different audiences, fromstroke survivors to health

professionals and the media.One of the features of the new website is TalkStroke, a discussion forum wherestroke survivors and theirfamilies can communicate with one another. The websitehas created a real strokecommunity and has providedanother channel of support for those affected by stroke.

A major success during the year was winning the BAESystems Charity ChallengePartnership. Through this wehope to raise £1 million, all of which will be spent onimproving services for peopleaffected by stroke.

We would like to thank ourdedicated staff, volunteers and Trustees, as well as alldonors, Friends and supportersfor enabling The StrokeAssociation to continuesupporting people at everystage of their stroke journey.

Our visionWe want a world where there are fewer strokes and all those touched by stroke get the help they need.

Our missionTo prevent strokes and reducetheir effect through providingservices, campaigning,education and research.

“The StrokeAssociation isworking to ensurethat people on thestroke journey haveaccess to the bestpossible information,treatment and care.”Jon Barrick, Chief Executive

Jon Barrick, Chief Executive

Andrea Elson had a stroke seven years ago when she was just 28. Her stroke was the result of ahaemorrhage (or bleed) in her brain. The bleed caused cells in Andrea’s brain to become damagedand die.


Stroke prevention

Healthy lifestyle, stopping smoking and regular bloodpressure measurements can together prevent astroke from happening.

Raising awareness of the linkbetween these factors andstroke is key to reducing thenumber of strokes. For thisreason The Stroke Associationran a series of campaignsthroughout the year targeting thedifferent risk factors for stroke.

Eat a rainbow campaignIn a typical week one in fivechildren eat no fruit at all. Studiesshow that eating at least fiveportions of fruit and vegetables a day can reduce the risk of a stroke by a third. The ‘Eat a Rainbow – Beat a Stroke’campaign succeeded inpromoting the benefits of eating a range of different coloured fruitsand vegetables to children, byworking with parents, guardians,teachers and organisations.

Anti binge drinking campaignBinge drinking is a major riskfactor for stroke – people whobinge drink are twice as likely to have a stroke compared tonon-alcohol drinkers. During

the campaign, The StrokeAssociation raised publicawareness of the dangers of binge drinking during theChristmas period. A surveycommissioned by The StrokeAssociation across the UKshowed that 60% of thosesurveyed did not realise thatstroke can be a consequence of binge drinking. The resultsof the survey also highlighted alack of understanding amongstthe public as to what actuallyconstitutes binge drinking –75% of people surveyedoverestimated therecommended daily limits ofalcohol for men and women(which are 3-4 units for menand 2-3 units for women).

Salt campaignEating too much salt raisesblood pressure, which triplesthe risk of having a stroke.Lowering salt intake by 3g perday could reduce the number of strokes by a third andprevent around 20,500 deathsfrom the condition in the UK.

The Stroke Association joinedforces with the Food StandardsAgency on a public healthcampaign on salt, launched in September 2004. This longrunning campaign aims to tackleexcessive salt consumption tohelp reduce the high number ofconditions associated with highblood pressure, stroke beingone of these.

“Raising awareness of the risk factors forstroke is vital in order to reduce the numberof strokes in the UK.” Joe Korner, Director of Communications


The Stroke Association hascalled on the government for a mandatory warning to beapplied to food packaging whenfood contains more than a third(2g) of the recommended dailyamount of salt consumption.

South Asian campaignThe Stroke Association hasbeen awarded a three-yeargrant from the Department of Health to fund a ‘strokeprevention in South Asiancommunities’ campaign, asthere is a higher risk of strokeamongst people of South Asian(as well as African Caribbean)origin than amongst whiteEuropeans. The grant hasenabled us to build partnershipswith existing Asian healthcareand voluntary organisations. Weplan to use these relationshipsto assist us in developing andproducing written and recordedinformation in Punjabi, Bengali,Gujurati, Urdu and Hindi,outlining practical steps thatindividuals can take to reducetheir risk.

Reducing the number of strokesA research study, funded by The Stroke Association andcarried out by Professor PeterRothwell at the University of

Oxford, found that better controlof the risk factors associated with stroke and increased use ofpreventative medicines resulted ina 40% reduction in major strokein Oxfordshire over the past 20years (Lancet 2004; 363: 1925-33). Professor Rothwell’s StrokePrevention Research Unit is nowresearching stroke preventionfurther, with the aims ofunderstanding the risks of

recurrent stroke, improving theidentification and treatment ofindividuals at high risk of stroke,and increasing understanding ofstroke and Transient IschaemicAttack (TIA). The StrokeAssociation is supporting aSenior Clinical Research Fellowwho is part of ProfessorRothwell’s team.

Andrea had high blood pressure during pregnancy and this caused the bleed in her brain. High bloodpressure causes 40% of all strokes in the UK. Smoking, stress, lack of exercise and poor diet can allcause high blood pressure.

African Caribbean and South Asian communities have a higher riskof stroke.


When a stroke happens

If the symptoms of a stroke are not recognised,then diagnosis and treatment are delayed whichreduces the chance of recovery.

The earliest possible diagnosisand intervention for stroke leadsto a lower risk of dying and anincreased chance of making abetter recovery. However, theRoyal College of Physicians’National Sentinel Audit of Stroke 2004, revealed that largeproportions of people who havehad a stroke are not gettingdiagnosis and treatment asquickly as guidelines suggestthey should, and thatgovernment and Health Servicetargets are not being met.

Stroke is an emergency – if you see the signs of a strokeyou should dial 999. A TransientIschaemic Attack (TIA) has thesame warning signs as a strokebut the effects last for 24 hoursor less. TIAs left untreated oftenlead to full blown strokes, so

they should also be treated asan emergency. Anyone who hashad a TIA should see a strokespecialist as soon as possible,and in any event within a week.

Evidence shows that stroke isnot yet identified as a medicalemergency by many GPs,ambulance services andaccident and emergency staff.For this reason, The StrokeAssociation is launching a‘Stroke is a Medical Emergency’campaign in autumn 2005 toraise awareness of the warningsigns of a stroke, and to ensurethat people who have had astroke receive diagnosis andtreatment as soon as possibleafter the first symptoms.

Identifying stroke FASTResearch funded by The StrokeAssociation, from ProfessorGary Ford and others at theUniversity of Newcastle uponTyne, has showed that theFace, Arm, Speech Test (FAST)can be used by ambulanceparamedics to accurately

identify stroke. This identificationprior to hospitalisation puts thepatient in a much better positionto receive treatment morequickly. The research lendssupport for the use of FAST inclinical and research practice(Stroke, 2004; 35: 1355-1359).

Information serviceWhen someone has beenaffected by stroke, whetherpersonally or as a result of afriend or family member havinga stroke, it is vital that they haveaccess to information about the condition. The StrokeAssociation’s stroke helplineprovides advice about stroke,local services and stroke clubs,as well as listening support. In 2004/05 the stroke helplinereceived over 14,000 enquiriesand distributed around twomillion free information leafletsand 280,000 copies of Stroke News.

During the year, we launchedour new website –www.stroke.org.uk. The new

The signs of a stroke are:

• Facial weakness• Arm and leg weakness• Speech problems


site features a comprehensiveinformation resource ‘All aboutstroke’ which aims to answer all of the questions on strokethat someone might have. The website provides clear and accessible information forall the different visitors to thesite including stroke survivors,families, carers, professionals,researchers, parliamentarians

and the media. The websitehas generated an additional 250 email enquiries to thestroke helpline a month, further expanding our reachinto the stroke community.

The website also featuresTalkStroke, an interactivediscussion forum which allowsusers to share experiences and

information, and to help themsupport each other whilst comingto terms with stroke. In addition,through special audio clips,visitors to the website can hearstroke survivors talking first handabout their experience of copingwith stroke, recovering andmoving on from the condition.

Andrea’s stroke happened six days after her son Harry was born. She was unconscious for a weekafter the stroke. When Andrea woke up she was very confused and didn’t remember anything aboutwhat had happened.

“ I just wanted to saythank you to everyonewho has had a hand in this website. Youhave saved me. Mydad passed away this morning but youhelped me cope withhis strokes. If I hadn’tread this website Iwouldn’t have knownwhat to expect. Youhave helped me copewith his illness somuch that I can neverrepay you. Thank you.”TalkStroke user Early treatment for stroke saves lives and increases recovery.

Only 46% of stroke patients are admitted to a stroke unit,with a specialist stroke team, at some point during their stay in hospital. This is despiteevidence which shows thatgeneral wards have up to a25% higher death rate fromstroke than stroke units. Inaddition, the quality and

resourcing of stroke units variesconsiderably across the UK. For this reason The StrokeAssociation has called on thegovernment to issue a definitionand standard for stroke unitsand specialised stroke services,and to ensure continualreassessment of services tocomply with these standards.

Once in hospital, rapid accessto diagnostic tools such asbrain scanning equipment isessential. However, less thanhalf of all patients in England,Wales and Northern Irelandhave a brain scan within 48 hours of having a stroke. The Stroke Associationbelieves that people who havehad a stroke should receive a brain scan within an hour ofbeing admitted to hospital, asthis leads to the best chance of recovery.

Family Support ServiceThe Stroke Association’s FamilySupport Service is run byFamily Support Organisers(FSOs) who work with strokesurvivors, their families andcarers, helping them adjust tothe changes caused by stroke.In 2004/05 there were 90 FSOsworking across England andWales. FSOs work with staff atlocal hospitals who inform themwhen a newly diagnosed strokepatient is admitted. The FSOscan then offer a listening ear


Stroke treatment and care

Stroke patients are more likely to survive, make abetter recovery and spend less time in hospital ifthey are immediately admitted to a stroke unit.

Rapid access to a brain scan leads to the best chance of recoveryafter stroke.


and emotional support for the whole family, as well asproviding information andpractical advice.

TrainingThe Stroke Association’s ‘Caring for people affected bystroke’ training is aimed at allthose professionals who carefor stroke people either inhospital, the community orresidential and nursing homes.With the publication of theNational Service Framework For Older People in 2001 itbecame a requirement thatspecialist training wasundertaken by those caring forstroke patients. In 2004/05 ourtraining package was deliveredto almost 3,100 professionals

to fulfil this need. The courseremains the only one availableon all aspects of stroke forprofessional carers.

Surgery can reduce the risk of a strokeResearch funded by The StrokeAssociation, from Miss AlisonHalliday and colleagues at StGeorge’s Hospital, has foundthat carotid endarterectomysurgery (an operation where the surgeon cleans out fattydeposits in the carotid arterythat supplies blood to the brain) can reduce the risk of a stroke for people who have significantnarrowing of this main artery(Lancet 2004; 363: 1491-502).A study undertaken by ProfessorPeter Rothwell, University ofOxford, also concluded that the timing of this surgery issignificant in determining theoutcome for stroke patients. The researchers, funded by The Stroke Association,recommend that this surgery be carried out within two weeksof initial stroke symptoms toprevent the occurence of amajor stroke. (Lancet 2003; 363: 915-924). This work hasresulted in the Royal College ofPhysicians revising its NationalClinical Guidelines for Strokerecommendation for this surgery.

Feeding methods after strokeFollowing a successful pilotstudy funded by The StrokeAssociation, the FOOD (FeedOr Ordinary Diet) research trialwas developed as the largestever multicentre internationaltrial researching feeding policyfor patients with stroke. Withcontinued support from TheStroke Association, NHS R&D,Scottish Executive and Chest,Heart and Stroke Scotland, the trial collaborators, led byProfessor Martin Dennis atGlasgow’s Western GeneralHospital, have established thefeeding methods that lead to a better chance of recoveryfollowing stroke.

“Through our ‘Caringfor people affected by stroke’ training in2004/05, we haveensured that over3,000 professionalshave the specialistskills needed to carefor stroke patients.”Dr Ben Jabuni, Director of Community Services

The stroke left Andrea paralysed on her left hand side and with vision problems. She was admittedto a Neurological Rehabilitation Unit where she was assessed by a team including Physiotherapistsand Occupational Therapists.

Scanning the carotid artery in the neck.


Stroke rehabilitation

To achieve the best recovery, rehabilitation of strokesurvivors needs to begin immediately after a strokehas happened.

More evidence is urgentlyneeded to identify and developthe most effective rehabilitationtechniques for patients withstroke so that clinical servicesacross the UK can beimproved. The StrokeAssociation RehabilitationResearch Centre, inSouthampton, is thereforeworking to investigate andunderstand which rehabilitationinterventions are most effectivefor stroke patients.

Dysphasia Support ServiceThe Stroke Association’sDysphasia Support Service helps people withcommunication difficulties afterstroke by maximising levels ofrecovery and independence inlanguage skills (complementingthe work of Speech andLanguage Therapists).

The service works through a combination of home visits,support group meetings, social events and cares'groups. In 2004/05 there

were 89 Dysphasia SupportOrganisers working acrossEngland and Wales.

Research funded by The StrokeAssociation, from Dr WendyBest and others at University

College London, hasdemonstrated that speech andlanguage therapy using soundand written cues is effective inhelping people to communicateafter stroke. Their intervention is now being widely adopted.

Group meetings help people with communication difficulties.

Welfare GrantsThe Stroke Association’sWelfare Grants scheme aims to improve the quality of life for stroke survivors and theirfamilies. In 2004/05 weprovided a total of £185,000 in grants which were used for a range of things includinghospital travel, family holidaysand replacement for householditems or clothing.

Young Stroke Groups and Buddy SchemeStroke is often thought of asonly affecting older people.However 20% of people whohave a stroke are younger thanthe age of retirement. This

equals 25,000 people a year,including children. For thisreason, The Stroke Associationruns support groups specificallyfor younger stroke people. In2004/05, our Young StrokeBuddy Scheme providedsupport to young stroke people,their partners, carers andfamilies to help them deal withthe physical, psychological andemotional challenges of stroke.

Stroke ClubsThere are over 400 StrokeClubs affiliated to The StrokeAssociation. These clubs allowpeople affected by stroke toshare experiences and supportone another. The Stroke Clubsare often described as a lifelineby the people that attend them.

Getting out of the houseResearch funded by The Stroke Association and the Department of Health, fromDr Philippa Logan and othersat the University of Nottingham,has found that many peopleaffected by stroke want to getout of their house more often.The researchers havedeveloped an OccupationalTherapy programme which is successful in increasingoutdoor mobility after stroke(BMJ 2004; 329: 1372-4).

Driving after strokeResearch funded by The StrokeAssociation, from ProfessorNadina Lincoln and others atNottingham’s City Hospital, has allowed the development of the Stroke Drivers ScreeningAssessment, to determinewhether a person is fit to driveafter a stroke. The researchershave found that the assessment,available to therapists, doctorsand nurses, is a more accuratepredictor of driving ability thanindependent advice given by a doctor.

“ In the next year wewill be introducing a Charter MarkStandard so that we can develop and improve all theservices that weprovide for peopleaffected by stroke.”Chris Rennison, Community ServicesBusiness Manager

Andrea’s rehabilitation continued for many months after her stroke. During this time her baby son Harry was brought into the rehabilitation centre every day. This motivated her to get better.


Kathy White, Dysphasia Support Organiser

business combination with cliffstar corporation

Documents