Stroke helpline Website 0845 3033 100 stroke.uk

2. The cost benefits of helping stroke survivors to be more independent

3. Stroke Association Services 350 services England, Wales and Northern Ireland Core �Information, Advice & Support� and �Communication Support� Around half of all survivors of stroke receive a service Carers integral in service provision and many volunteer

4. The Stroke Association�s Life After Stroke Services Each client is different � no one care package will suit everyone. Within each category of service we have been developing local responses in service design, with an increasing range of services tailored to local needs and priorities We�ve worked hard to ensure that our offer to stroke survivors and carers is as wide and varied as possible � we�ve developed a range of new services aimed at different audiences, such as BME groups or younger stroke survivors. We also tailor each service to individual goals and needs. Egg. our Communication Support Service is increasingly offering choices of one-to-one peer or staff support, group support, befriending situations and carer support. For one person, a group might provide the perfect combination of social interaction, motivation and the skills required to begin communicating again, whereas someone else may simply want someone to work with them as they return to a former hobby or regain the confidence to consider employment.Each client is different � no one care package will suit everyone. Within each category of service we have been developing local responses in service design, with an increasing range of services tailored to local needs and priorities We�ve worked hard to ensure that our offer to stroke survivors and carers is as wide and varied as possible � we�ve developed a range of new services aimed at different audiences, such as BME groups or younger stroke survivors. We also tailor each service to individual goals and needs. Egg. our Communication Support Service is increasingly offering choices of one-to-one peer or staff support, group support, befriending situations and carer support. For one person, a group might provide the perfect combination of social interaction, motivation and the skills required to begin communicating again, whereas someone else may simply want someone to work with them as they return to a former hobby or regain the confidence to consider employment.

5. The need Traditionally - unsolicited thanks and dramatic stories of achievement More recent organisation focus on impact, goals and outcomes But the future agenda is to demonstrate affordability

6. 2010/11 Audit - Methodology Poor research base Could we demonstrate not only impact and outcomes but financial impact? Prioritised services with insecure funding Current / recent cases studies, identifying:

7. The problem/s Action taken Consequence Impact Savings

8. Health warning��.. Not independently conducted research Not claimed that all the savings are generated by The Stroke Association (usually multi-agency) Absolute proof of savings impossible

9. aggregated 3 service audits Savings identified in 29 �recent� clients (average 10 per service) Carers issues featured prominently in 21

10. Potential cost savings � independent consultancy Hospital related care: �719 - One night stay �4,348 - Average cost of stroke �11,033 � intracranial procedure �225 � OP follow up surgical appointment �117 �A&E attendance, high cost imaging �76 - Average ambulance attendance �166 - Missed hospital appointments

11. Other statutory costs - illustrations �499 per week - Nursing home package Benefits costs consumed and avoided Costs of missed GP appointments

12. Other costs � to be used with caution. �340 � Depression (review of published research) �28,000 � Relationship Breakdown (Aviva Report)

13. Carers audit � common themes Generally, Need for information, information and information!

14. Specifically Exhaustion / need for respite (5) Anxiety (4) Isolated / distant from family (4) Confusion (4)

15. Understanding and managing symptoms e.g. vision, choking, aphasia (5) Agencies completely uninvolved (3) Survivor is/was a primary carer (3) Relationships and family dynamics (2)

16. Actions taken Listening! Information and explanation Emotional support Engagement and involvement with family issues � within sensible limits

17. Inter-agency liaison and referral e.g. to GP, SLT, OT, social services, housing Financial / benefits support Liaison / referral to carers organisations and other community support Crisis intervention and prevention!

18. Case studies Margaret, only child of parents now 91 and 89, originally from St Lucia Father 3 strokes since 2004, vascular dementia. Mother 1 stroke 2009. Margaret avoiding a major operation because of her carer responsibilities

19. Risk: Exhaustion / breakdown in Margaret�s own health Parents potentially admitted to nursing homes (additional fear of different homes) Break up of family and failure to fulfil her responsibilities � �this is what West Indian families do, Chris!�

20. Actions: Carer support 4 hours respite Friday (Crossroads) and 2 hours Saturday to go to church Persuade Margaret to have her operation, engaging social services for respite admission for dad and on-going support package Practical support - hoists and table supplied Financial support - Attendance allowance

22. Impact: Quality of life Health and well-being Choice and control Dignity Economic well being

23. Economic Impact �495 x 2 x 52 = �51,480 3 years so far = �154,440

24. Case studies Isolated widowed stroke survivor, supported move to Cardiff to be with and be supported by children � risk of breakdown of support Not coping due to choking. Mealtimes 1� hours. Next stop, nursing home or risk of inhalation pneumonia. Support / SLT emergency visit. Wife of aphasic husband �hitting brick wall�. Approaching crisis. Multiple referrals including Crossroads. �Support was a lifeline�

25. Client isolated, with physical needs met, but expressive aphasia and family not communicating. Instructed wife, provided home volunteers, arranged respite care. Mother in her 30�s. 6 children. Husband a shift-worker, main carer an adolescent. Denying need for social services help. Multi agency involvement and young carer group.

26. Economic impact Relationships Depression Emergency admission Nursing / residential care Indefinable