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National service frameworks and strategies

Standards for stroke care

Stroke Act F.A.S.T. campaign poster

What is stroke

Stroke is a ‘brain attack’ caused by a disturbance to the blood supply to the brain. There are two main types of stroke

  • An ischaemic stroke – The most common form of stroke, caused by a clot blocking or narrowing an artery carrying blood to the brain. The likelihood of suffering an ischaemic stroke increases with age.
  • A haemorrhagic stroke – A less common form of stroke caused when a weakened blood vessel supplying the brain bursts and causes brain damage. It accounts for around 15% of all strokes but its mortality risk is greater than for ischaemic stroke. 

The most important care for people with any form of stroke is prompt admission to a specialist stroke unit. This applies to those with either ischaemic or haemorrhagic stroke of any severity and for people of any age. That's why the Department of Health developed the Act F.A.S.T. campaign to highlight the symptoms of stroke and the importance of emergency treatment. 

Transient ischaemic attack TIA

transient ischaemic attack (TIA), or minor stroke, is a temporary stroke that occurs when the blood supply to part of the brain is cut off for a short time only. The symptoms are very similar to an ischaemic stroke but are temporary, lasting a few minutes or hours and normally disappearing completely within 24 hours. However, a TIA is a sign that you may be at risk of a more serious stroke in the future. So, do not ignore signs of a TIA and seek medical help by calling 999 immediately. 

For more information about stroke, including symptoms and diagnosis of the condition, visit our Health A-Z section.

The National Stroke Strategy

The National Stroke Strategy, launched in December 2007, sets a clear direction for the development of stroke services in England over a 10-year period.

This strategy has been developed in partnership with representatives from stroke charities, stroke professionals in the NHS, social care professionals and those affected by stroke and their carers.

The strategy is an evidence-based document, clear on what needs to be done across the care pathway to achieve world-class stroke care.

The strategy sets out a 10-point action plan for England that summarises what constitutes a good stroke service across the whole pathway. Download the full stroke strategy (PDF, 1.04Mb).

The National Institute of Health and Clinical Excellence (NICE) quality standard for stroke

Stroke was the first quality standard that NICE published in June 2010. It covers care provided to adult stroke patients by healthcare staff during diagnosis and initial management, acute-phase care, rehabilitation and long-term management. Read the full stroke NICE guidelines.

Act F.A.S.T. campaign

The Act F.A.S.T. campaign was launched in February 2009 and includes strong imagery to highlight the visible signs of stroke.

F.A.S.T., which stands for Face-Arm-Speech-Time, is a simple test to help people recognise the signs of stroke and understand the importance of emergency treatment. The campaign encourages people to call 999 as soon as possible. The sooner a stroke patient receives treatment, the better their chances are of surviving and reducing long-term disability.

Results show an exceptionally high awareness of the campaign and a significant improvement in the public’s ability to spots signs of stroke. It is hoped that the Act F.A.S.T campaign will continue to help increase awareness about the signs of stroke so people can help family, friends and others should a stroke occur.

The Department of Health’s Act F.A.S.T. website has been updated and now includes a simple online exercise enabling people to test their knowledge of F.A.S.T..

Preventing stroke

NHS Health Check

Collectively, vascular disease (heart disease, stroke, diabetes and kidney disease) affects the lives of more than 4 million people and kills 170,000 in the UK every year. These conditions also account for more than half the mortality gap between rich and poor. Modelling work undertaken by the Department of Health has found that offering the NHS Health Check to all people between the ages of 40 and 74 in England, and recalling them every five or 10 years, would be a cost-effective and clinically beneficial programme.

The NHS Health Check assesses people’s risk of heart disease, stroke, kidney disease and diabetes by looking at their age, gender, family history, height and weight, as well as their blood pressure and cholesterol levels.

Everyone will receive a personal assessment, setting out personal levels of risk and strategies to reduce it. For those at low risk, this might be no more than general advice on how to stay healthy, weight management programmes or stop smoking services. Those at the highest risk might also require preventive medication with statins or blood pressure treatment.

NHS Health Checks have the potential to prevent 1,600 heart attacks and strokes and save up to 650 lives each year. They could prevent over 4,000 people a year from developing diabetes and detect at least 20,000 cases of diabetes or kidney disease earlier.


The Change4Life campaign was launched in 2009 as part of a strategy to help reduce obesity, which can result in stroke, and to help people maintain a healthy weight. Aimed at families, it promotes messages such as healthy eating and being more active.

Stroke strategy 10-point action plan for England

1. Awareness: ensure the public and professional groups have a clear awareness of stroke symptoms.

2. Preventing stroke: to alert people to vascular risk, for example hypertension, atrial fibrillation and high cholesterol.

3. Involvement: people with stroke need to be informed partners in their care planning. Those with communication or physical disabilities need to be involved from the outset in the planning and evaluation of local services.

4. Acting on the warnings: local areas need to be able to respond quickly to people who have had a transient ischaemic attack (TIA) – eg within 24 hours for the group most at risk of stroke.

5. Stroke as a medical emergency: local networks need to plan to ensure that everyone who could benefit from urgent care is transferred to an acute stroke centre that provides 24-hour access to scans and specialist stroke care, including thrombolysis.

6. Stroke unit quality: stroke unit care is the single biggest factor that can improve a person’s outcomes following a stroke. Successful stroke units are built around a stroke-skilled multi-disciplinary team that is able to meet the needs of the individuals.

7. Rehabilitation and community support: intensive rehabilitation immediately after stroke, operating seven days per week, can limit disability and improve recovery. Specialised rehabilitation needs to continue across the transition to home or care home, ensuring that health, social care and voluntary services together provide the long-term support people need, as well as access to advocacy, care navigation, practical and peer support. Commissioning and planning needs to be integrated across the whole care pathway.

8. Participation: assistance across the range of community services, to overcome physical, communication and psychological barriers to engage and participate in community activities helps people to lead more independent lives and move on after stroke.

9. Workforce: people with stroke need to be treated by a skilled and competent workforce. Local areas need to undertake a local needs assessment and to develop a workforce action plan.

10. Service improvement: services need to work together in networks to look across all aspects of the care pathway. Regular local and national audit and increased participation in clinical trials will also bring improvements.


Page last reviewed: 02/07/2012

Next review due: 02/07/2014

Stroke key facts

Stroke is the third biggest cause of death in the UK and the largest single cause of severe disability. Each year more than 110,000 people in England will have a stroke, which costs the NHS over £2.8 billion.

Every year, around 150,000 people in the UK have a brain stroke. South Asians (Indians, Pakistanis and Bangladeshis), have a higher risk of brain stroke than the rest of the population.

Watch TV adverts for

Stroke: Act F.A.S.T. (male)

This video shows how to spot the signs of stroke in men. Call 999 immediately if you think someone is having a stroke.

Media last reviewed: 10/07/2013

Next review due: 10/07/2015

Stroke: Act F.A.S.T. (female)

If you think someone is having a stroke call 999 immediately. This video shows how to spot the signs of stroke in women.

Media last reviewed: 10/07/2013

Next review due: 10/07/2015


Take the F.A.S.T. test

Learn more about signs of a stroke and make sure you know what to do in an emergency

Photo of stroke case study

'I'm a stroke survivor'

A stroke forced Jim Whyte to give up work. Now he makes a point of living an active, healthy life. Hear his story