Redesigning stroke servicesspecialising care and improving rehabilitation

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• Redesigning stroke services - specialising care
  and improving rehabilitation
• Chris Streather - Clinical Director HfL Stroke
  Project

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The case for change
London stroke units sentinel audit comparison
2004 and 2006
Above Target
Below Target
Target
90
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Project objective - raise standards and improve
outcomes
Current situation
Aspirations raising standards Door to needle
time lt 30mins CT scan within 24 hours of
admission 95 Physio assessment within 72
hours of admission 100 Patients admitted to
Stroke Unit on day of admission - 90
CT within 24 hours
90
Units will need to demonstrate how and when they
will meet the required standard
Physio assessment within 72 hours
90
Patients treated in a stroke unit
90
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Sentinel audit
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Scope end-to-end pathway
Prevention
Acute
Rehab
Prevention
Awareness
Initial Assessment
On-going Assessment
Transfer of Care
On-going Care
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Scoping education along the stroke pathway

• Successful bid for funding from NHS London for a
  Project Team to
• Undertake a needs assessment for the skills and
  knowledge required along the Stroke Pathway for
  all healthcare professionals
• Devise a leadership programme to develop
  leadership skills across the stroke community
• Development of a core syllabus to deliver the
  skills and knowledge required to bridge the
  theory-practice gap.
• Identify and commission potential providers to
  undertake provision of training for the syllabus
  
• Develop a standardised competency framework for
  all professional groups working with stroke
  patients

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Prevention - what are we trying to achieve?
? Educated workforce and public able to
recognise the symptoms and risk factorsfor
stroke/TIAs
? All health and social careorganisations take
prevention seriously
? Public/patients make lifestyle choices to
reduce their stroke risk
? More patients presenting toacute care within 2
hours of symptom onset
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Stroke awareness
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Rehabilitation and community care

• For rehabilitation and community care, we are not
  commissioning a new service model but would like
  to improve the current models of care
• Focus on a set of performance standards that all
  care settings can refer to
• High level understanding of need and service
  costs

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Patient pathways into community therapy -
currently
Vocational rehab Psychology
Social care
Community therapy
Early supported discharge
Community stroke team
Intermediate care
Generic team
Hyper-acutestroke unit (HASU)
Stroke unit
Neuro team
Long-term Care
Inpatientspecialistrehab
No therapy
End of life care
Voluntary services
GP and community nursing
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Patient pathways into community therapy new
model
Access to lifelong care
No therapy
Hyper-acutestroke unit (HASU)
Stroke unit
In-reach or Out-reach
Inpatientspecialistrehab
End of life care
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Stroke patient and carers views

• What made things worse after your stroke?
• No continuous support e.g. a key-worker
• People felt passed around
• Services did not share information
• Not giving people time
• Time not given enough

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Suggestions for improvement key themes
identified in the responses
Experience of care
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Long Term Care

• Separate piece of work will be carried out
• Area identified by stroke patients, carers and
  variety of others as vital to improving service
• Links with social services need to be explored
• Need to understand process of regular review
  who does it?

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Long term care strategy
Vocational rehab Psychology
Social care
Community therapy
Early supported discharge
Community stroke team
Intermediate care
Generic team
Hyper-acutestroke unit (HASU)
Stroke unit
Neuro team
Long-term Care
Inpatientspecialistrehab
No therapy
End of life care
Voluntary services
GP and community nursing
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Long term care patient and carers views

• For patients
• it takes years we need emotional and mental
  support
• having my own wheelchair has helped me and my
  carer
• a month ago I could only use my lawnmower for ½
  hour. Yesterday I used it for 1 ½ hours

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Long term care patient and carers views

• For carers
• the sense of complete loneliness fear
• no adequate provision for respite care
• It was like having a bereavement

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Role of the stroke networks
Network Board
Commissioners
Service Providers
Clinical Leadership
Innovation
Audit
Education and Training
Quality
Evaluation of Performance Patient and Carer
Involvement
R D Research Networks Service
Redesign Technology
Stroke registry
Opportunities across network
Network Connections
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• They have helped me get back to my old self
  again
• (Stroke Survivor)

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