1. Life After Stroke Commissioning Guide
Mark Hindmarsh
Senior Project Officer,
Commissioning Support for London
2. London stroke strategy – where this fits
London stroke
strategy (2008)
Public consultation
(2008/09)
Rehab commissioning
guide (2009)
Life after stroke
(2010)
4. Scale of need
• Prevalence ranges from 1.6% to 0.8% of registered GP population
• 88,000 people across London on GP registers have had a stroke or TIA
Sum of stroke and TIA patients in a GP register in 2008/9
5. Diverse needs
15% have on-going
continence problems
25% of nursing home
residents have had a stroke
33% of stroke survivors report
depressive symptoms
20% “silent stroke” –
underlying cognitive problems
6. Regular review
Needs change over time
Recognise variability of needs and aspirations
National guidance – 12 monthly review
Stroke
survivor
Social
care
GP
Therapist
Stroke
navigator
Structured
social
group
7. Information
Stroke care navigator
– Single point of contact
– Direct role in delivering care
– Coordinate care packages
– Training stroke survivors and carers
– Work across different sectors
London stroke directory
www.londonstrokedirectory.org.uk
8. Engaging with community life
Stroke survivors do not
get out of the home as
much as they would like
Building confidence
Addressing practical
issues
Community/social groups
have benefits beyond
primary purpose
9. Peer support & peer-led services
Peer
support
Improve
emotional
wellbeing
Build
capacity
Sense of
purpose
Range of
functions
Confidence
Source of
information
Improve
functional
status
10. Carers and families
Carers have a right to
their own needs review
Training and education
should be provided
Local authority and
charitable sector
support is available
11. Conclusion
Operating services across the different sectors
has track record of success
Develop and empower people
Published guide is available today
Will also be available to download
stroke@csl.nhs.uk
Hinweis der Redaktion
Next document in series – now looking at entire stroke care pathway
Redress the balance and focus from acute to community care
Increase focus on community and home care services after discharge and after acute care has ceased
Multi-disciplinary team involving commissioners, third sector, therapists, GPs
Three guiding principles for the document.
Active citizenship is about re-engaging with society. Not getting stuck in the community services and giving people the opportunity to continue to progress and realising what is possible for them.
The improvement of quality of life should be the key marker by which services are judged.
Empowerment also aligns with the personalisation agenda
London average prevalence is 1.0%
People are living longer and more people are surviving strokes. This figure is therefore likely to continue to increase
Numerous other statistics that could be quoted in these fields.
Given the diversity of need it is not possible to define a single life after stroke service. A life after stroke service will mean different things to different people. Services need to be responsive and flexible to meet the exacting needs on the individual. This, is person-centred care.
Give example of south London stroke patient forum also at Coin street
Not only are the needs of stroke survivors diverse, but they also change and evolve over time
Using the South London Stroke Register Kings College London looked at the needs of stroke survivors over a 10 year period
Return to themes of empowerment – people need to know what is available around them and how to access it.
Although mentioned, focus to encourage people to get involved with community life – less focus on the specifics of which therapy based services people need and how to design them.
People need to be able to get out and about and so guide has case studies of how this can be achieved
Social groups have positive benefits on mood/emotional status, functional status. Sharing experiences builds confidence
Peer-led initiatives need to be supported by commissioners in their areas
Other stroke survivors are a resource that should be encouraged to get involved with local services, they should be supported to get involved with the local design and organisation of services – this includes carers
Actively involving carers in decisions help to reinforce messages and support best practice
Joint commissioning of services working across boundaries works
