Rehabilitation
Stroke Improvement Programme National Project 2009-10
Quality Marker 10
Quality marker 10 is about access to rehabilitation for all, at the right time, in the right place, of the right
amount, for as long as is required, and delivered by appropriately skilled people. The National Stroke Strategy advocates high quality specialist rehabilitation for all stroke patients, describing desired levels of access, quality and duration.
Project objectives
The Rehabilitation national project aimed to show how to make real changes and improvements to stroke rehabilitation services. The project identified issues around quality rehabilitation for stroke patients and
their carers, the opportunities and barriers around the use of outcome measures, and collecting meaningful
data within rehabilitation to enable robust evaluation of quality service improvements.
Each project site worked with an individual tailored project plan to improve the rehabilitation experience and services locally, reflecting the aspirations of quality marker 10, with common focus on specific agreed qualitative and quantative metrics.
Project sites
• Aintree University Hospitals NHS Trust
• Portsmouth Hospitals NHS Trust
• NHS Hampshire
• NHS Medway
• Norfolk and Norwich University Hospitals NHS Foundation Trust and NHS Norfolk
• Northampton General Hospital, Kettering General Hospital and NHS Northamptonshire
• NHS West Sussex, West Sussex Health and West Sussex County Council
• York Hospitals NHS Foundation Trust
Measures/anticipated outcomes
Specific project measures:
• Reduced length of stay in acute/rehabilitation environments.
• Reduction in time from admission/referral to first therapy assessment.
• Increase in direct therapy contact time (hours) - physiotherapy, occupational therapy, SALT.
• Increase in percentage of patients receiving rehabilitation from stroke specialist staff.
• Improvement in patient/carer satisfaction with therapy.
• Improvements in therapeutic outcome scores.
• Increase in percentage of patients with rehabilitation progress, measured against goals, reviewed regularly using validated outcome measures.
Additional outcomes from the projects:
• Raised awareness of the issues around quality rehabilitation for stroke patients and understanding of the differing needs when providing rehabilitation in different settings.
• Development of methods to recognise and include the aspirations and views of stroke survivors and their carers in rehabilitation service developments.
• Improved access for stroke survivors to a more appropriate and broader range of clinicians with relevant skills and knowledge through raised awareness of the significance and role of these professionals, and metrics around assessment of cognition and mood.
• Influence on the pre and post registration education planning and thinking for all professional groups involved in delivering care to the stroke survivor.
• Examples of successful changes/development of different models of service provision, shared nationally.
• Some standardisation of therapy approaches, consistency and consensus around frequency and efficacy of interventions.
• Embedding of strategies that provide for carer support within delivery of rehabilitation context that offer education and support at all stages of the patient experience.
National policy/strategy
The national work that this project links into includes:
Rehabilitation tariff
Unbundling the national tariff for acute services to direct funding into specialist rehabilitation, through directly working with the PbR best practice tariff team and the Rehabilitation Expert Reference Panel.
Stroke Specific Educational Framework (SSEF)
The development of stroke competencies and a stroke skilled workforce, through the
development of a competency library.
Commissioning new services
Particularly around the development of ESD, community services and linking with social care and the voluntary sector. This includes project representatives working with the Chartered Society of Physiotherapy (CSP) to develop their rehabilitation toolkit for commissioners, The Stroke Association’s raising awareness of physiotherapy campaign, Different Strokes’ development of exercise programmes and three joint health and social care commissioning project teams.
Academic work
Focused on defining and measuring clinical effects of rehabilitation, including consultation with CLAHRC and their work around the academic aspects of ESD, and evaluation of quality therapeutic rehabilitation
interventions.
Development of national rehabilitation metrics
Consultation with clinical professional organisations, with the authors of the RCP Rehabilitation Guidelines chapter, and relevant national nurse and AHP consultants.
Development of national stroke quality standards.
NICE Quality Standards for Stroke topic expert group.
Stroke rehabilitation clinical guidelines.
What has helped the project progress?
• Building on early work undertaken in NHS North Lincolnshire on unbundling the rehabilitation tariff.
• Sharing of successful models of community stroke rehabilitation and early supported discharge services nationally established in Blackburn, Portsmouth and Knowsley.
• Evaluating new models of care and opportunity for data collection with sites offering 6/7 and 7/7 therapy, such as Peterborough and Stamford Hospitals NHS Foundation Trust.
• Partnership working with stroke networks undertaking the development of Gold Standard Rehabilitation frameworks – North of England Cardiovascular Network, Coventry and Warwickshire Cardiovascular
Network and Anglia Stroke and Heart Network.
Learning from the projects
• Going up a gear: practical steps to improve stroke care publication, June 10
• Project case studies
• Presentations and posters from the Accelerating Progress in Stroke Care event, 22 June 10
Contact details
Project lead: Jill Lockhart
National Improvement Lead
NHS Stroke Improvement Programme
Email: Jill.lockhart@improvement.nhs.uk
Tel: 07920 081199
Resources
Joint Commissioning in Early Supported Discharge: Creating patient and carer-centred pathways through joint commissioning
National Stroke Strategy Quality Marker 10, 12, 13 and 15
NHS Knowsley have set up an early supported discharge (ESD) service to meet what service users consider to be their unmet needs. By integrating both health and social work components, the ESD team has been able to extend its scope of practice, and be more responsive to the needs of the both the service user and their family. To find out more about this service, please click here.
Useful links
• Department of Health (DH)
• National Institute for Clinical Excellence (NICE)
• Stroke Care Networks
• The Stroke Association
• Different Strokes
• Connect
• Crossroads Care
• Collaborative Leadership in Applied Health Research and Care (CLAHRC)
• The Chartered Society of Physiotherapy
• The Royal College of Physicians (RCP)
• Care Quality Commission (CQC)
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