tom penman head of stroke services tower hamlets community health services sue perkins commissioning...
TRANSCRIPT
Tom Penman Head of Stroke Services Tower Hamlets Community Health Services
Sue Perkins Commissioning Manager for Long Term Conditions NHS Tower Hamlets
Every PCT should commission a community rehabilitation service for stroke patients delivered by staff with stroke specialist skills
Service configuration should be locally determined and the service must meet all of the performance standards
▪ Tower Hamlets demographics …▪ Deprived▪ Overcrowded▪ Diverse▪ Young ▪ Growing population▪ High unemployment▪ 20% families live on less than £15,000
And our health our needs assessment tells us …▪ Low life expectancy▪ Health inequalities (male life expectancy vs national
average)▪ High burden of cardiovascular disease▪ Health inequalities within the borough
But …▪ Ranked 1st nationally for economic growth
▪Approx 2,000 residents on GP stroke registers
▪Absolute number of deaths from stroke low compared to London (young population)..but..
▪Deaths in under 75s (“preventable”) from Stroke third highest in London
▪Death rates in under 65s fourth highest in London
▪Highest hospital admission rates for Stroke in London
Health Needs Assessment – Stroke in North East London
Parts of the jigsaw in place in 2008Agreed, mapped Stroke pathway Service development & innovation driven by staff
• Staff working across acute and community pathway• Inpatient community rehabilitation ward• Multi-disciplinary Community Stroke Team (CST) established
Stroke a priority area - Commissioning Strategic Plan
Missing pieces1.Capacity of CST and inpatient rehabilitation2.Accountability for stroke pathway3.Clear service specification for community rehab team and structured Performance Monitoring process4.Ongoing patient and public involvement5.Clear link to prevention
Post discharge 12 week input
Some staff shared across Acute Stroke Unit, or across Older People’s Ward, or all Community Intermediate Care & Rehab services
Further pathway review From patient perspective & against Stroke Strategy
Stakeholder involvement Staff interviews, ward observations, discovery interviews, Local Authority engagementTo develop a “vision” for the service
Skill mix review Identified need for more specialist nursing staff & nursing clinical leadership role
JSNA To add to PHAST data re. admissions, expected prevalence, current inequalities
Investment and redesign neededEarly Supported DischargePathway available to stroke survivors without an acute admissionPost 12 week follow upSpecialist vocational rehab service
Head of Stroke Services, Clinical Nurse Specialist – leadership and management accountability
POST RATIONALEHead of Stroke Services Management accountability for stroke
pathway, service development, strategic leadership
Clinical Nurse Specialist Clinical leadership across acute, inpatient rehabilitation and community
Patient Facilitator & Family Support Worker
Champion stroke survivor, family, carer voiceGuide through pathwayNon clinician point of contact
ESD team Physio, OT, Speech & Language, RSW, Dietitian
Appropriate frequency & intensity of rehab7 day a week serviceHealth and social care interventionsESD to target 20% of admissions
Vocational Rehabilitation Support for people to remain in, or return to work or meaningful occupation
Agreed patient pathway From prevention, through acute, out to community, ongoing care
Performance Management process
Performance Dashboards, quarterly reviews for CST and inpatientsHfL performance monitoring link
Governance structure Important for multidisciplinary teams working across a number of settings
Link to Prevention Role of CHD Nurse Specialists and Vascular Strategic Board
Clear Service Specification
Department of Health new contract template
Where does community rehab start and stop e.g. in-reach
The role of Local Authority commissioner and LA Stroke funding
How to commission for a pathway rather than for a care setting
How to capture data for performance monitoring
How to engage primary care in what we develop
How to “share” savings in social care package costs
Where does community rehab start and stop e.g. in-reach
The role of Local Authority and / or third sector providers
How to engage primary care and the role of GPs in rehab
Can we combine uni-disciplinary budgets for a multidisciplinary service
How to capture data for performance monitoring
Who manages new posts across disciplines e.g. Rehab Support Workers
How does the service work with more general reablement teams
Additional resources sometimes distract from bigger issues
Transitions can be improved (acute to community and community to long term support) without investment
Stroke Networks have information about best practice
Important to engage GPs – 12 month follow up
Be clear what you want to commission (service specification)
Meaningful PPI is difficult in short timescales and needs to be embedded in whole process
Establish an explicit performance management process