Stroke is a condition whereby improvements can still be achieved over many years. For this reason, people need rehabilitation to help them recover and improve and they also need support to help them manage the disabling factors caused by a stroke that may continue in the long term. Individuals affected by a stroke value continuity, being kept informed and having a clear and consistent point of contact with services, as do their families and carers.
The National Stroke Strategy sets out the markers of a quality service for stroke survivors. The aim is to ensure that those who have had a stroke and their relatives and carers achieve a good quality of life with optimal independence, well being and choices.
Taskgroup
A Network task group was established in 2008, to focus on the longer term care pathway for stroke patients, starting from the end of the acute phase when they leave hospital. This is a challenging remit for the group, which has representation from specialist stroke therapies, consultant stroke physicians and neurologists, specialist stroke nurses, commissioners, social services and service users.
Workplan 2011/12
- Work with sector colleagues to improve stroke prevention across the Network.
- Improve identification of Atrial Fibrillation (AF) in primary care and anti-coagulation of people with AF and develop a Network-wide primary care education programme.
- Work with colleagues pan-London to revise the London stroke tariff.
- Support commissioners to ensure appropriate and adequate rehabilitation provision across the sector.
- Pilot a central co-ordination role for Early Supported Discharge (ESD) at the Hyper Acute Stroke Unit (HASU).
- Facilitate discussions between providers and commissioners regarding the future provision of ESD.
- Ensure stroke teams are undertaking regular reviews for stroke patients at 6 weeks, 6 months and 12 months.
- Undertake training for stroke teams on how to manage psychological problems following a stroke.
- Develop a Stroke Handbook for patients which will be the main information resource for people along their care pathway.
- Continue to seek members for Stroke Patient Panel, develop their skills in user participation and seek and review patient feedback on their experience of the new service.
Key guidelines and documents
National Service Framework for Coronary Heart Disease (2000)
National Service Framework for Older people [Standard 5] (2001)
National Stroke Strategy (2007)
Mending Hearts and Brains - a clinical case for change (2007)
Healthcare for London: Consulting the Capital (2008)
Healthcare for London Stroke Strategy for London (2008)
Healthcare for London Stroke Rehabilitation: supporting London commissioners to commission quality service in 2010/2011 (2009)
Commissioning Support for London: Life After Stroke Commissioning Guide (2010)