Healthcare for London – Stroke Project Rehabilitation and Community Care Event 8 th August 2008.

Healthcare for London – Stroke ProjectRehabilitation and Community Care Event 8th August 2008

Welcome!

Rachel TyndallHealthcare for London Stroke Project

Senior Responsible Officer

Chief Executive, Islington PCT

Developing an Improved Stroke Pathway

• The Stroke Project has been established to develop and deliver a pan-

London Strategy for the end-to-end stroke pathway

• The scope for this phase of work includes:

Scope for Today

PREVENTIONPREVENTIONPREVENTIONPREVENTION ACUTE CAREACUTE CAREACUTE CAREACUTE CAREREHABLITITATIONREHABLITITATION

& COMMUNITY & COMMUNITY CARECARE

REHABLITITATIONREHABLITITATION& COMMUNITY & COMMUNITY

CARECARE

1 2 3

HASU SU• Primary Prevention• Secondary Prevention• Awareness

• Community Therapy• Healthcare – GP and Community Nursing• Social care• Voluntary services• In-patient specialist Stroke rehabilitation

• Hyper-Acutestroke care (first 72 hrs)

• Stroke Unit(post 72 hrsacute rehab)

Programme and Project Governance

ProjectBoard

CAG

ProjectTeam

LCG

PEG

ExpertPanel

Clinical & Social Care

Patient / Carer

Commissioning / Finance

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr

Preliminary Acute Stroke StrategyPreliminary Rehab Stroke StrategyPreliminary Prevention Stroke Strategy

Stroke Strategy

Phase 1

Phase 2a Engagement Process

Pathway Investment Case

Acute Designation Document

Phase 2b Initial Designation

Phase 2c Consultation

Phase 3

Preliminary Evaluation

Pre-consultation Business Case

from 2nd Quarter

Project Plan – Phases 1 and 2

Prep Consultation Docs Consultation Options

Proposals from Trusts

Specification of model

Investment case

Produced

Designation Process

New Service

Kevin HunterHealthcare for London Stroke Project

Project Manager

The Stroke Strategy

Strategy for Community will follow a

similar structure:

•As-Is Assessment

• Early support

• Long-term care

• To-Be Design

• Resolutions to current challenges

• Performance Standards

• Impact Assessment of Gaps

• Action Plan to Address Gaps

• Process for Making the Changes

http://www.healthcareforlondon.nhs.uk/ (this can be found under “Reports” on right side of the homepage)

We’ve just issued our Preliminary Acute Stroke Strategy…

And now we are engaging with a range of stakeholders to gain feedback prior to the Acute designation process

http://www.healthcareforlondon.nhs.uk/

Key Difference for Community Rehabilitation

Because we are commissioning a new service model for ACUTE we need…

• A service specification (entry criteria) for service providers

• Performance standards to monitor improvements once a service provider is designated and the new service is established

• A detailed need and affordability assessment

For COMMUNITY 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

A Generic Pathway for Rehab and Community Care

Referral Assessment Plan InterventionDischarge &

Follow upRe-

assessment

Referralreceived

and prioritised

by service

Assessmentof patientand carer

needs

Plan ofintervention

agreed

Interventionundertaken

Re-assessneeds,

review andadjust

plan of intervention

Decisionon ongoinginterventionand follow

up

The Scope of Stroke Rehabilitation and Community Care

Community therapy

Social care

Voluntary services

In-patient specialist Stroke rehabilitation

Health care - GPand community nursing

09.30 – 09.50h Introduction

09.50 – 11.05h As-is Challenges – Early Support

11.05 – 11.20h Coffee Break

11.20 – 12.20h As-is Challenges – Long-term Care

• Speaker: Chris Clark, Stroke Association

• Speaker: Carole Pound, Connect

12.20 – 13.05h Lunch

13.05 – 14.00h To-be Resolutions of Challenges

14.00 – 14.30h To-be Performance Standards

14.30 – 14.45h Tea Break

14.45 – 16.00h To-be Performance Standards cont.

16.00 – 16.55h Data Sets

16.55 – 17.00h Close Reception to follow at the Inn the Park, St James Park

Agenda

Gill CluckieStroke Nurse Specialist, Guys & St

Thomas’ NHS Foundation Trust

&

Heather CampbellNeuro Rehabiliation Team Manager

Southwark PCT

As-Is Challenges – Early Support

• Issues and challenges impacting current service provision were collated from:- Site visits- Previous stroke event- Expert working group

• Aim of this session is to complete sign off of the list of current challenges impacting stroke services across London

Patient pathways into Community Therapy

Stroke unit

No therapy

End of life care

Inpatientspecialist

rehab

Voluntary services

GP and community nursing

Community therapy

Early supported discharge

Community stroke team

Intermediate care

Generic team

Neuro team

Social care

Vocationalrehab psychology

Hyper-acutestroke unit

(HASU)

therapy long term Outside project scope Service gaps

Challenge Summary Poor practice Good practice

Workforce and skills

Need for appropriately skilled staff to provide required intensity and duration of treatment, care or support

Lack of clinical psychology input in stroke rehabilitation

Availability of rehabilitation support workers in patients’ home 7 days per week where necessary

Information and technology

Appropriate information is not available at key points in the patients’ pathway

Lack of integration of IT systems between providers

Patient management IT tool in use for information and audit

Major challenges - Workforce & Information/Technology

Major challenges – Transfer of Care and Linkages


Transfer of care Need for seamless transfer of care between providers along the patients’ pathway

Inconsistencies with access to seamless liaison between in-reaching and out-reaching teams from the acute to the community setting

Availability of specialist medical outreach for community follow up of stroke patients

Linkages Cross- organisational working to encompass the complexities between providers e.g. networks

Inequality of access to social services provision dependant upon boroughs

Community rehabilitation teams which are fully integrated with social services

Major challenges – Finance and Infrastructure


Financial structures, costs and income

Costs of provision of rehabilitation in the community setting are more complex to track than other areas

No clear system of recording intensity, duration and outcomes of community based rehabilitation

The use of the RIO system within a stroke rehabilitation pathway to identify details of likely costs

Infrastructure Appropriate equipment and system organisation to deliver care and treatment

Delays in the delivery of essential equipment for patient independence and safety at home

The use of OT technicians to assess and fit appropriate pieces of equipment

Major challenges – Personal and Social


Personal and social

Personal, social and family challenges

Difficulty in equipment supply via private landlords

Regular access to a benefits advisor to help with access to appropriate benefits and financial support

Workshop 1: Early Support & Challenges

1.Critique the high level pathway presented:

• Does it represent the services patients receive across London?

• Is there anything missing which should be included?

On your table, you will find a grid documenting the current challenges that were provided from the previous stroke event.

2. In your table groups, we would like you to critique the challenges:

• Do the categories reflect the key areas of challenge?

• Do these reflect current issues across London?

Time for workshop – 60 min







12.20 – 13.05h Lunch



14.30 – 14.45h Tea Break


16.00 – 16.55h Data Sets


Agenda

COFFEE BREAK

11:05 – 11:20am







12.20 – 13.05h Lunch



15:30 – 15:45h Tea Break

15.45 – 16.45h Data Sets

16.45 – 17.00h Q&A Session

17:00h Close Reception to follow at the Inn the Park, St James Park

Agenda

Chris StreatherHealthcare for London Stroke Project

Clinical Director

Medical Director, St Georges Healthcare NHS Trust

Patient pathways into Community Therapy

Stroke unit

No therapy

End of life care

Inpatientspecialist

rehab

Voluntary services

GP and community nursing

Community therapy

Early supported discharge

Community stroke team

Intermediate care

Generic team

Neuro team

Social care

Vocationalrehab psychology


(HASU)

therapy long term Outside project scope Service gaps

Long-term Care

Why a Focus on Long-term Care is Required

• “Much more physiotherapy – we had to pay for more physiotherapy”

• “Counselling would have made a difference”

• “A local group for family/carers to give them support”

• “More therapy for the sufferer on an ongoing basis – six weeks is not enough for victims with dysphasia/memory/movement difficulties!”

• “More speech care”

Q: In relation to your long-term care what financial, social, medical care or help would you have liked?

• “ Now my husband has finished rehab again we feel again complete abandon – there is no follow-up – it’s like saying ‘you’ve had your twelve weeks – that’s your lot, get on with it!’”

• “I had to chase for any help!”

• “I left hospital and went home and basically nothing was done for me!”

• “His rehab did not start for 3.5 months later”

Q: What one thing made your experience of having a stroke worse for you?

Results from stroke survivors and carers consultation

Chris ClarkStroke Association

Stroke helpline Website0845 3033 100 www.stroke.org.ukStroke helpline Website0845 3033 100 www.stroke.org.ukStroke helpline Website0845 3033 100 www.stroke.org.uk

Stroke helpline Website0845 3033 100 www.stroke.org.ukStroke helpline Website0845 3033 100 www.stroke.org.uk

SERVICES

• Unique in spread and inclusion of all ages and conditions

• Crossing health and social care

• Complementary, adding value to statutory services


Philosophy

• Client led

• Promoting empowerment and control

• Enabling, not disabling


Philosophy

• Service design must reflect complex and interacting problems and needs …..

• From service centred to client centred


Establishing Need

• Listening to users and including in service design, but

• A “reductionist” and patchy research base - gaps in mental and emotional well-being, social and carer needs


Our Services

• Organised Regionally and in Countries

• 250 contracts with PCTs and SSs

• Cost supplemented by grants programme and “extras”, primarily social reintegration


Staff and Volunteers

• Staff: mostly former health professionals, nurses and AHPs

• Volunteers: high proportion of people affected by stroke

• High premium on training and support


Our Clients

• 16,000 referrals p.a. ….and rising

• 87% from health professionals

• 95% of referrals are accepted

• 16,000 caseload ……and rising


Access• 31% of referrals received within a week

of the stroke

and

• 40% more within 4 weeks of stroke

• 82% “active” within one week of referral


Who?

• 4% aged <45• 22% aged 45 - 64

• 25% live alone

• 33% from black and ethnic minorities in London


Completion

27% Completed - with improvement

24% No longer requires the service

14% Died


Access to our services(estimated:)

1:20 London

• 10:20 North-West

• 12:20 Wales


Our Services

• Continued modernisation…….

• Centred around the client …….


Family & Carer SupportInformation, advocacy, representation, liaison, signposting

Assessment & Goal SettingCommunication

Support

Working Age

&

Return to work

Community Integration

Activities e.g. arts

Family & Carer Support

Health Promotion

BME

Training

Aids & Appliances

EmotionalSupport

&Counselling

Goal Review & Reassessment

Long Term support“Goodbye” Stroke

Club

S I S

SelfReferral


Quality

• Charter Mark – achieved

• IIP – in progress

• Service Standards – achieved and improving


Research Overview

• RCTs on newly formed services in the 1990s failed to demonstrate measurable health gains

• But they did show patient satisfaction, information needs met and that “someone had really listened”


Impact Survey 2008 - satisfaction

• Information

• 76% - all needs met

• 18% - needs partly met

• Expectations

• 27% -met

• 49% - exceeded


Impact Survey 2008 - outcomes

• Communication Support

• 92% report that we have fully or partly helped them face the world



• Signposting – Family & Carer Support

• 85% recorded having received information about other support organisations



“I was able to recover my confidence, make friends and thanks to the art class recover the use of my hands…………... I have a normal life back”

Stroke helpline Website0845 3033 100 www.stroke.org.uk

Carole PoundConnect

www.ukconnect.org

Carole Pound

Jane Stokes Harry Clarke

Responding to Healthcare for

London consultation themes

www.ukconnect.org

About Connect• Our vision

– to enable people living with aphasia and communication disability across the UK to find opportunity and fulfilment

• Our mission – To improve the lives of people living with aphasia and

communication disability through…• Innovation projects – piloting new ideas and service

improvements• Training, consultancy, publications• Collaboration and authentic involvement of people living with

aphasia at every level

www.ukconnect.org

Consultation themes

• ‘Not knowing’

• Communication skills and communication access

• Time and timing

• Value of peer support and peer led services

• Long term support beyond health

www.ukconnect.org

Practical solutions from Connect - communication

• Training in communication skills and communication access for all

• ‘consultant to tea lady’; Social care staff ; employers ; Relatives and friends

• Paperwork!!

www.ukconnect.org

Practical solutions from Connect - information

• Information, advice and support developed by people living with stroke and aphasia for people living with stroke and aphasia

– Information resources e.g. Stroke and Aphasia Handbook; Having a stroke being a parent; Caring and Coping

– Information events e.g. Connect for a day GP events; community roadshow events

– Information people e.g. trained and supervised volunteers, befrienders and peer supporters; expert storytellers

www.ukconnect.org

www.ukconnect.org

Practical solutions from Connect – peer led support

• Counselling and emotional support• Relatives groups, information sessions and

befriending• Conversation and self help groups• Leading and modelling self management e.g.

work, volunteering, photography, Women’s Group• Community awareness raising• Social networking activities• Hospital and home befriending

www.ukconnect.org

Stories from Connect

• Jane – co-facilitator of conversation groups; befriender

• Harry – trained counsellor; staff member; facilitator Men’s Group

www.ukconnect.org

Hospital and Home Befriending

• Provide emotional and practical support in hospital or at home

• Share experience, know how and knowledge• Befrienders with a variety of experiences, time

since onset of stroke, communication abilities• Trained and supported – CRB check,interview,

training, feedback sheets, support groups

www.ukconnect.org

Hospital and Home Befriending

• Evaluation by people with stroke and aphasia– ‘hope …there is a future’– Encouragement to do new things – ‘I told him how I’d

got my driving licence – he’s got his now’ – ‘Mood lifts , not so depressed, not so stuck’– ‘Her confidence was very low ..I picked it up’– ‘Someone different to the family …befriender fills a

space’– ‘Man to man or woman to woman chat – chatting to

someone outside the family’– ‘Nurses and care home staff learn can learn from

what befriender is doing , like communication skills’

www.ukconnect.org

More about Connect

• Visit our website – www.ukconnect.org

• Subscribe to our e-newsletter – [email protected]

• Contact us about training, publications and consultancy –– [email protected]

mailto:[email protected]

Workshop 2: Long-term Care Challenges

1. Taking the 7 categories as in workshop 1 : discuss their appropriateness for long-term care

2. Identify the current challenges relating to long-term care

Time for workshop: 25 min







12.20 – 13.05h Lunch



14.30 – 14.45h Tea Break


16.00 – 16.55h Data Sets


Agenda

Lunch 12:20 – 13:05







12.20 – 13.05h Lunch



14.30 – 14.45h Tea Break


16.00 – 16.55h Data Sets


Agenda

Example of Suggested Resolutions to Welfare Challenges

Summary Issues

Specific examples of

good practice

Specific examples

of bad practice

Resolution

Linking health and social care

Difficult or no access to benefits and vocational training

Differences in rehabilitation provision dependent on age

Units operating on age criteria (health inequality)

Provide capacity and resources to meet need and negotiated health outcomes

Lack of skilled and knowledgeable staff to deal with stroke-related issues for younger people

Staff/patients/carers to liaise with Different Strokes to understand the experience of the young stroke sufferer

Workshop 3: To-Be Resolutions to As-Is Challenges

• Following on from the identified challenges, we need to identify likely resolutions to these• Some were suggested at the last stroke event and some from the expert working panel

Workshop:

On your table, you will find a large poster version of the challenges and potential resolutions

1. Critique the suggested resolutions

2. Are there any additional resolutions to the challenges?

Time for workshop: 50 minutes







12.20 – 13.05h Lunch



14.30 – 14.45h Tea Break


16.00 – 16.55h Data Sets


Agenda

Cathy IngramHead of Adult Therapies, Lambeth PCT

&

Diane PlayfordConsultant Neurologist,

University College London Hospitals NHS Trust

The Generic Pathway for Rehab and Community Care

Referral Assessment Plan InterventionDischarge &

Follow upRe-

assessment

Referralreceived

and prioritised

by service

Assessmentof patientand carer

needs

Plan ofintervention

agreed

Interventionundertaken

Re-assessneeds,

review andadjust

plan of intervention

Decisionon ongoinginterventionand follow

up

Outcomes across settings

CARE

PATHWAY

SETTING

In-patient specialist stroke rehab

Community therapy -generic or specialist

ESD teams

Healthcare by GP and community

nursing

Social CareVoluntary services

Referral

Assessment

Plan

Intervention

Discharge & follow-up

Re-assessment

APPROPRIATE SHARING OF RELEVANT INFORMATION FROM JOINT ASSESSMENT PROCESS OCCURS ACROSS THE PATHWAY SERVICE PROVIDERS

CONTINUITY OF CARE AND LONG TERM NEEDS OF PATIENTS AND CARERS ARE SUPPORTED ORGANISATIONS WORK PROACTIVELY TO

MAKE APPROPRIATE REFERRALS AND SIGNPOST EFFECTIVELY

ALL PATIENTS’ AND CARERS’ NEEDS ARE ASSESSED IN A TIMELY MANNER

THERAPY / CARE PROVISION IS NEEDS LED AND RESPONSIVE

CONSISTENT, APPROPRIATE AND TIMELY ACCESS TO HIGH QUALITY THERAPY / SUPPORT / CARE AVAILABLE TO ALL

PLANS TAKE ACCOUNT OF PATIENT AND CARER NEEDS AND WISHES, ARE COMMUNICATED IN AN APPROPRIATE FORMAT IN A TIMELY MANNER AND TAKE ACCOUNT OF OTHER SERVICES

BEING PROVIDED

Outcomes/Outputs - Community Therapy

Referral Assessment Plan InterventionRe-

assessmentDischarge

& follow-up

Early dischargesupported

Therapy needsand disablement/

impairments assessed within 24 hours

of discharge

Therapy plans take account of long term

need and are tailored to individuals’ goals

Therapy to start within 7 days of

assessment and meet minimum requirements

Review at 6 monthsof needs with

reassessment where required and then annually

Follow-up contact made post discharge.

Signposting/referral if appropriateO

utpu

tsC

are

path

way

Out

com

es

Appropriate sharingof relevant

information from joint assessment process

occurs across pathway

Service providers work in partnership

to seek/make appropriate referrals

Patients andcarers are

appropriatelysupported during

care transitionperiod

All patients andcarer needs

assessed in a timely manner

Place patient andcarer needs and

wishes at centre of therapy plans. Plansare communicated

Plans are communicated in an appropriate

media/format and are timely, taking

into accountother services being

provided

Consistent, appropriate and

timely accessto high quality

therapy/support/care available to all

Therapy/care provision is needsled and responsive

Continuity of careand long term needsof patients and carers

are supported

Appropriatenessof care provision

reviewed, referralsmade as necessary

Organisations workproactively to makeappropriate referrals

and signposteffectively

Outcomes/Outputs - Inpatient Specialist Stroke Rehab

- GP informed of admission

- Care Coordinator allocated

- Appropriate bed found

- Medical, non-medical and carer support

assessments completed and communicated


wishes at centre of therapy plans. Plansare communicated

- Client centredintegrated care plan

completed- Signposting to

services

- Residual medical andnon-medical support

needs assessed

- Patients and carers areprepared for discharge

and supported during theprocess

- Discharge planning starts from admission- Medical and support

needs assessment

- Individuals have tailored care plan covering at least

6 months

- Patients and carers are aware of diagnosis

and prognosis; appropriate care

is planned

- Rehab starts from day 1

- Reassessment occursevery two weeks

& immediatelyprior to discharge

- Follow on care planned

- Care coordinatorvisits on day 2 after

discharge


assessmentDischarge

& follow-up

Out

com

esO

utpu

tsC

are

path

way

Outcomes/Outputs - Voluntary Services


assessmentDischarge

& follow-up

Organisations work proactively withclinical and non-clinical service

providers to seek appropriate referrals

Patient and carer needs assessed.

Signposting to other organisations

if necessary

Support provision is patient/carer driven

Peer/group/familysupport & volunteering

opportunities madeavailable as appropriate

Appropriateness ofongoing support

reviewed annually

Annual review.Re-referral if appropriate

Out

puts

Car

e pa

thw

ayO

utco

mes












wishes at centre of plans.




provided




Service provision is needsled and responsive


are supported

Appropriatenessof service provisionreviewed, referrals

made as necessary



Outcomes/Outputs - Healthcare by GP & Com. Nursing


assessmentDischarge

& follow-up

GP visit within 3 days of discharge

Community nursing visiton day of discharge.Care plan reviewed and communicated

Patient and carerare appropriately

supportedupon return home

Clinical nursing careprovided as needed

from time ofdischarge

Quarterly review ofpatient and

carer needs with referral where required

Quarterly review of patient/carer needswith referral where

requiredOut

puts

Car

e pa

thw

ayO

utco

mes
















provided




Service provision is needsled and responsive


are supported

Appropriatenessof service provisionreviewed, referrals

made as necessary



Outcomes/Outputs - Social Care


assessmentDischarge

& follow-up

Home adaptationscomplete before

discharge. Patient &carer are

appropriately supported

to return home

Re-ablement visiton day of discharge.Care plan reviewedand communicated

Care plans to be delivered as

required (24/7)

Social care supportstarts within 1 week

of discharge. Signposting to otherservices and advice

Appropriateness ofongoing care

reviewed annually

Follow-up contact madepost discharge.

Signposting / referralif appropriateO

utpu

tsC

are

path

way

Out

com

es
















provided



support/care available to all

Serviceprovision is needsled and responsive


are supported

Appropriatenessof care provision

reviewed, referralsmade as necessary



Performance Standards - Community Therapy

Measure/ Origin of data Reporting

Indicator BSRM Other Full Interim Frequency

1 I * 100% 80% Regular

2 I * 90% 80% Regular

Target

% of patients assessed within 24 hrs of discharge

% appropriate patients withTreatment started within7 days of assessment

Performance Standards - In-patient Rehabilitation

Measure/ Origin of data Reporting

Indicator BSRM Other Full Interim Frequency

1 I % of patients appropriately

seated within 5 working days of admission

* 100% 80% Regular

2 I% of patients with predicted

discharge date within2 weeks of admission

* 90% 80% Regular

Target

Workshop 4: Performance Standards Each table has been given one care setting to review

1) Review the outcomes for the care setting you have been allocated- Do they reflect what that setting is aiming to achieve?

2) Review the outputs for the care setting- Do they reflect what the care setting is aiming to deliver?

3a) Review performance standards for In-Patient Rehab and Community Rehab

OR

3b) Develop performance standards if your care setting is Voluntary, Social Care or Healthcare


Workshop 4: Table Allocations

Table no. Workshop 4

1 Community therapy

2 Community therapy

3 Community therapy

4 Voluntary services



7 Healthcare by GP and community nursing

8 Social care

9 Inpatient specialist stroke rehab



12 Social care

13 Social care









12.20 – 13.05h Lunch



14.30 – 14.45h Tea Break


16.00 – 16.55h Data Sets


Agenda

Tea 14:30 – 14:45







12.20 – 13.05h Lunch



14.30 – 14.45h Tea Break


16.00 – 16.55h Data Sets


Agenda

Workshop 4: Performance Standards Each table has been given one care setting to review

1) Review the outcomes for the care setting you have been allocated- Do they reflect what that setting is aiming to achieve?

2) Review the outputs for the care setting- Do they reflect what the care setting is aiming to deliver?

3a) Review performance standards for In-Patient Rehab and Community Rehab

OR

3b) Develop performance standards if your care setting is Voluntary, Social Care or Healthcare








12.20 – 13.05h Lunch



14.30 – 14.45h Tea Break


16.00 – 16.55h Data Sets


Agenda

Timothy D’EstrubeHealthcare for London Stroke Project

Project Data Analyst

Stroke Project Data Products – Acute

• For the Preliminary Acute Stroke Strategy Healthcare for London developed the Acute Care Model and Volumes, with assistance from London School of Economics and Political Science.

• The model provides a reasonable depiction of the new acute care pathway in the terms of estimated volumes of patients and required bed days.

Stroke Project Data Products - Rehab & Comm. Care

• For the Rehab& Stroke Strategy we need to understand what happens to patients following their acute care.

• Unfortunately the variables that predict a Stroke event do not easily predict the level of disability an individual may be left with at discharge from Acute Care.

Propose Data Products: Rehab and Community Care

Stroke unit

7,237 people

No Therapy (1,578 people)

End of life care


(HASU)

11,503 people

Mild Disability (2,745 – 2,840 people)

Moderate Disability (1,562 – 1,657 people)

Severe Disability (331 – 379 people)

Year One Year Two Year Three

6,3

11

Pe

op

le

25%

43.5% - 45%

24.75% - 26.25

5.25% - 6%

• For Phase Two we are proposing to use a model that assigns patients a disability category based on discharge statistics from selected acute care providers.

• This will provide insight into patient disability and the yearly survivorship rates.

This model is populated with preliminary data only.

We will be collecting discharge statistics from selected providers and publish the results as part of the final Stroke Strategy.

Simon MilliganHealthcare for London Stroke Project

Finance Lead

Context – Where Do Stroke Costs Lie?

Prevention

SecondaryCare

PrimaryCare

SocialServices

Wider Economy

LAS

Where the health service costs of Stroke exist:

Category Secondary Care

Primary Care Ambulance

Admitted Patient Care (APC)

Outpatients Critical Care Any Rehab specifically excluded from APC

Rehab in Intermediate Care beds

Transport A/E Early supported discharge team

Community Rehab team

GP

= estimated relative size

Stroke Costs in Acute Hospitals

HRG and description £m (inc MFF)

£m (exc MFF)

Stroke events A19 - Haemorrhagic Cerebrovascular Disorders 11.0 8.8 A20 - Transient Ischaemic Attack >69 or w cc 2.3 1.8 A21 - Transient Ischaemic Attack <70 w/o cc 0.6 0.4 A22 - Non-Transient Stroke or Cerebrovascular Accident >69 or w cc 26.0 20.9 A23 - Non-Transient Stroke or Cerebrovascular Accident <70 w/o cc 6.3 4.9 A99 - Complex Elderly with a Nervous System Primary Diagnosis (*) 16.3 13.0 Sub-total 62.5 49.8 Procedure related events A01 - Intracranial Procedures Except Trauma - Category 1 (**) 0.1 0.1 A02 - Intracranial Procedures Except Trauma - Category 2 (**) 1.2 0.9 A03 - Intracranial Procedures Except Trauma - Category 3 (**) 1.5 1.1 A04 - Intracranial Procedures Except Trauma - Category 4 (**) 2.0 1.5 Q05 - Extracranial or Upper Limb Arterial Surgery(**) 2.0 1.5 Sub-total 6.8 5.1 Total 69.3 54.9

Possible changes to costs

Area Cost type affected

Likely Increase / decrease

Provision of 24/7 imaging Pay, capital charge / lease

Provision of 24/7 thrombolysis Pay, Drugs High dependency care Pay Ward stay Pay, hotel

costs

Ambulance Pay, capital charge / lease

Early supported discharge teams

Pay

Rehab Pay ?

Examples of Rehab models from 2 PCTs

Model 1

Model 2

Secondary care Primary Care

A/EAcute

episodeRehab

episode

Acute Hospital

Community Rehab

Intermediate Care

Home

A/EAcute

episodeRehab

episode

Acute HospitalCommunity Rehab

Intermediate Care

Home

Early Supported Discharge

=> Wide variation of provision and hence cost

Establishing the costs

• How far do we need to go into setting out the current costs?– Needed for context– Needed for Investment Case for Acute

Service• How much are costs likely to change?• For the acute side - service specification• For the rehab side - performance standards

Workshop 5: Service Costing

1. How do we establish current rehab costs?a) Extrapolate from selected PCTsb) Conduct a survey using a proforma –

comments on the proforma2. Have any PCTs done any detailed work costing

Stoke rehab?3. What are the possible consequences of the

Investment Case on:a) Rehabilitation and Community Care costsb) Social Service costsc) Voluntary Sector costs


Proforma for each PCT

1) establish how each LHE operates

what services are providedhow does primary care work with acute hospitallist down the "assets" used for inpatient Stroke rehab - owned/leased/spot purchased

2) establish what each PCT is paying for in primary care 3) establish activity / capacity

Stroke£k

Non-Stroke

£knumber of beds

number of bed

days

number of

patients

number of

people looked

afternumber of visits

own provider -arm community beds x x Can this be broken down intonon-own provider arm community beds x x staff by grade?ESD team x x non-payCommunity Rehab team x x overheadsOther x x

note:GP costs?

4) Brief summary of future plans

Questions?

?

Close

Please join us for drinks and at:Inn the Park, St James Park

Healthcare for London – Stroke Project Rehabilitation and Community Care Event 8 th August 2008.

Documents

Transcript of Healthcare for London – Stroke Project Rehabilitation and Community Care Event 8 th August 2008.