Cynthia Bower believes impovements made to stroke services must be made with the patient in mind
In January the Care Quality Commission published Supporting Life After Stroke, a major review of the support provided in England to people who have had a stroke and their carers. While most work in this area focused on hospital care, we chose to look at the care provided after people return home. This was to look across both health and social services and test how well different services were working together, but the key reason was because stroke survivors told us it was an important area where services needed to improve.
There has been progress in recent years in the way stroke is treated in the hours and days after the initial episode, but the quality of longer-term care varies significantly across England. The best services are built around the individual, with care planned to take account of the needs, circumstances and preferences of the person who has had a stroke, their carers and family.
People in some parts of the country are likely to experience a smooth return home from hospital and have access to a broad range of services to help them cope and recover, but services in other areas could be improved.
Early supported discharge was available across 37% of areas. In 48% of areas, average waits for community-based speech and language therapy exceed two weeks. Only 37% of areas provided rehabilitation services to people in their community, focusing on helping them return to work. In a third of areas, not all carers could access peer support, such as support groups or befriending schemes. Most people are given an information pack when they leave hospital but only 40% of these contained good information on local services. While 68% of areas provided a named contact to help people plan and organise their care after transfer home, in only half of areas did these contacts look across health, social and community services.
The level of variation is a concern, but it also shows that the barriers to effective care after transfer home can be overcome. To help local services identify where they need to improve we have published customised reports for each primary care trust area (cqc.org.uk/stroke). Our main recommendation is that providers and commissioners review these reports and agree a plan to improve services.
Nursing staff can do a lot to support these improvements, for example, by ensuring care processes work effectively. If plans for transfer home do not involve the right people (the patient, carers, family members, and community health and social care staff) this will not run smoothly and people are more likely to experience gaps in services or anxiety.
Similarly, nursing staff can help ensure reviews take place six weeks and six months after transfer home, either by leading these processes or contributing to them as part of a multidisciplinary team. These reviews should cover all individuals’ health, social and emotional needs and check they are getting the help they need. We heard cases of stroke survivors not being told about local support groups for some months; others said how valuable these were.
We also found there was limited awareness and understanding of stroke among some staff, such as those in care homes, while other staff may not have been given training to help them communicate with people with aphasia or other stroke-related communication problems.
Plans to improve stroke services must also take account of the changes set out in NHS reforms. Frontline staff will have a key role in ensuring the strengths of current arrangements are not lost in the upcoming reorganisation.