The NHS Long Term Plan committed to make stroke rehabilitation more intensive, more integrated, and more out-of-hospital. There’s strong evidence that high-intensity, home-based rehabilitation is the most effective form of rehabilitation for stroke survivors, with trials and observational studies demonstrating that this increases survivors’ independence, reduces long term disability and reduces hospital admissions.
From 2021, NHS England and Improvement is piloting stroke rehabilitation interventions across three pilot sites, which all have different models of delivery focussing on the integration of high intensity models of stroke rehabilitation, incorporating increased availability of seven-day home-based therapy, virtual rehabilitation, structured follow up in the community, improved psychological support, and delivering vocational stroke rehabilitation.
The stroke rehabilitation pilot sites will also support the implementation of evidence based enhanced rehabilitation across the stroke pathway including Early Supported Discharge and community-based rehabilitation. The pilots will inform future national stroke service developments with the intention of improving functional outcomes and quality of life for patients who have experienced a stroke. The three selected pilot sites are identified below in further detail.
Northamptonshire (covering 750,000 people). Northamptonshire will begin to comprehensively integrate their rehabilitation offer with wider patient needs. Occupational therapists and other stroke-specific staff will collaborate with psychologists to help stroke survivors return to the workplace and improve psychological wellbeing.
In addition, clinical staff will focus on supporting activities of daily living for patients who need additional carer support to get home. This will provide a more intensive and extended rehabilitation experience, maximising patient independence and quality of life.
North Central London (NCL) (covering 1,500,000 people). NCL will deploy a roving group of rehabilitation assistants, whose aim will be to help patients get back home as soon as possible and ensure their living environment sets them up for successful rehabilitation. They will be flexible, supporting a holistic approach to delivery of therapy overseen by senior staff and providing advocacy and support for patient and family needs.
Northumbria (covering 500,000 people) will initially focus on revolutionising psychological support in the area. For the first time, this service will employ a senior clinical psychologist to ensure that stroke survivors’ psychological needs are given the same priority as their physical condition. This will be supplemented by a vastly enhanced peer support offer, which will be made available to families and carers as well as patients themselves. Northumbria will also extend and expand their Early Supported Discharge provision.
Evaluation of the pilots
The NHS stroke rehabilitation sites will be pilot services, but the evaluation will be a full and robust evaluation not a pilot study. Evaluation will be based on levels of Early Supported Discharge (ESD) and community based rehabilitation, and standardised clinical measures at each transition. Evaluation will also have a clear focus on system level changes, clinical outcomes and patient satisfaction. The evidence obtained will inform future national stroke service developments.