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  • Next document in series – now looking at entire stroke care pathway Redress the balance and focus from acute to community care Increase focus on community and home care services after discharge and after acute care has ceased Multi-disciplinary team involving commissioners, third sector, therapists, GPs
  • Three guiding principles for the document. Active citizenship is about re-engaging with society. Not getting stuck in the community services and giving people the opportunity to continue to progress and realising what is possible for them. The improvement of quality of life should be the key marker by which services are judged. Empowerment also aligns with the personalisation agenda
  • London average prevalence is 1.0% People are living longer and more people are surviving strokes. This figure is therefore likely to continue to increase
  • Numerous other statistics that could be quoted in these fields. Given the diversity of need it is not possible to define a single life after stroke service. A life after stroke service will mean different things to different people. Services need to be responsive and flexible to meet the exacting needs on the individual. This, is person-centred care. Give example of south London stroke patient forum also at Coin street
  • Not only are the needs of stroke survivors diverse, but they also change and evolve over time Using the South London Stroke Register Kings College London looked at the needs of stroke survivors over a 10 year period
  • Return to themes of empowerment – people need to know what is available around them and how to access it.
  • Although mentioned, focus to encourage people to get involved with community life – less focus on the specifics of which therapy based services people need and how to design them. People need to be able to get out and about and so guide has case studies of how this can be achieved Social groups have positive benefits on mood/emotional status, functional status. Sharing experiences builds confidence
  • Peer-led initiatives need to be supported by commissioners in their areas Other stroke survivors are a resource that should be encouraged to get involved with local services, they should be supported to get involved with the local design and organisation of services – this includes carers
  • Actively involving carers in decisions help to reinforce messages and support best practice
  • Joint commissioning of services working across boundaries works


  • 1. Life After Stroke Commissioning Guide Mark Hindmarsh Senior Project Officer, Commissioning Support for London
  • 2. London stroke strategy – where this fits London stroke strategy (2008) Public consultation (2008/09) Rehab commissioning guide (2009) Life after stroke (2010)
  • 3. Principles
    • Active citizenship
    • Quality of life
    • Empowerment
  • 4. Scale of need
    • Prevalence ranges from 1.6% to 0.8% of registered GP population
    • 88,000 people across London on GP registers have had a stroke or TIA
    Sum of stroke and TIA patients in a GP register in 2008/9
  • 5. Diverse needs
    • 15% have on-going continence problems
    • 25% of nursing home residents have had a stroke
    • 33% of stroke survivors report depressive symptoms
    • 20% “silent stroke” – underlying cognitive problems
  • 6. Regular review
    • Needs change over time
    • Recognise variability of needs and aspirations
    • National guidance – 12 monthly review
    Stroke survivor Social care GP Therapist Stroke navigator Structured social group
  • 7. Information
    • Stroke care navigator
      • Single point of contact
      • Direct role in delivering care
      • Coordinate care packages
      • Training stroke survivors and carers
      • Work across different sectors
    • London stroke directory
    • www.londonstrokedirectory.org.uk
  • 8. Engaging with community life
    • Stroke survivors do not get out of the home as much as they would like
    • Building confidence
    • Addressing practical issues
    • Community/social groups have benefits beyond primary purpose
  • 9. Peer support & peer-led services Peer support Improve emotional wellbeing Build capacity Sense of purpose Range of functions Confidence Source of information Improve functional status
  • 10. Carers and families
    • Carers have a right to their own needs review
    • Training and education should be provided
    • Local authority and charitable sector support is available
  • 11. Conclusion
    • Operating services across the different sectors has track record of success
    • Develop and empower people
    • Published guide is available today
    • Will also be available to download
    • [email_address]