The Sentinel Stroke National Audit Programme (SSNAP) for the first time has launched an audit report on the organisation of care for stroke patients once they have left hospital. The audit covers England, Wales and Northern Ireland, and includes care in community hospitals, care homes and in patients’ own homes.
| There has never been a more important time than now to look systematically at what stroke care people receive when they leave hospital|
| Dr Geoffrey Cloud |
The stroke care pathway is a complex one and very little is known about the organisation and structure of services outside hospitals, and for the first time SSNAP is pushing to change this.
The report highlights information provided by commissioners in England and Northern Ireland and health boards in Wales about what services are being commissioned. It gives important information about the number and range of services and to what extent co-commissioning with other areas or with social services is happening. The second report, expected by the end of the year, will demonstrate in more detail what a patient might expect to receive in waiting times for treatment and intensity and duration of treatment. The report will cover resources needed to provide service including team numbers and expertise.
Participation in the SSNAP inaugural organisational audit of post-acute stroke care commissioning has been excellent, with 222 out of 223 commissioners and health boards providing data. This partnership and commitment between commissioners and providers towards auditing the organisation of stroke care provides a firm foundation for service improvement challenges ahead. The results reflect services commissioned on 1 December 2014. The results are available online at the SSNAP results portal.
Main findings and recommendations for commissioners include:
- There is widespread variation, both by region and country, in the types of post-acute stroke care currently being provided.
- There is a concern that care home residents may be being denied access to stroke rehabilitation services in some areas.
- All commissioners should draw up consistent service specification with their provider organisations and include participation in SSNAP clinical audit as a requirement – the report found that 186 (61%) of services identified were already participating on SSNAP for collection of clinical data.
- All commissioners should support a 6-month post-stroke assessment for all patients as recommended in the National Stroke Strategy and required by the CCG Outcome Indication Set (CCG OIS) – 120 (54%) of participating organisations are commissioning the 6-month post-stroke assessment.
- All commissioners should be commissioning stroke-specific Early Supported Discharge (ESD) – 180 (81%) of participating organisations are commissioning ESD Service, with 92% being stroke specific.
- All commissioners should consider joint health and social care collaboration to address major shortfalls in provision of emotional and psychological support after stroke and vocational rehabilitation.
- Commissioners should participate with providers in using SSNAP as part of a programme of managed quality service improvement.
Dr Geoffrey Cloud FRCP, associate director for stroke (CEEU), said:
| We have been delighted and encouraged by the overwhelming participation of CCGS, LCGs and health boards and hope the results will be a useful starting point for community stroke service improvement locally, regionally and nationally|
| Dr Geoffrey Cloud |
“Stroke mortality has almost halved in the last decade within the NHS and people are spending less time in hospital recovering from their stroke. There has never been a more important time than now to look systematically at what stroke care people receive when they leave hospital. This inaugural SSNAP community-based organisation audit is the first step towards this. We have been delighted and encouraged by the overwhelming participation of CCGS, LCGs and health boards and hope the results will be a useful starting point for community stroke service improvement locally, regionally and nationally.”
The audit programme is commissioned by the Healthcare Quality Improvement Partnership (HQIP), as part of the National Clinical Audit Programme (NCA). The audit is led by the Royal College of Physicians Clinical Effectiveness and Evaluation Unit on behalf of the Intercollegiate Stroke Working Party.