AGENDA ITEM

REPORT TO HEALTH AND
WELLBEING COMMISSIONING GROUP
24 JANUARY 2018

REPORT OFTHE INTEGRATED STRATEGY AND SERVICE DEVELOPMENT MANAGER

REVIEW OF FUNDING FOR THE STROKE ASSOCIATION

  1. SUMMARY

The Stroke Association receives £38,000 per annum from Stockton-on-Tees Borough Council (SBC) to provide the Stroke Recovery Service Stockton (hereinafter referred to as ‘the Service’). The existing contract is due to end on 31stMarch 2018 and a review of the Service has been undertaken in order for the Commissioning Group to consider whether to continue to fund this Service.

  1. RECOMMENDATIONS

The Commissioning Group is recommended to:

  • Note the work being undertaken by the Stroke Association’sStroke Recovery Service Stockton;and
  • Approve an extension of the contract until the end of May 2018 in order to allow the Service to be reviewed alongsideother elements of the Better Care Fund’s workstream on Prevention which are being reviewed at that time.
  1. BACKGROUND

The Stroke Association currently receives £38,000 per annum from the carers’ strand of the Better Care Fund to provide the Stroke Recovery Service Stockton. The aim of the Service is to provide information, emotional support and practical advice to stroke survivors, their families and carers.

The current three year contract commenced on 1 April 2014 with an option to extend for one twelve-month period. The total value of the contract (including the twelve-month extension) is £152,000. Having extended the contract for twelve months, the contract is due to expire on 31 March 2018.

Prior to 2014, the Stroke Association had received funding from SBC to provide the Service and when this funding arrangement came to an end it was agreed not to go out to tender because a full service review in January/February 2014 identified that a high quality service was being delivered which contributes greatly to improving the quality of life and ability of stroke survivors to live independently and reduces the need for them to access health and social care services. There was no other organisation in the area with the same expertise and access to resources to benefit clients.

The Service is delivered by the Stroke Association Support Co-ordinator (hereinafter referred to as ‘the Co-ordinator’) who co-ordinates support across a range of services following the stroke survivor’s discharge from hospital. The Co-ordinator works alongside a multi-disciplinary team of professionals across health and social care to provide information and advocacy support for stroke survivors and their families.

The Co-ordinator is employed 30 hours per week (4 days per week) and, until recently, has been solely responsible for delivering the Service in Stockton-on-Tees. The £38,000 per annum provided by Stockton-on-Tees Borough Council pays the Co-ordinator’s salary and travel expenses, as well as part-time administrative support, 10% of management costs, IT and mobile phone costs, and stationary. There are no rent costs for office facilities.

4. REFERRAL PROCESS

Access to the Service is primarily through the Stroke Unit at the University Hospital of North Tees. Discharge letters for all stroke survivors are sent by the Stroke Unit to the Community Stroke Team (CST). A member of the CST undertakes an initial home visit to assess the stroke survivor, identifies which stroke survivors would benefit from engaging with the Service and makes referrals as appropriate. Due to limited capacity, not all stroke survivors can be referred to the Service. It is up to stroke survivor whether they take up this offer of support from the Service.

The Service also receives referrals from other sources, including GPs, community health professionals and social services, and self-referrals are also accepted.

In 2016/17, 174 new referrals were accepted into the Service. This is similar to previous years.

However, in the first two quarters in 2017/18, there have been a total of 105 new referrals accepted. This increase in the number of new referrals is a result of funding obtained from the Martin Lewis Foundation which is paying for an increase in the Service from four days to five days per week. This is discussed further below.

All of the referrals accepted by the Service are for stroke survivors who live in the Borough of Stockton-on-Tees and who are registered with a GP in Stockton. Stroke survivors living in other local authority areas are referred to the Stroke Association Service for the relevant area.

Although the majority of stroke survivors accessing the Service are over 65 years of age, the Service has seen an increase of young stroke survivors referred into the service who receive support with a more diverse range of topics, including employment, training, support relating to relationships and children.

  1. LOCATION OF THE SERVICE

The Service Co-ordinatorworks exclusively in the Stockton-on-Tees area and is located in Everley House at the University Hospital of North Tees, alongside the CST. This means he has established close and effective working relationships with the physiotherapists, OTs, dieticians etc. working in the CST,which has positive results for service users. The Co-ordinator is seen as an integral part of the CST and, because the Co-ordinator is located in the same office as the CST, he is able to discuss clients with CST members and has input into case discussions at the weekly CST meetings. He is also able to make referrals to members of the CST.

When a referral is received, the Co-ordinator conducts a home visit to assess the individual’s needs.

The Co-ordinator provides an important link between stroke survivors and those involved in their care, and promotes joint working between professionals. For example, the Co-ordinator attends the Stroke Work Group meetings at the University Hospital of North Tees which includes Stroke Consultants, Ward Matrons, Stroke Specialist Nurses from CST and Psychiatrists. The Co-ordinator has established effective working relationships with other relevant teams and professionals, e.g. Falls Team, Psychology, the Department of Work and Pensions,the Stockton and District Advice and Information Service (SDAIS), and hospital consultants.

The Co-ordinator maintains close links with the national Stroke Association to ensure good practice and development of skills. This includes regular peer support meetings and twice yearly regional meetings.

  1. AIMS OF THE SERVICE

The aims of the Service are as follows:

  • Timely and appropriate information and advice in relation to stroke;
  • Carer support;
  • Secondary prevention advice;
  • Practical and emotional support for stroke survivors;
  • Support with discharge planning and/or transfer of care;
  • Case management and appropriate interventions;
  • Joint working with Specialist Stroke Teams;
  • Liaison and joint working with other key agencies to meet family needs;
  • Signposting to ongoing support upon discharge from the Service; and
  • Access to other Stroke Association rehabilitation and support services.
  1. SERVICES PROVIDED

Although the primary focus is the stroke survivor, the Servicealso supportsthe carers of people who have had a stroke.

Once a referral is received, the Co-ordinator aims to contact all new clients within three working days of receiving the referral. He initially visits the stroke survivor at home to carry out an assessment of need. This usually lasts approximately one hour but can take longer (e.g. if there are speech problems). At this visit, the service and type of support is explained and realistic goals and aspirations for each patient are identified. Maintaining close links with the CST means that the Co-ordinator is able to reinforce any advice that the CST has given the service user and use information from the CST to contribute to client goal-setting.

The Co-ordinator initially aims to visit at home once every 4 weeks and later speak by phone once every six weeks. Reviews are conducted every six months and support can be provided for up to twelve months after discharge from hospital. After that time, the stroke survivor can self-refer back into the Service.

The Service offers practical advice on lifestyle changes, emotional and practical support to both stroke survivor and their family, and signposting to other agencies (including Social Services and Carers’ Support Groups). The Service helps clients and their families to deal with and understand the benefits system and provides assistance in obtaining and completing the various forms.

The Co-ordinator has established strong working relationships with the staff of the Stroke Unit at the University Hospital of North Tees and undertakes regular ward visits.

The Service has established a drop-in group for stroke survivors which is led by the Co-ordinator and meets every Wednesday afternoon at the Independent Living Centre. Although carers can attend, they are not encouraged to do so because the focus of the group is to develop the stroke survivor’s independence. The group therefore provides a respite opportunity but carers have the opportunity to talk to the Co-ordinator informally and to seek advice while the stroke survivor attends the group. The group includes a variety of chair based exercises, a social element and a group activity (e.g. quiz, crossword). The group is usually attended by about 15 stroke survivors each week, with a maximum capacity of 20. If there are more than 20 attending regularly, those who have been going for a while are encouraged to go to Happy Talk, which is a social group run by volunteers on a Wednesday afternoon. It is self-funding and its governance is supported by the Stroke Association.

  1. ADDITIONAL FUNDING AND ACTIVITIES

The Stroke Association has actively sought opportunities to build upon the existing Service.

Welfare Plus is a project in partnership with the SDAIS. The Stroke Association in Stockton and the SDAIS have explored ways of working more closely together and have secured funding for 12 months from the Martin Lewis Foundation to pay for a dedicated case support worker to support the Service. As part of the initial assessment, the Co-ordinator identifies stroke survivors or their carers who need support from the SDAIS support worker, who can carry out a whole benefits review for the household. From April to December 2017 applications have been made for £104,000 additional money for clients of which £60,825 has already been received. The project will run until the end of March 2018 before being evaluated. This is currently the only such project in the UK and it is hoped it will provide a benchmark for services across the country.

The funding from the Martin Lewis Foundation is also supporting a Drop-in Group in the Stroke Unit of the University Hospital of North Tees. The Service was initially approached by the Ward Matron of the Stroke Unit to set up and run a Drop-in Group for both stroke survivors and carers to take place before and during hospital visiting times on alternate Friday afternoons. An additional support worker has been taken on to run the Group, thereby increasing the capacity of the Service from 4 days per week to 5 days, with a consequent increase in the number of new referrals that are being accepted. This project will also run until the end of March 2018.

The Service in Stockton iscontributing to a researchproject/pilot (‘OSCARSS’) about the needs of carersof stroke survivors which is being undertaken by the Stroke Association in collaboration withManchester University. A report is due at the end of March 2018.

  1. REVIEW OF THE SERVICE

A full service review was undertaken in January/February 2014 and it concluded that at that time a high quality service was being delivered which contributed greatly to improving the quality of life and ability of stroke survivors to live independently and reduced the need to access health and social care services.

Since then, and under the current contract, the Co-ordinator has continued to deliver the same Service, which has recently been enhanced by the additional funding obtained from the Martin Lewis Foundation.

Satisfactory reviews have been undertaken during the course of the current contract, the most recent being in July 2017.

The Service has submitted quarterly and annual monitoring data in accordance with the requirements of the Service Specification.

  1. OTHER LOCAL SERVICES WORKING WITH STROKE SURVIVORS

There is no other local service providing the same services or level of support for stroke survivors and their carers in the Borough. Other services working with stroke survivors include:

  • The CST is an NHS service which is an NHS service which helps and supports the rehabilitation of people who have had a stroke after they have been discharged from hospital. The Co-ordinator works closely with the CST.
  • MATRIX Neurological, based in Middlesbrough, provides practical therapy and support to children, young people and their families who are living with the effects of an acquired brain injury.
  • Volunteering Matters provides a befriending service and clients include people who have survived a stroke.
  • Positive Strokes is part of the Stroke Association. It is Tees Valley-wide but meets monthly in Middlesbrough. It is a well-established self-help, support and social group which offers social and communication support to people affected by stroke and provides support for carers.

5.SUMMARY

The funding from the carers’ strand of the Better Care Fund forms the basis of this specialised service in Stockton-on-Tees, paying for staffing and expenses to deliver the Service. The review in 2014 identified that the Service reduced demand on health and social care services. This needs further analysis.

It is recommended that the Commissioning Group approves an extension of the contract until the end of May 2018 in order to allow the Service to be reviewed in line with other secondary prevention activities which are funded out of the Better Care Fund and are being reviewed at that time. This would allow us time to undertake the work outlined above in order to inform decision-making about possible future funding.

Name of Contact Officer:Emma Champley

Post Title:Integrated Strategy and Service Development Manager

Telephone No:01642 528476

Email address:

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