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Improving community neurorehabilitation services

Patient opening their front door to a therapist

Community rehabilitation used to be hugely variable in our region and provided via different models of care, with several areas offering no specialist services at all.

Led by our Community Clinical Director Tracy Walker, we are working to introduce an integrated model of community rehabilitation for stroke and neurorehabilitation patients, so that residents receive the same high level care regardless of where they live. Almost all boroughs in the region now offer this model, and we are helping the remaining few to implement integrated services.

The stroke model is within a service specification that mandates the professionals needed within the core team and provides guidance on staffing levels. It details three pathways of care and where possible (based on the evidence), outlines what care should be provided and by when. The model advocates early involvement of the voluntary sector to support life after stroke, and also details access to key NHS support services such as orthoptics.

A similar service specification has been developed for neurorehabilitation that can be delivered as part of a single neurological specialist service (either a separate or a single team). We also collect data in community to help understand the quality of care being provided in each area.

As a result of this work many areas have now increased investment in their specialist community services. For example, Stockport commissioned both service specifications and launched a community team that sees both stroke and neuro-rehabilitation patients, with support from the Stroke Association embedded. You can hear why this support is much needed from Beryl, a local patient who did not have access to community support after her stroke. You can also hear from Ken and Tammy about the support they received in Bolton following Ken’s stroke in June 2019. You can also view a webinar explaining our work.