2 Increasing access to better post-hospital
and longer term support
12. Although stroke patients sometimes spent several
days or weeks in hospital, it was in the months and years after
discharge that they, their families and carers, experienced the
full impact of stroke.[25]
Access to long-term support services and rehabilitation for stroke
patients and carers remained a postcode lottery.[26]
The National Audit Office found that less than a third of patients
and carers surveyed considered that emotional support, including
counselling, respite care and training for carers to help them
support people in their homes, was very poor.[27]
The Department acknowledged that there was a lack of guidance
on what worked, for example, on the impact of psychological and
social support, due to a lack of evidence. The Department told
us it had not addressed this shortcoming due to limitations in
its resources but that it planned to turn its attention to this
issue over the next 12 months.[28]
13. The Department planned to use the findings of
the Collaboration for Leadership in Applied Health Research
and Care (CLAHRC) to develop its future work programme. CLAHRC
was a national programme established to undertake research on
patient needs and to support the translation of research evidence
into practice in the NHS.[29]
The Department considered that evidence should also be improved
through dissemination of the Stroke Improvement Programme's work
at pilot sites.[30]
14. The Department had set aside £100,000 for
each local authority every year for three years to pump-prime
investment in long-term support, starting in 2008.[31]
There was a risk that once the funding ends, even the current
level of provision would not be sustained. The Department had
no direct leverage over Local Authorities but in its experience
of previous programmes, local authorities continued to fund services
after ring-fenced funding had ended.[32]
The Stroke Improvement Programme was also going to set out a series
of measures which the Department planned to use, to monitor whether
investment in long-term services continued.[33]
15. Around 11% of stroke patients were admitted to
care or residential homes after their stroke and at least a quarter
of care home residents have had a stroke. There were no requirements,
however, for care home staff to be trained to meet the specific
needs of stroke patients, and care home staff had a lack of understanding
of stroke, although the Department's Stroke—Act F.A.S.T.
campaign may have helped address this issue.[34]
16. The Department recognised that shortcomings in
care homes could be addressed through the recently completed stroke-specific
educational framework, which sets out the core competencies for
health and social care professionals, including care home staff.
The Department told us that the Care Quality Commission (the Commission)
was analysing the entire post-acute care pathway for stroke across
England including nursing homes, and that the Commission could
use its regulation and information collection powers to improve
services, including the alignment with social care. The Department
was working with the Commission to develop proposals for accrediting
staff who care for people with stroke in care homes, requiring
them to have qualifications in stroke.[35]
25 C&AG's Report, para 3.1 Back
26
Q 12 and 81; C&AG's Report, para 3.13, Figure 17 Back
27
Q 81; C&AG's Report, para 3.14, Figure 14 Back
28
Qq 12 and 79 Back
29
Q 79 Back
30
Q 81; Stroke Improvement Programme, National Projects 2009-10,
www.improvement.nhs.uk/ Back
31
C&AG's Report, Figure 4 Back
32
Qq 13 and 48 Back
33
Q 49 Back
34
Qq 81 and 82; C&AG's Report, para 3.15 Back
35
Qq 71 and 82-83 Back
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