4 Learning lessons to help deliver
improvement in stroke
21. In 2009, the Department set out its intention
to improve the standards of services across its national priorities,
including stroke, over the following five years based on the approach
it had used to reduce waiting times.[46]
To help improve stroke care, the Department had also used lessons
learned from its experience of implementing other national strategies
and programmes.
22. A barrier to improving stroke care is a lack
of joint working between health and social care organisations.[47]
This issue has already been raised in our other health related
hearings on Dementia, End of Life Care, Autism and Alcohol.[48][49][50][51]
As part of the Department's accelerated development programme,
Primary Care Trusts were told, in November 2009, to submit by
March 2010, local plans for stroke care, which should be developed
jointly with their local authorities.[52]
The Department told us that, it also expected all patients to
receive a joint care plan on discharge from hospital which should
cover both health and social care needs. The care plan should
also be shared with all relevant organisations involved in that
individual's care.[53]
23. The Department acknowledged that it had a range
of tools available to facilitate better joint working. These included
providing support from its Stroke Improvement Programme in two
ways: through Local Area Agreements which include all of the Department's
highest tier performance indicators; and by permitting greater
flexibility in joint budgeting across organisations. There were
also opportunities to improve joint working through Stroke Networks,
which bring together all local stakeholders and through the Commission's
oversight and monitoring of progress in coordinating health and
social care.[54][55]
24. There was also scope for the Department to transfer
the successful elements of the stroke strategy to other areas.
The Department recognised that many elements of the stroke strategy
had contributed to progress being made, including leadership,
organisational and cultural changes. These included setting up
Stroke Networks, and aligning incentives to the required improvements.
Key elements in the development and implementation of the stroke
strategy were that its timing aligned closely to the Treasury's
development of the 2007 Comprehensive Spending Review and that
the Department identified it as a national priority in its NHS
Operating Framework.[56]
46 Department of Health: NHS 2010-2015: from good
to great. Preventative, people-centred, productive, December
2009 Back
47
C&AG's Report, para 1.15 Back
48
Committee of Public Accounts, Nineteenth Report of Session 2009-10,
Improving Dementia Services in England-an Interim Report,
HC 321 Back
49
Committee of Public Accounts, Nineteenth Report of Session 2008-09,
End of life care, HC 99 Back
50
Committee of Public Accounts, Fiftieth of Session 2008-09,
Supporting people with autism through adulthood, HC 697 Back
51
Committee of Public Accounts, Forty-seventh Report of Session
2008-09, Reducing Alcohol Harm: health services in England
for alcohol misuse, HC 925 Back
52
Qq 63-66 Back
53
Q 28 Back
54
Qq 20, 26 and 84 Back
55
Q 83 Back
56
Qq 2-4, 35, 84-85 and 87 Back
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