1. Meeting the standards Marisa Rose Acute Stroke Lead NEL Cardiac and stroke network Marisa.rose@bdpct.nhs.uk Sue Winnall Head Occupational therapist – Rehabilitation Mile End Hospital Sue.winnall@thpct.nhs.uk

2.  National stroke strategy  London stroke strategy  RCP guidelines

3. What is needed?  Specialist rehabilitation (NS QM 10)  Community stroke service with staff with stroke specialist skills (LSS)  ESD service with staff with stroke specialist skills (LSS)  Vocational rehabilitation (NS QM16)  Long term support (NS Qm13 and 15)

4. Appropriate seating, posture and positioning within 24hrs of admission Outcome measure given and recorded within in one week of admission and discharge Named key worker within one week of admission Negotiated goals within one week of admission with appropriately format copy given 5 x 45 mins face to face sessions per week of OT/PT/SLT as necessary

5. Cognitive/perceptual screening and full assessment within one week if required Screening for emotional support as soon as possible At least one family meeting with MDT before discharge and receiving copies of minutes and care plan during their admission Discharged on clinically preferred day

6. Standards- community Contacted by a member of the community rehabilitation team within 24 hours and assessed within three days Treatment programme started within 24 hours (ESD intensity level) or seven days (non-ESD) of assessment Visited at home by community nursing team within 24 hours where agreed as part of care plan Outcome measures recoded within one week of arrival to, and one week of discharge from, community rehabilitation service

7. A set of short term and long term goals negotiated with them, their family/carers and the rehabilitation team of which they receive a copy appropriately formatted for their individual needs within 2 weeks of admission to the community rehabilitation service Receiving 3 hours 45 minutes per week (ESD) and/or two hours 15 minutes per week for the first four weeks (non- ESD/post ESD)- of individual sessions of OT/PT & SLT Cognitive/perceptual screening within 1 week of admission and full ax within 12 weeks if required

8. Patients previously in work receiving vocational rehabilitation Patients and family who the community rehab team idenitify as having a need for further ax or intervention to meet adjustment, behavioural or psychological needs and who were seen within 2 weeks of referral to the team Locations with commissioned activity where a comprehensive set of standards and information about services is available Outcomes recorded for patients who have accessed voluntary services as part of stroke care

9.  Who its provided by  What’s provided  How it is provided

10.  Intensity  Specialism  Duration

11.  How much to buy? What are the benefits?  London stroke strategy standards  Inpatient – 5 x 45 mins of OT, PT, SLT per week as necessary (R15)  ESD- 3 hours 45 mins per week within the first two weeks  Community- 2 hours 15 mins per week for the first four weeks of individual sessions OT, PT and SLT

12. Specialism

13.  How much is enough?  Your choice … what outcome do you want?

14.  MDT  Specialist

15. What is the difference …  Intermediate care teams  Neurology teams  Case management  Outpatient clinics  ESD vs community team

16.  Standards provide basic requirements  Type and purpose of the service will guide measures used  Stroke rehabilitation is worth the investment!