Case Studies

Improving specialist care for stroke patients

Added 03/03/2008


The introduction of the national stroke strategy provided the ideal opportunity for the commissioning PCT to tender its specialist stroke services, with the aim of delivering more integrated pathways of care for patients. This coincided with a major review of the PCT’s intermediate care strategy and use of community rehabilitation beds.
Keen to make the most of the opportunity to improve stroke care, the local community healthcare provider commissioned Sustain to develop its tender bid, working in partnership with an acute trust, social services and a local charitable organisation.

Key challenges
Working across – and engaging with – a range of organisations and key stakeholders inevitably brought challenges, including winning universal support for the integrated approach. Negotiating governance and contractual arrangements across two NHS organisations, social services and the charity also proved complex.
Elements of the tender itself posed further challenges, including the rationalisation of community rehabilitation beds while simultaneously introducing the new specialist stroke care pathways.

Main actions

Through careful negotiation with the director of social services and the acute trust’s chief executive and senior management team, Sustain brokered an important agreement to develop the tender bid in partnership. The acute trust would act as lead provider.
Sustain then formed a steering group to develop the project plan and oversee its management. Workstreams were also set up, and were tasked with developing:

  • each element of the care pathway in line with the national stroke strategy
  • performance and quality standards
  • the clinical interface with general practice, general rehabilitation, palliative care services and third sector provision
  • detailed financial and efficiency planning
  • the tender document presentation and format 
Throughout the process, Sustain offered valuable guidance to the steering group on all community rehabilitation elements of the care pathway while also driving and supporting the workstreams. A detailed governance framework was developed, and contractual arrangements agreed in principle.
Another important element of the project saw Sustain manage negotiations with the PCT to secure capital funds for two new 24-bed rehabilitation units, with the first providing specialist stroke services and the second general rehabilitation.

Outcomes and achievements
Sustain’s input ensured all partners were able to effectively deliver a comprehensive bid document, which was highly acclaimed for its relevance to the tender requirements and the national stroke strategy. As a result, the partnership was awarded the contract.
Sustain then developed a project plan so that the new pathway could be delivered in phases, while also leading all community service elements of the project. This included the capital schemes to build new rehabilitation units, as well as the formation of clinical teams to work within the community.
Thanks to an unwavering focus on delivery, work on the ward was completed and the important facility opened on the scheduled date, with no delays. Sustain also ensured all of the community teams were put in place and trained quickly and efficiently, in turn allowing them to treat their first patients two weeks ahead of schedule.



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