This was a project which to explore a potential new model of provision, using enhanced community services. A need to review stroke spasticity provision arose from feedback from patients and clinicians that the current spasticity service delivery model for the region was not easily accessible for patients and referral routes were not clear, resulting in significant variation in access, waiting times and referral process. It was felt that the service could be improved by developing new networked relationships between organisations to promote equity across the region and enable the sharing of best practice.
A network task and finish group was set up to review current provision and explore a potential new service delivery model. This involved:
· Commissioning the KSS AHSN to undertake a review and provide an economic evaluation of the based on current service models, data and practice.
· Proposed Modelling options and draft governance guidelines to support service delivery
· Stakeholder workshops to review the potential new pathway and seek feedback for further refinement to any modelling
· Development of a guidance document to accompany future modelling within the new ISDN's
Results: Task and finish work and patient focus groups supported the anecdotal evidence and feedback of poor patient experience and gaps in access to spasticity management across Kent Surrey & Sussex. The working group proposed and developed a new model of service delivery for spasticity management using a Hub and Spoke approach, building on existing regional rehabilitation hubs within the SE region. An AHSN economic analysis showed in favour of the new model with savings of £1.64 million within health and £3.6 million in social benefits over 5 years. Guidance document produced to support clinical, governance, workforce and delivery arrangements.
Conclusion(s): The proposed new model is seen as : • Financially viable, with cost savings calculated. • Provides a better patient experience
· More flexible access to spasticity service
· More options to reduce travel times
· Better experience for patients in community care
· Provides a clear Pathway with standardised referral routes
o better use of MDT through stratification of referrals
o Good clear governance
o Better patient safety
o Reduced pressure on London Centres
· Looks forward to future workforce sustainability
o Exciting opportunity to expand AHP role
o Exciting opportunity to fill gap in workforce and use current workforce more efficiently.
o Opportunity to provide peer network & clinical support
Cost and savings
AHSN commissioned for economic evaluation (£25K) and projected cash releasing and social benefit over 5 years £5 million
Improved patient experience
· GIRFT for spasticity management
· Improved use of existing resources
· Cost effective use of AHP’s to support wider access to treatment
· Region wide data set to support spasticity population profile, outcomes evaluation and governance.
· £1.64 million health saving (over 5 years)
· £3.61 m social saving (over 5 years)
Top three learning points
No further information.
SE Stroke Clinical Network