Better Care

A new stroke pathway for Birmingham

  • Stroke is a life changing condition that affects 1,400 people in Birmingham and Solihull every year.

  • Forty-five per cent of stroke patients report feeling abandoned once discharged home (Stroke Association, 2016) 

BCHC provides therapy and support to help rehabilitate Birmingham residents who have experienced a stroke. After leaving hospital, people living in the north, east and west of the city are supported by our community stroke team; while in the south, support is provided by a combination of our early supported discharge and Birmingham neuro-rehabilitation teams and our assessment and treatment service based at Moseley Hall Hospital.

community stroke pathway

As part of our commitment to the communities we serve, work is in hand to transform the support we give people recovering from strokes into a fully integrated community service ensuring Birmingham residents who have experienced a stroke receive high quality specialist care following discharge from hospital.

Our ambition is to see the national model embedded across Birmingham, with fully integrated stroke services across the whole pathway. Our community stroke pathway project was set-up to evaluate the care provided to stroke survivors following discharge from hospital, to address any gaps in service provision, and to align BCHC stroke services with national standards for stroke care.

The first phase of the project has been to identify gaps in our current service as scoped against national standards. As part of the current phase two, a  service redesign process has begun, seeking the views of service users and relevant colleagues to guide the remodelling of community stroke services, ensuring that the new design complements the trust’s strategic objectives.

While restructuring in response to the pandemic has led to unprecedented disruption to NHS services, we remain committed to seizing all opportunities to progress or launch service improvement projects. A window of opportunity to transform the city’s stroke pathway remains open thanks to a national mandate to reform stroke services set out in the NHS Long Term Plan 2019. Integrated Stroke Delivery Networks (ISDNs) have been created to support health providers and commissioners in transforming NHS stroke services into the best in Europe, using the national stroke programme as a template.

The vision is to provide high quality community stroke care across the whole of Birmingham, which will require investment in facilities and uplift in workforce to provide a comprehensive seven day service. Commissioners are supportive of the vision in principle and further meetings to engage stakeholders across the whole stroke pathway are planned.

Further information

In 2019 the NHS Long Term Plan identified stroke as a clinical priority and outlined several specific ambitions to improve the pathway from pre-admission through to long term care. One of the goals of the NHS plan was to centralise hyper acute stroke services. In Birmingham and Solihull STP, this change took place in spring 2020 with all hyper acute care relocated to the Queen Elizabeth Hospital. The centralisation of acute stroke services has led to improved outcomes and patient experience of hospital care. Early access to community rehabilitation can help to improve recovery following discharge from hospital, however the Stroke Association reports that 45 per cent of patients report feeling abandoned once discharged home due to inadequate community service provision.

The current Birmingham pathway incorporates services provided by two trusts and six individual community stroke teams. Gaps in service provision have created a ‘postcode lottery’ in terms of available support and there is no arrangement for monitoring and managing performance across the whole system.

The West Midlands Cardiovascular Disease Network conducted a review of stroke rehabilitation services in Birmingham and Solihull in 2019. This identified problems with current provision of stroke care following hospital discharge and highlighted a number of key issues that need to be addressed including:

• a chronically under resourced workforce relative to the number of referrals;

• stroke teams commissioned for five-day-a-week services;

• variable funding streams;

• no stroke in-reach for enhanced assessment bedded (EAB) units or care home residents;

• community stroke service variation across Birmingham and Solihull;

• inefficient referral systems.

Successful implementation of an integrated community stroke team would realise the following benefits:

  • a comprehensive service at the point of need, at the right intensity and for as long as treatment remains beneficial with high quality care provided by a team of specialist healthcare professionals;

  • equal access to services for healthcare professionals looking after stroke survivors, irrespective of discharge destination or stroke severity;

  • improved health and wellbeing outcomes, in line with national targets and standards;

  • staff empowered to provide care based on patient’s needs rather than available resource, benefiting from efficient ways of working and appropriate clinical support;

  • comprehensive community care model offering the opportunity to discharge patents from hospital at an earlier stage in their recovery;

  • financial benefits due to more efficient and effective use of resources.