Financing stroke community
rehabilitation
Outline of work plan
Healthcare for London: stroke project
Martin Hewings
Healthcare for London is part of Commissioning Support for London – an organisation providing clinical and business support to London’s NHS.
Remit
Support the HfL stroke rehab team by:
• Understanding how best practise
community rehab has been
commissioned and funded;
• Understanding the financial (and other)
benefits of such services;
• Drawing lessons from the examples that
could be used by other PCTs
Methodology
1 Establishing good practice across
London & elsewhere;
• Covering:
–
–
–
–
Community Rehab;
Early Support Discharge;
Support worker/designated person;
Defined review.
Methodology (2)
• To answer the following questions:
– Is an incremental approach to investment
possible?
– Are there financial benefits from investment
and where do they sit?
– How have PCTs funded these services?
– Can ranking of investments options be
made on financial grounds?
Findings so far
1. There are significant areas of good clinical
practice;
BUT not so many examples of good
commissioning & financial practice;
2. The Comprehensive Review of Stroke Rehab
services across South London IS very
comprehensive and a robust model;
BUT a number of the assumptions have
been challenged including:
Findings so far (2)
• Is 45 minute average travel time for each patient
high?
• Is community rehab suitable for all stroke
victims?
• Could the clinical care be undertaken by less
qualified staff?
• Do polyclinics have a role to play in delivering
rehab services?
The perception is that changing these
assumptions could have a significant impact on
the financial outcome of the model.
Findings so far (3)
•
Research elsewhere supports investment in
community rehab services:
– North Lincs PCT made savings of approx £750k on
introduction of an outreach rehab service:
– Mc Nee research suggests savings of £325 per
patient on implementation of ESD;
– Beech, Rudd & others suggest savings of £632 per
patient on implementation of ESD;
– Additional evidence being sought from NHS
Hampshire, Manchester, Coventry & Solihull.
Further work required
1. Identify more examples of good clinical /
commissioning practice. Understand
how funded;
2. Consider updating South London
Comprehensive review for revised
assumptions;
3. Look further at commissioning,
particularly Joint Commissioning, to
ensure full costs & savings are identified.
Conclusions to be reached on:
1. Incremental approach to investing;
2. Identify financial benefits from
investment, wherever they sit & over
whatever timescale;
3. Consider a ranking of investment options
on financial grounds;
4. Review methods of financing
developments.
Interim Conclusion
• On the basis of the work completed to
date it would seem that:
– Community based stroke rehabilitation
services can be financially viable and cost
effective.
– The underlying issue is how to free up
resources to invest in the services.