1. Michelle Graham LIFE AFTER STROKE

2. The Stroke Population 6000 new strokes per year 2.7% of over 18 population (TIA and Stroke) 50% of all stroke survivors significant level of physical, psychological or social need

3. Evidence RCP Stroke Guidelines (4 th Ed, 2012) National Stroke Strategy (2007) Scottish Intercollegiate Guidelines Network (2010) Stroke Delivery Plan (2012) Care Quality Commission Stroke Care review (2011) Stroke Association Life after Stroke

4. Change of direction/approach? WHC 058 & 082 Intelligent Targets LAS structurally different Cross organisations Multi Agency Person Centred

5. Change of Approach Move away from “check lists” Policy context Person centred listening

6. What we Learnt Services aren’t designed for individuals Carers GP services Equity and fairness Social Access Dignity Specialist services Access to information Fears for the future

7. Person centred and joint working progress Multi Agency Steering group Expanded on the listening events Developed driver diagram capturing key drivers and changes

8. The Aim To empower stroke survivors to reintegrate into community and enable optimum quality of life

10. Person Centred Goal Plan Individually tailored SDP: “services need to be planned and delivered around the patient and their individual needs rather than the needs of the organisation”

11. Person Centred Goal Plan Regular Reviews Access to Facilitator Individual Stroke Survivor Passport

12. Have responsive Access to services The right services on offer Match Capacity to demand