1. Healthcare for London is part of Commissioning Support for London – an organisation providing clinical and business support to London’s NHS. Financing stroke community rehabilitation Outline of work plan Healthcare for London: stroke project Martin Hewings

2. 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

3. Methodology 1Establishing good practice across London & elsewhere; Covering: –Community Rehab; –Early Support Discharge; –Support worker/designated person; –Defined review.

4. 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?

5. 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:

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.