ESD

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ESD

• Catherine Williams
• Vicky Johns
• Peterborough Community Services

2
Today we aim to

• Explain why we have chosen to develop ESD
• Describe the current community stroke provision
  in Peterborough
• Look at the process
• Describe the challenges and positive experiences
  we have encountered along the way
• Look at where we are now

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Why aim for ESD?

• All the evidence points to ESD being the model of
  best practice for people coming out of acute care
  back into their homes (RCP, NSS, NICE)
• More importantly, because we want to improve
  community stroke services for the population we
  serve

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The current position

• No specific stroke services commissioned in
  Peterborough beyond the acute phase
• Only the Intermediate Care Service able to offer
  a multi-disciplinary service to people including
  those with a stroke
• ICS not regarded in literature as being stroke
  specific
• No additional funding available for service
  developments

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Current position

• Silo-ed uni-professional services eg
  physiotherapy, OT, SALT etc
• Multiple hand-offs between services
• Duplication of assessment
• Poor carry-over
• Zero continuity of care
• Limited stroke specific-skilled practitioners
• Professional and service conflict
• Dispersal of provider organisation

6
The process to date

• Allocated funding to 31st March 2011 for
  Community Stroke Coordinator
• Monies allocated from Dept Health (Adult Social
  Care) budget for 14 months of above post
• Built excellent links with local Network Anglia
  Stroke and Heart Network

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The process

• ASHN co-hosted two workshops with PCS staff
• Asked staff to map current services and identify
  gaps
• Examples of current good practice
• Engendered a sense of joint responsibility and
  opportunity to make things better
• Provided a safe space for people to be open and
  honest
• Staff identified the need for a Community Stroke
  Team

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The process .

• By the 2nd workshop we were aware of the
  Accelerated Improvement Programme
• Reached agreement that ESD would form part of the
  service offered by the community stroke team
• Meeting with commissioner to explain current
  situation and our proposal for CST and ESD.
  Agreement gained from commissioning to continue
  to develop our thinking pending the completion of
  a service specification

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Challenges

• Lack of clarity around current commissioned
  pathways
• Managing expectations
• Managing organisational barriers between
  community and acute providers

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and positives

• Senior management recognition of problems and
  need for change
• Lots of enthusiasm and drive from PCS staff to
  change and improve the service for people who
  have had a stroke
• Improved relationships with colleagues in acute
  trust
• Commissioners now focused on commissioning
  services according to the accelerated metrics

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Where are we now?

• Agreed a pragmatic approach to trial the ESD
  pathway
• Identified key people physio and OT
• Secured agreement with in-house home care to
  support ESD trial with re-ablement staff
• Agreed draft criteria for acceptance onto ESD
  trial
• Will support 3 patients through the ESD pathway
  during August
• Use outcomes from trial to inform the
  implementation of the ESD pathway in November
  (when new hospital is due to open)

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Proposed ESD criteria

• Patient medically stable
• Patient able to transfer with assistance of 1
  (therapy staff and main carer)
• Home visit has been carried out to promote safe
  environment
• Patient has good carer support
• Continence and nutritional risks are managed
• Patient/carer able to deal with an emergency
• There are no tissue viability issues

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Desired outcomes from trial

• Enable patients to benefit from home-based rehab
  rather than stay in hospital after medically
  stable
• Ascertain level of input required
• Identify any gaps
• Build staff confidence through experiencing
  process
• Provide a high quality service when ESD goes
  live in November

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Where are we now?

• Commissioning now in process
• Management team sign off of proposed pathway
• Working with HR to pull appropriate staff into
  Community Stroke Team
• Liaison with acute trust regarding CST
  in-reaching to identify people for ESD

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Contacts

• Thank you for listening
• Catherine Williams Vicky Johns
• Any queries, please contact
• Vicky Johns or Cathy Semple
• Community Stroke Coordinators
• vicky.johns_at_nhs.net / csemple_at_nhs.net