Care Quality Commission
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CQC review of stroke care finds large variation in support for people after stroke across England

A major review by the Care Quality Commission (CQC) on stroke care has found the extent to which patients are supported in coping with life after stroke varies significantly across England.

Although the report highlights some good services built around the individual, their family and carers, The North East and South West of England being particularly good, however the CQC found that this approach is far from universal.

The report found that rehabilitation services after transfer home from hospital were inconsistent across the country and people in some areas had little or no access to stroke specialist community-based rehabilitation. The Commission found only two-thirds of PCTs commissioned specialist stroke physiotherapy and less than 40% of areas provided good access to psychological therapy or stroke counsellors.

CQC chief executive Cynthia Bower said “Stroke is the single largest cause of disability in adults and our evidence shows that early access to intense rehabilitation is beneficial to people’s recovery.

“Services have made improvements over recent years in the care provided in the hours and days that follow their stroke. It is vital that this momentum is maintained and that improvements are made in the care and support provided in the longer term.

Ms Bower went on to say: “The level of variation is a concern, but the report also shows that the barriers to effective care after transfer home and around person centred care can be overcome and improvements made, which can help people to recover from, and cope with, life after stroke.

“We expect to see local health and social services working with stroke survivors, carers and representative groups to agree and implement a plan to improve services drawing on the results of our assessments of services in local areas.”

Other areas where people were not always getting access to services they needed when they needed them.

  • Early supported discharge, which provides more rehabilitation at home rather than in hospital and is known to achieve better results for people and cut pressure on hospital beds, was available across only 37% of areas.
  • In 48% of areas, people had to wait two weeks or more, on average, until they received community based speech and language therapy.
  • Only 37% of areas provided rehabilitation services to people based in their community, focusing on helping them return to work.
  • While most carers were given access to information and advice, in around a third of areas not all carers could access peer support, such as carer support groups or befriending schemes.

While most people received good general information on stroke, fewer got clear information on local services or support to help them access services, sort out problems, or personalise services to meet their needs and preferences.

  • Most people are given a pack of information when they leave hospital but it is often poorly organised – only around 40% of people told us it was easy to find things in them and only 40% of these packs contained good information on local services.
  • While 68% of areas provided a named contact to help people plan and organise their care after transfer home, but in only a half of areas did these contacts looked across health, social and community services.
  • 65% of stroke survivors had a care plan for community-based support which included goals they had agreed.

Services were not always adapting well to meet people’s needs, such as the communications needs of people with aphasia or the needs of people who do not speak English. Other communications issues included:

  • While 87% of areas provided a helpline, only 26% were available outside office hours and 38% did not train helpline staff to deal with people who have aphasia.
  • Around three-quarters of social services could direct people to community-based services to help them with their physical disabilities, but less than half could signpost similar services for people with aphasia.
  • Only a third of areas provided information on stroke in relevant community languages other than English.

Reviews after transfer home provide a key opportunity to ensure people get the support they need – but, while most areas have systems for reviews after six weeks, systems for reviews after this are in place in less than a quarter of areas and only a third of areas carry out joint assessments, looking across both health and social care needs.

For further information please contact the CQC press office on 0207 448 9401 or out of hours on 07917 232143.

Note to editors:

The review looked at progress against the National Stroke Strategy (2007) and focussed on care provided to stroke survivors and carers from the point patients are transferred home.

Aphasia is a communication disability usually caused by stroke, which affects around a third of people who have a stroke. Each person with aphasia experiences it differently. Some people cannot speak at all; some people have just a few words. Others can no longer read, write or use numbers.

About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of all health and adult social care in England. Our aim is to make sure that better care is provided for everyone, whether it is in hospital, in care homes, in people’s own homes, or anywhere else that care is provided. We also seek to protect the interests of people whose rights are restricted under the Mental Health Act. We promote the rights and interests of people who use services and we have a wide range of enforcement powers to take action on their behalf if services are unacceptably poor.

We are introducing a new regulatory system that brings the NHS, independent healthcare and adult social care under a single set of essential standards of quality and safety for the first time. We register health and adult social care services if they meet essential standards, we monitor them to make sure that they continue to do so and we respond quickly if there are concerns that standards are not being maintained.  We rely on people who use services and those who care for and treat them to tell us about the quality and safety of services. This feedback is a vital part of our dynamic system of regulation which places the views, experiences, health and wellbeing of people who use services at its centre.