Different strokes: seven-day services and stroke care

The provision of seven-day services in the NHS remains high on the political agenda. Prime minister David Cameron’s vision for a ‘seven-day NHS’ has been moderated by NHS England chief executive Simon Stevens, who stated that seven-day services will need to be developed through a ‘careful and disciplined approach’. For services keen to deliver physiotherapy over a seven-day period, it would seem that it is an appropriate time to review their existing service provision and decide what model of care delivery is required to meet the needs of the population they serve. 

 

One clinical area where therapy can be delivered over seven days is stroke rehabilitation. Stroke rehabilitation, largely delivered by physiotherapists, occupational therapists and speech and language therapists, is a recognised and essential part of stroke management. 

 

Reported benefits of seven-day working in stroke rehabilitation include earlier access to and provision of therapy, reduction in hospital length of stay and greater improvements in patients’ functional abilities. However, a recent review of London stroke services by the London Stroke Strategic Clinical Network (SCN) found that only 63 per cent of hyper-acute stroke units, 38 per cent of stroke units, 10 per cent 

of early supported discharge teams and no community stroke teams were delivering some therapy at weekends and that weekend therapy provision varied greatly across the different regions of London. 

 

The review highlighted that some services were staffed by voluntary rotas, which can be difficult to maintain. Therapy staff working on a weekend often took time in lieu back during the week, which can have a detrimental effect on the delivery of stroke rehabilitation during the working week. 

 

The SCN review also found that stroke survivors felt that a lack of structured weekend therapy led to frustration over missed opportunities to practise rehabilitation tasks and difficulties in ‘starting again’ on the following Monday. 

 

Service providers keen to deliver seven-day therapy will need to ensure that services are appropriately staffed and funded. This is vital if they are to deliver the anticipated benefits that seven-day care can provide without causing a detrimental effect on existing weekday service provision. 

 

To assist commissioners and service providers in the development of sustainable, high-quality seven- day stroke therapy services, the London stroke SCN has developed guidance outlining three different levels of weekend service delivery and their respective benefits and costs which could be implemented across the whole stroke pathway.

 

While the commissioning guidance was designed to increase access to weekend stroke therapy across London, its principles can be applied to other stroke services across the UK.