The East Midlands Academic Health Science Network Stroke Rehabilitation Programme was commissioned from February 2014 and finished in August 2016.

Work to improve care in the community has brought together stroke survivors, commissioners and providers of stroke services to collaborate on the development of high quality service specifications and guidance to support the commissioning of evidence based stroke specialist care. Our current projects include:
The overarching vision for stroke services across the East Midlands was to ensure that all patients who experience stroke have access to high quality and timely care.  This means provision of a stroke care pathway including hyper-acute and acute care, provision of stroke specialist rehabilitation delivered by multidisciplinary Early Supported Discharge and community stroke teams and provision of six month reviews. Supporting longer term, life after stroke care, for stroke survivors needs to focus on providing patient and carer centric care, empowerment and facilitation of self-management.

The programme's key role was to ensure that inequality and variation in community stroke services available to stroke patients in the East Midlands was addressed and to support evidence based service improvement during times of economic challenges faced by health and social care authorities.

Key project outcomes:

Improving community stroke services: How far have we come? | May 2016
This was an event focused on provision of community based stroke care for stroke survivors in the East Midlands. It celebrated service improvement initiatives and provided networking and shared learning opportunities for attendees.
pdfImproving community stroke services May 2016 event agenda
pdfJocelyn Cornwell Improving community stroke services how far have we come
pdfEMAHSN programme team - Improving community stroke services
pdfSuzanne Horobin EM Clinical Networks - Improving community stroke services
pdfSummary of the EMAHSN Community Stroke Event June 2016

Commissioners event - 17 June 2015 | Flying the flag for Stroke
We held an event on 17 June 2015 for commissioners about the continuing importance of stroke rehabiliation across the East Midlands. Presentations from the event can be downloaded below.

pdfSummary from Stroke Commissioners event
pdfStroke Commissioner Event 17 June 2015 Agenda
pdfArlene Neville Stroke and Neurology Rehabilitation
pdfJen Yates - Use of data to inform Stroke commissioning intentions
pdfRachel Munton - The East Midlands Academic Health Science Network
pdfRebecca Fisher - Reducing the burden of stroke in the community
pdfRebecca Larder - Transforming stroke services
pdfRussell Pitchford Commissioning for Stroke


All stroke patients in England should be offered a follow up review at six months post stroke

It is important that every stroke survivor is offered a six month review so that their unmet needs are identified and they can be referred back into stroke specialist services where appropriate. Reviews should be undertaken by trained staff, using an evidence based review model.

Key project outcomes
  • Patients receive evidence based care and support at home, to address unmet needs and enhance recovery
  • Reviews are evidence based, consistent and thorough, enabling clinicians to focus on particular areas of difficulty and create ongoing care plans or onward referrals
  • Variation is reduced ensuring equal access to care
A resource toolkit providing a step by step guide about how six month reviews can be commissioned and delivered is available. 

National Survey of six month reviews
We have conducted a national survey of stroke six month review services, supported by the Global Stroke Community Advisory Panel (GSCAP) and sponsored by Allergan. The GSCAP recognize that long term stroke management has been a sadly neglected area in both clinical service development and research. 

The purpose of the survey was to map current provision of six month follow-up reviews after stroke in England and identify adopted processes and data collection tools. You can access the pdffinal report and a pdfposter presentation (UK Stroke Forum 2014) by clicking on the links.

Poststroke Checklist
The Global Stroke Community Advisory Panel have developed an evidence based tool that can be used to conduct six month reviews. The Poststroke checklist has been developed by an expert panel to standardise follow-up care for stroke survivors and is easy and quick to use. For more information you can read the related paper pdfhere.

We have created an electronic version of the pdfPoststroke checklist in SystmOne which is available for use. Please look at our resource toolkit for more information.

If you have any questions please contact one of the EMAHSN project team at This email address is being protected from spambots. You need JavaScript enabled to view it.              
This service improvement programme was rolled out to teams providing Early Supported Discharge and specialist community rehabilitation to stroke survivors. The programme is a follow-up to a successful pilot of the programme facilitated by The University Of Nottingham, with collaboration from the East Midlands Cardiovascular Network and the East Midlands Higher Education Innovation Cluster, involving community stroke teams from Nottinghamshire.

The pilot programme was established using research, policy and evidence based standards. Currently, very little multidisciplinary team effectiveness training takes place in community health care settings, despite a recognised need for it, and this programme aims to address that gap.

The programme involved a series of workshops covering both theoretical and practical elements that are important to effective multidisciplinary team working. A knowledge champion was identified to ensure that knowledge and skills developed by participating team members was fed back to other team members unable to participate and sustained. A networking day to give teams the opportunity to meet with each other completed the programme.

Key outcomes:
  • To deliver a model of team effectiveness adapted from the work of Borrill, et al (1999) and West, et al (2012)
  • To provide teams the opportunity to explore their effectiveness and embedded team practices, celebrate successes, and reflect on issues for change
  • To support teams to explore how they benchmark their services, enter data into the Sentinel Stroke National Audit Programme (SSNAP) and share data across the stroke care pathway

Copies of the final reports for each session we held can be found here:

pdfOverall project report Derbyshire

pdfOverall project report Lincolnshire

pdfOverall project report Leicestershire

pdfOverall project report Northamptonshire              
The EMAHSN Stroke Rehabilitation team work with various stakeholders in the stroke care pathway to facilitate the use of data in service improvement initiatives.

We conducted a scoping exercise to explore the feasibility of an East Midlands Stroke Care pathway data repository. This led to further investigation of how both acute and community stroke service providers and commissioners use data to address quality improvement and measure effectiveness of services. We have been working with stakeholders to align data reporting across the East Midlands, and support teams in taking part in the national stroke audit (SSNAP).

Key outcomes:
  • To support stroke teams with SSNAP registration
  • To facilitate workshops to encourage consistent and accurate entry and interpretation of SSNAP
  • Development and production of pdfCommunity Stroke Team Help Notes (adopted by the Royal College of Physicians)
  • UK Stroke Forum Poster Presentation – pdfSSNAP Helpnotes Poster
  • To investigate the appetite of community stroke teams to align key metrics across the East Midlands
We have produced a report: 'pdfBarriers to data sharing across the stroke care pathway'. This report details the scoping exercise to explore the feasibility of the East Midlands Stroke Care pathway data repository.