Stroke Early Supported Discharge Service

NHS Ipswich and East Suffolk and West Suffolk Clinical Commissioning Groups are looking to commission a Stroke Early Supported Discharge (ESD) Service across the Ipswich, East Suffolk (minus Waveney) and West Suffolk localities.

This service has been designed to support people after stroke, transferring care from an inpatient environment

to a primary care setting to continue rehabilitation at the same level of intensity and expertise that they would

have received in the inpatient setting. This service will maximise rehabilitation potential for stroke survivors

and lessen long term disability. A multi-disciplinary approach will ensure rehabilitation needs are met. Full integration of this service with other community provision is required to ensure all interactions are delivered in a collaborative and co-ordinated approach. The overall aims of the Stroke ESD service are:

- Deliver specialised rehabilitation through a multidisciplinary and co-ordinated approach

- Provide a seamless pathway and continuity of care for the stroke survivor and their carers through the

acute stay to rehabilitation and beyond

- Ensure a whole system approach that raises standards across the stroke pathway

- Ensure the stroke survivor and family/carer have access to support, advice, advocacy and information

- Ensure rehabilitation is delivered with a person-centred, goal planning approach

- Achieve maximum potential for independence in all aspects of the stroke survivors and their family/carer's

lifestyle while, acquiring the skills to adapt to new situations.

- Deliver a five days a week ESD service as standard, with 7 day working a future development

- Reduce premature admission into Long Term Care.

- Enable the stroke survivor to reach and maintain their optimum potential in their physical, psychological and

social functional abilities.

- Integrate Health, Social and voluntary organisations

Please note that the services and associated specification and prices commissioned within this contract may

be subject to review and change, moving forward the Commissioners may further review its Stroke services in

conjunction with the selected providers; therefore, the scope of the possible changes to be made to this contract

shall relate to the outcomes of any continuous improvement, through a variation to the contract in accordance

with Regulation 72 (1) (a) of the Public Contracts Regulations 2015.

Additionally, the contract may also be amended in terms of the original services supplied, where, following

assessment it is identified that it is logical for additional services be delivered in conjunction with this contract

and by the provider, both in terms of actual service delivery and to avoid duplication of costs.

These services may include but are not limited to other services and specialties formally delivered in the

community and secondary care settings where it is foreseen that these services can be delivered more

effectively as part of this contract.