The need for an evidence review
As part of a wider health and social care system, we have a duty to ensure the support we provide is informed by appropriate evidence. By this we mean both evidence that is drawn from external research studies, and evidence that we generate internally to continuously understand and improve our support offers. We're also referring to evidence of the need for support, as well as evidence related to specific interventions that respond to those needs.
We recognise that each of these types of evidence has an important but distinct role to play. We have made good progress with our own internal evaluation but lack capacity to maintain, synthesise and disseminate up-to-date external research evidence.
In 2017 we commissioned NPC to review the literature informing the evidence base for our Stroke Recovery Service. We believe there is now a further body of evidence which has become available since this review. The policy and commissioning landscape in which we operate and in which stroke services are delivered, have also changed substantially over the past five years.
We would like to work with a partner to review and synthesise the current evidence base around the core components/interventions that make up the Stroke Key Worker role, as well as any available evidence base for services that are similar to our Stroke Recovery Services in which the key worker role is the core component. The partner should work with us to support us to develop an accurate, strong and enduring internal and external narrative about the research evidence base for Stroke Key Workers.
This review will support us in both further developing our own services and in influencing external decision-makers and commissioners to prioritise and fund life after stroke services.
Background to Stroke Association Services
The Stroke Association delivers a number of different support services directly to stroke survivors:
Support provided within localities
These services are delivered locally and embedded within the stroke pathway. They are usually funded via statutory income sources (i.e. NHS and Local Authority). They are only accessible to people affected by stroke in areas where funding is secured. We currently have services in England, Wales and Northern Ireland. Similar services in Scotland are provided by Chest, Heart and Stroke Scotland and in Northern Ireland by Chest, Heart and Stroke, Northern Ireland.
Our portfolio includes:
Through these services, we also offer Hardship Grants for those in financial crisis.
Support available UK-wide
These services are delivered across the UK and are available for anyone anywhere. Stroke Association Support Groups are not reliant on local funding but are delivered in localities and are volunteer-led.
We also provide health information on our website and also via all of our services listed above.
Stroke Key Worker
Our Stroke Recovery Service is our most widely commissioned and available service, supporting circa 28,000 newly diagnosed stroke survivors a year. The core component of our Stroke Recovery Service is the support provided by our Stroke Coordinators. A Stroke Coordinator is a community-facing professional who supports the practical, informational, emotional and social support needs of people affected by stroke. They play a unique role within the stroke multidisciplinary team.
The type of support delivered by Stroke Coordinators is comparable to the type of support provided by Key Workers or Link Workers in other conditions such as cancer.
Our current context
There are some considerations to be aware of when carrying out this work:
Our Stroke Recovery Service is our most widely delivered service, delivering support to around 40,000 stroke survivors per year (note - this figure is different to that mentioned earlier, as some stroke survivors are supported beyond their first year post stroke). Whilst the service has a number of key components (such as personalised care and support planning and level 1 emotional support) it can be delivered flexibly to integrate into the local stroke pathway, therefore there is variability in the service we provide.
We have a bold ambition to try and reach every newly diagnosed stroke survivor by 2025. The Stroke Recovery Service is one of the ways in which we can reach people, however, we will be developing the service alongside our growing understanding of how to reach this ambition and anticipate changes to our delivery including possible integration into more widely available services so that we ensure equitable access to everyone affected by stroke. The insight gained through this evidence review will therefore be a key input into this work and the future design and delivery of our services.
The RCP Stroke Clinical Guidelines will be published in April 2023 and includes guidelines in the life after stroke space for the first time. The update lasts for five years and covers all four UK nations and the Republic of Ireland, so this a key opportunity for us to strengthen the evidence-base around the need for life after stroke services and influence for universal access to these services.
We have worked with NHS England to publish an Integrated Life After Stroke Service (ILASS) model. The model provides details about the types of life after stroke support that should be provided to stroke survivors across the stroke pathway. The longer-term support it describes should be commissioned alongside recommended community-based stroke care, as outlined in the Integrated Community Stroke Service (ICSS) model, which is also part of the overarching National Stroke Service Model (NSSM).
The model emphasises the types of services that can and should be provided by a 'Stroke Key Worker' - which is a more generalised term for a professional like a Stroke Association Stroke Coordinator, but which is not specific to the Stroke Association.
The types of interventions to be explored
We would like to understand the evidence base associated with both:
Services similar to our own Stroke Recovery Service and/or roles similar to our Stroke Coordinators / Stroke Key Workers (both within stroke and other conditions).
The individual intervention components that make up our Stroke Recovery Service and those that are listed in the ILASS model. These are listed in the table below.
* although not everywhere
Scope
The scope of this work should focus primarily on the collating and analysing of the evidence base for stroke key workers provided both through our own Stroke Recovery Services (via the Stroke Coordinator role) and through other key worker roles.
Therefore the evidence base should look far beyond our own services, drawing on key elements of the service and what is delivered elsewhere and in other service models. For example, key workers/link workers that work with patients post-discharge exist for other conditions such as cancer, and there are also equivalent roles internationally in developed countries. We would like this evidence to be drawn upon, as well as from related areas such as social prescribing, to give a fuller and more holistic view of the evidence that exists for these roles.
Although the published academic literature on life after stroke services and post-acute/community care has grown in the past few years, much of the evidence still sits in the 'grey literature' such as non-peer-reviewed reports and commissioned reviews from Think Tanks and others in the Third Sector. Therefore in addition to looking at clinical trials and published research, the evidence synthesis should include this more non-academic work - both nationally and internationally where feasible.
A further important component of this evidence review should be on better understanding the types of outcomes (and experiences) that should be measured for these interventions. Clinical or impairment-focused outcomes, or those related to burden on health systems, do not typically correlate easily to interventions delivered by key workers. However, this does not mean that the interventions are not impactful or do not meet the needs of the beneficiaries they serve. It will be important for this to be clear in any synthesis. We therefore also wish to understand the types of outcomes that can be used to demonstrate the benefits of these interventions to individual stroke survivors and the wider health and social care system.
Project objectives and outputs
We'd like this work to consider a number of questions:
1. What is the evidence-base associated with Stroke Coordinators / Key Workers, both:
a. Evidence considering similar services (including in stroke, but in other contexts too).
b. Evidence for the individual component interventions, plus other elements listed in the ILASS.
This should include consideration of the design of the interventions delivered, impact on different outcomes (including patient experience, and system / economic benefits), for whom, in what contexts etc.
2. What are the current strengths and weaknesses of the existing evidence base?
a. What are the gaps, strengths and weaknesses?
b. What are the pros and cons of different evidence sources?
c. Which sources should we continue to draw upon to update our understanding of effectiveness and to inform future service design?
The expected outputs for this work are:
1. A review, analysis and interpretation of the current literature related to the interventions provided by Key Workers addressing the questions described above. This should be in the form of a full report and an Executive Summary in plain English.
2. A peer-reviewed publication of the findings in a recognised journal in the stroke field.
Specification
We are looking for someone to carry out this review who:
Has a track record and experience of conducting literature reviews and synthesising the findings; or is a PhD student being supervised by someone with experience of conducting reviews.
Can complete the work within six months.
Will provide the report in Plain English, so that it can be understood by non-academics.
A knowledge of stroke or service delivery pathways is desirable.
The support we will provide
Previous evidence reviews and other reports in this space that may be useful.
Access to our internal evaluations of our services.
Project steering group that will meet monthly with the team to review progress, discuss challenges, and address issues as they arise.
Links to our networks and researchers in this space if this would be helpful.
Process
Please e-mail acquisitions@stroke.org.uk with your written proposal (subject heading: Key Worker Review Proposal), by 9 am on Monday 3 April 2023, to cover:
Number of days you estimate for the work to take.
Day rate or total price for the work.
Whether you are an individual trader or a limited company (or part of a trading association).
If VAT is applicable.
How you match the specification.
Please also include a timeline, with the key activities that you envisage, milestones and outputs.
Please explain who will carry out the work, the methodology and approach you will use, and previous experience the team has in conducting literature reviews or producing similar reports.
Include dates for submitting a draft report and receiving feedback, as well as a date for providing the final report.
Proposals will be reviewed by a panel of three people. Selection will not be made on the basis of cost alone. We may wish to interview the team before making a final decision. We will contact everyone concerned within two weeks of the closing date. Once we have made a selection, there will need to be a contracting process which may take another two to three weeks.