Development of Stroke-Specific Vocational Rehabilitation

"Early intervention for those who develop a health condition should be provided by healthcare professionals who increasingly see retention in or return to work as a key outcome in the treatment and care of working-age people."
— Dame Carol Black, 2008

Every year more than 10,000 working age people suffer a stroke. Although returning to work is a key goal and critical to health, wellbeing and financial independence, less than half of stroke survivors return and many who would like to work can't access the support they need to do so.

Stroke rehabilitation often acts as a barrier in that it ends prematurely, intervenes too late or lacks content to facilitate a return to work.

Despite national policy directives supporting the establishment of vocational rehabilitation (VR) services, conflicting commissioning priorities, a lack of robust evidence and poor descriptions of content to inform service delivery and local commissioning mean that it is not routinely delivered, and where it is, services are often limited. Only 37% of PCTs provide rehabilitation that addresses work needs (Quality Care Commission, 2011).

Study aims

This study addresses the problem of getting stroke survivors back to work after a stroke. We want to understand more about the ways in which stroke survivors are currently supported to return to work by existing services in health and social care, the Department for Work and Pensions and the independent and voluntary sectors and the factors that help or hinder them on this journey.

By identifying service gaps and unmet need, we hope to develop and test a stroke specific return to work intervention that is acceptable to stroke survivors and employers and which can be implemented in the NHS.

Therefore the purpose of this study is to design a vocational rehabilitation service for stroke survivors by first exploring:

What people with stroke, their employers and other stakeholders (NHS, Job Centre Plus and the Third Sector providers) want; gaps in existing provision and the contextual factors likely to affect VR service delivery in CLAHRC- NDL and elsewhere.
Then a service can be developed and its feasibility and cost effectiveness, usefulness and acceptability tested in a pilot RCT.

Findings so far

Preliminary systems analysis and stakeholder interview findings:

Many different stakeholders in health and social care, the voluntary and independent sector offer advice about returning to work but few assess a person's abilities in relation to their job or go into the workplace.
Existing health services for people with stroke fall short of meeting work needs. The lack of a sanctioned Vocational Rehabilitation pathway means access to support relies on brokered provision and knowledge of health systems. There are geographical differences in service provision, and people with milder strokes are often missed. Those who need help later struggle to access services because they are full to capacity.

Some health providers have difficulty liaising with employers due to lack of confidence, uncertainty about boundaries, legal and consent issues.
Partnership working between health and other sectors is complicated by fragmented services and limited knowledge of co-existing services.
Stroke presents challenges to the timing of VR intervention, retraining and finding new employment.
People with stroke want individually tailored support, family involvement, advice for GPs and employers and providers with stroke specialist and VR knowledge.
VR services are fragile and not always seen as core health business. The lack of stroke specific VR evidence and competing commissioning priorities pose a threat to future delivery.