Coastal Gap in Equality for Stroke Care Management (CoastGEM)

Reducing inequality. Improving care.

People living in areas of high deprivation and inequality already face a multitude of health problems such as cardio-vascular disease and circulatory issues, which increase the risk of a stroke. Health and social care services in these areas are also underfunded, creating a dual issue; more people need support, but there is less money to fund that support.

The East Suffolk and North Essex coastal areas rank highly in the Index of Multiple Deprivation. As a result, the School of Health and Social Care is running this project in collaboration with East Suffolk and North Essex NHS Foundation Trust to identify inequalities in effective stroke care, their negative health outcomes, and their determinants.

Work streams

The project is structured into three primary workstreams that follow a phased approach:

1. Quantitative Workstream to Identify Inequalities in Stroke Care: This phase aims to determine the extent of inequalities in stroke care delivery and their negative health outcomes. It also examines the determinants of these disparities related to gender, ethnicity, age, and their intersections across ESNEFT’s service area compared to the national landscape in England. By using robust data sources, including SSNAP and NHS Digital. The findings will inform actionable recommendations to improve stroke care coverage and outcomes.
2. Qualitative Workstream to Explore Individual and Structural Barriers: It delves into the intersection of personal and structural factors influencing access to stroke services. By gathering service users' perspectives, it provides insights into barriers affecting care utilisation.
3. ESNEFT’s Stroke System Assessment Workstream: This segment focuses on evaluating how different components of the health system contribute to disparities and inequalities across the stroke care pathway. From the point of view of service providers and field professionals, this workstream will gather insights on the challenges faced in delivering equitable care and identify opportunities for systemic improvements.

Our research will involve stakeholders from both service provider (clinicians and healthcare professionals) and service user (patients and their carers) groups. By involving multiple participants involved in stroke care we will gain a better understanding of the needs and frustrations across the board. This will allow us to make recommendations that will improve stroke care for all.

Outcomes

As part of the ESNEFT Stroke System Assessment workstream we have already identified three key areas for improving stroke care:

• Equitable Allocation of Rehabilitation Beds to ensure all stroke survivors have access to appropriate recovery resources.
• A Data System for Health Inequality Monitoring to have a systematic approach to data collection across the stroke rehabilitation pathway after patients leave hospital.
• Enhanced Post-Stroke Care for Patients with Comorbidities, focusing on improving the integration, availability, and ability to navigate follow-up care and ensuring tailored support for diverse health needs to enhance long-term outcomes.

By improving stroke recovery from an early stage we can reduce the physical and mental health impacts on patients and their carers. Earlier and better recovery will also reduce the cost of long-term care and rehabilitation services, reducing pressure on a stretched healthcare sector.

We have published a short report on the findings from our Rehabilitation and Life After Stroke workshop. A full report is available on request, please email Katie Chadd at katie.chadd@essex.ac.uk.