Lincolnshire set to transform stroke care through CLEAR Programme, improving patient outcomes and their experience of care
Stroke care in Lincolnshire is set to be transformed following a major service redesign delivered through the CLEAR Programme, with recommendations projected to improve the outcomes of stroke patients reduce hospital stays and enhance care in the community. The work has supported United Lincolnshire Hospitals NHS Trust (ULHT) and Lincolnshire Community Health Services NHS Trust (LCHS) to streamline pathways, strengthen multidisciplinary collaboration, and redesign both acute and community stroke services.
Dr Abduel Elmarimi, Clinical Lead and Consultant in Stroke Medicine at Lincoln County Hospital, said:
“The CLEAR team members were accessible, knowledgeable, and helped bridge long-standing gaps in our knowledge and experience of bringing acute and community teams together. It also helped us make a stronger case for change in a way that was more accessible and easier to understand both for clinical and managerial teams at all levels of the organisation.”
Analysis of five years of local stroke data revealed that half of stroke patients were transferred at least once during admission, extending stays by up to 32 days and reducing access to therapy by 45 percent. Rising demand on community stroke services, with admissions to inpatient rehabilitation increasing by 47 percent since 2020, highlighted the urgent need for change.
The CLEAR programme’s recommendations for acute services include developing a virtual stroke ward for patients with minor or no disability, streamlining emergency department to Stroke Unit transfers, prioritising bed management for stroke patients, introducing mimic pathways to reduce inappropriate admissions, and redesigning multidisciplinary teams and board rounds to improve decision-making. In community services, recommendations focus on integrating community stroke services into discharge planning, establishing a Stroke Case Management Team, consolidating rehabilitation into a Stroke Specialist Rehabilitation Unit, ringfencing rehabilitation beds, and deploying digital tools to reduce administrative burden.
Implementation is forecast to reduce acute and community hospital length of stay by around three days each, increase the proportion of patients spending the majority of their stay on specialist stroke wards, and deliver over 4,000 bed days per year. Patients are expected to benefit from faster, specialist-led care and more consistent therapy, while staff experience will improve through clearer roles and reduced administrative burden.
Patients and carers have welcomed the project and its recommendations, particularly the focus on timely access to the right care, improved rehabilitation across the pathway, and better long-term support after hospital discharge.
Claire Brewster, Managing Clinical Consultant at 33n, added:
“The new models of care and recommendations have been warmly received by patients and their carers. Their insight has been invaluable, highlighting how a stronger focus on rehabilitation, safe admission avoidance and better community and vocational support could make a real difference to recovery. Their perspective has helped shape a model of care that is more responsive to real needs. “
Many also spoke enthusiastically about the potential for a dedicated community-based stroke rehabilitation centre, with modern facilities and equipment to support both inpatient and outpatient recovery.
