One of the objectives of my redesign project has been to demonstrate improving quality can be achieved at the same time as reducing expenditure. Not an aim for the faint hearted, but one that we all know is now absolutely fundamental to the way we develop NHS services in the future. In fact, my business case was submitted and approved on this assumption, so it’s crucial I keep a grip on this.

The field work I have carried out over the last few months supports this assumption. There is a strong correlation between more intense, stroke specific, rehabilitation that is given in those early days and the reduced amount and complexity of longer term residual social care support. My work with patients and their carers has also reiterated their aspirations for being able to live more independently again, making the most of opportunities to do things for themselves.

If I am to make this redesign happen, I need to find a way to secure savings that will arise further along the stroke care pathway and use them to help pay for the increased therapy input required in those early days after stroke. This is a great opportunity to work jointly with social care colleagues to look at how we might pool our time and money resources to get a better fit with a much bigger impact.

Leicester’s social services have been really supportive of the stroke redesign project so far. This is when that support will be tested. We have started talking through the practical considerations we need to think about if we want to use savings to fund costs upstream. Also on the agenda are options to transfer data from health to social care information systems, the possibilities of joint rehabilitation assistant posts that can bridge the health and social care divide, and how formally pooling our financial resources might be the best approach to achieve this redesign.

I have been so impressed with the enthusiasm of my social care colleagues to work with me on this. The door to joint commissioning is wide open and we should be taking every opportunity to walk through it and get the biggest impact we can for our pounds spent. I know it will be tricky once we get down to the transactional detail of making it happen. But if we are clear about our aims then we are all agreed those details can be worked through.