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Header image for the current page Improving allocative value decision-making in the stroke pathway

Improving allocative value decision-making in the stroke pathway

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The Mid and South Essex stroke stewardship group wanted to better understand which of the interventions they delivered were high value and which were low value to inform decision-making on use of resources and investment.

Arden & GEM’s Healthcare Solutions team provided training and support to enable the group to use the Socio-Technical Allocation of Resources (STAR) process in value based decision-making. As a result, the MSE stroke stewardship group has the insight needed to improve the allocation of their existing resources and improve outcomes for their patients.

The challenge

Mid and South Essex (MSE) Integrated Care System has established stewardship groups, within key service areas, with responsibility for considering the health needs of their population and coordinating care across organisations and sectors. One of these key service areas is stroke care.

The MSE stroke stewardship group wanted to better understand which interventions they delivered were high value and should continue to be invested in and which interventions were of low or no value and should potentially be stopped. Disinvestment in some interventions could then possibly be used to move resources into higher value interventions.

Arden & GEM had already collaborated with the Oxford Value and Stewardship Programme to deliver a customised development programme for the six MSE stewardship groups. Arden & GEM was commissioned to continue working with the stoke stewardship group, supporting them in using the STAR approach to improve value based decision-making.

Our solution

Arden & GEM’s Healthcare Solutions team planned a programme of support with the following objectives:

Introducing the STAR process
The group was introduced to the STAR process as part of the previous development programme. STAR is an innovative approach, developed by The Health Foundation and the London School of Economic, that supports healthcare commissioners in decision analysis by combining technical value-for-money analysis with stakeholder engagement. The STAR tools and methodology underpinned the two workshops delivered by the Arden & GEM team, with introductory information sent to participants in advance of the sessions.

Facilitating dedicated sessions
The team began by preparing and facilitating an initial half day session which brought together attendees from the stroke stewardship group with patients to identify stroke pathway interventions across prevention, acute and recovery. The output was a list of possible interventions for further exploration and an initial categorisation by ‘potential disinvestments’ and ‘potential increased investment’.

Two months later, a further half day workshop was delivered to undertake a more detailed analysis of the two options lists. Potential interventions for disinvestment were explored with estimates of resources that could be released calculated. Where interventions were shown to be delivering value, there was further consideration of whether they could be increased and what resources would be required to achieve this.

Reviewing the evidence
Public health experts within the Healthcare Solutions team also conducted a librarian review of economic evidence relating to cost-effectiveness of the stroke interventions to feed into the first workshop. This comprised a review of existing economic cost-effectiveness assessments (ideally by NICE as these are recognised as the guiding authority within the NHS). Where an economic assessment hadn’t been undertaken then this was noted for further consideration.


Following the training, workshops and evidence reviews, the MSE stroke stewardship group now has the information and process needed to improve allocation of their existing resources.

Stakeholders have come together to collaboratively identify, investigate, discuss and categorise interventions so that decision-making can be value based and ultimately improve outcomes for patients.

"The STAR process, which Arden & GEM facilitated, helped us to involve a much broader range of people, including clinicians, stroke survivors and their carers, in decision making about the future of stroke services. By boiling down complex information and presenting this in simple, visual ways, we were able to break down barriers and in doing so have developed a new and effective tool for shaping services in the ICS in the future."

Edward Cox, Director of Clinical Policy at NHS Mid and South Essex ICS