Bridges in Practice: Community Stroke and Neuro Rehab, Guy’s and St Thomas’

2nd October 2026

We sat down with Karen Coster, Deputy Clinical Lead at the Community Stroke and Neuro-Rehabilitation Service at Guy’s and St Thomas’ NHS Foundation Trust, to find out about the effect Bridges has had on their service since she started training her team in 2019.

The Community Stroke and Neuro-Rehabilitation Service at Guy’s and St Thomas’ NHS Foundation Trust supports adults in Lambeth and Southwark who have had a stroke or are living with other neurological conditions. The service includes multidisciplinary staff such as Rehabilitation Consultants, Occupational Therapists, Speech and Language Therapists, Physiotherapists, Neuropsychologists, Nurses and Social Workers.

Why Bridges?

“The older, traditional model of one-to-one didactic therapy meant that we weren’t going to have the capacity to meet a growing demand. We had to work differently. The evidence base shows we know we need to be working in a self-management way, and all of the policies and guidelines that we work under advocate the need for self-management. The leadership are invested in it. They want us to see more patients. The sooner we can see people, the better. Obviously that’s part of the NHS 10-year plan, but we also know that it’s better for the patient, reducing their secondary complications.”

“Working in the Bridges way that helps us manage our capacity and demand is really helpful. Since using Bridges in our service, I’ve definitely seen that we direct our resources to where they’re needed most. While Bridges may not reduce the length of stay, we are not providing the same level of intensity each week, so staff have more capacity.”

“We adopted Bridges in our service as the approach has a really good evidence base with the stroke and neuro population. It’s already got all of the tools, the books, the structure to then be able to deliver effective, personalised self-management support.”  Importantly, it offers a ready implementation route and it aligns with system realities. “It saves you having to work out how to implement it. It’s set up as a way to train and induct staff to be able to deliver self-management.”

Implementing and sustaining Bridges effectively

 “Keeping a workforce that was trained in Bridges was a real challenge. The transient nature of everywhere I’ve worked in London means you can move places quite easily.”

Karen’s solution was to initially prioritise training staff in static posts, the staff in Band 7 and Band 3 & 4 roles. While this was effective to embed Bridges and make it ‘business as usual’, Karen “was really noticing that there were too many gaps in the Band 6s.”

“We applied for more funding and then we were able to get the Band 6s trained.” This has had a big effect on how Bridges is viewed within not only Karen’s team but other teams they work closely with. Staff at Band 6 level tend to be staff on a neuro rotation, working within services that refer into Karen’s. The better their knowledge is of Bridges then the better the referrals they receive, but also the more prepared their patients are to work in a Bridges way, delivering greater impact across the pathway.

“Bridges Champions have definitely been one of the biggest aspects of sustaining Bridges in the team and service effectively. I started out by being one of the only ones flying the Bridges flag but as we’ve embarked on our Bridges journey together, other Champions have really embraced their role and are taking things on in new and exciting directions. We meet collaboratively with Bridges Champions from other teams in the wider service, and from other teams through the Bridges networks, and there is a lot of peer support and learning that we share amongst each-other, sharing ideas and helping to keep momentum, particularly in some of our service development projects.

She also revealed how critical it has been to get the buy in from her senior leaders “Their support has been so helpful in orchestrating all the funding behind the scenes, getting more people trained and creating space in team meeting agendas.” They have recognised the value of this as an approach and the benefits it brings to patients and families, staff and team and the wider service and system.

Service impact

Karen identified some key operational shifts she and her colleagues made using the Bridges approach which improved how their service operated:

Longer initial assessments

 “Giving our staff permission to do that longer initial assessment to establish what’s most important to the patient in the here and now. It can take more time in the beginning, but when you really identify what’s most important to them, and tailor the intervention to that, then it doesn’t take more time in the long run.

It does sound counterproductive, like I want you to see more patients but you’re going to spend more time with them, but we give staff permission from the outset that that’s how we work as a team. The staff definitely prefer working in that way, and the feedback we get from patients when surveying them on discharge is that they felt that they were listened to and that they had a really positive experience.”

Groups for waiting list patients

 “We’ve set up a Parkinson’s group based on evidence that peer support strengthens a person’s ability to self-manage.” They might not be able to remove the wait itself, but they were able to start to get people engaged with their service and introduced to a self-management mindset during that time they were on the waiting list.

“We do a screening call to identify patients that might be appropriate for a group, to then set up an exercise program, provide an element of education and an element of peer support in those groups for people who are already on a waiting list.” 

Self-referral and discharge

 “A patient can self-refer again at any time.” This allows patients to not feel abandoned at the end of care and work on their goals over a longer period of time, and has helped resolve patient complaints where people have not wanted to be discharged from the service.

Changing language around their old discharge report; now an end of care summary report, and using this with the Bridges goal-setting template, has helped show the patient in a visual way the steps they have taken and the next steps they have planned. This helps patients by showing them that it is not the end, but a transition period in recovery. “While the patient may still think they are being discharged too soon, they have agreed next steps in a clear way with the option to return to the service at the next stage.”

“Having the framework for the goal setting, self-referral, and writing the summary letter in a patient-friendly format, which Bridges has helped us implement, has helped us feel much more equipped to have those challenging conversations.”

Team Changes

Bridges supported the change of team discussions away from lists of people’s impairments towards what people can do instead. “Changing our MDM proforma so that we’re talking about what’s most important to the patient. Not necessarily just what impairments they have, but the barriers to recognising what’s important to them.” This has focussed the discussion while helping the team be more holistic and has achieved more ownership by patients.

Karen introduced a phrase from a Bridges webinar she attended several years ago, “What is your responsibility and where does it stop? ”They have integrated it into their supervision process, which has “helped the team identify their role when not all of the patients’ problems are relevant to their goals or us as a service.”

How it feels to work in this way

Karen then went on to reflect how Bridges changed how she works with patients and what it has brought to her as a professional. “The most significant aspect of the ways Bridges has changed how I interact with patients and families is learning how to blend my expertise with theirs. They are the experts on what’s going to work best for them, understanding their health beliefs and supporting their priorities has made my job so much more interesting and enjoyable. Being able to work with patients to find out what they need from me; being able to ask, “What do you need my support with, or “When do you need me to see you again”.

She explains, “I really feel a sense of freedom in the way that we tailor our rehab programs. The team do an amazing job of offering bespoke person-centred interventions. The freedom to then just work with what the patient wants rather than trying to meet our own agenda or working towards a fixed time frame.”

“Lots of us went into healthcare because we genuinely love the people and we’re interested in people. That was made so much easier using the Bridges approach.”