Making rehabilitation work better for people 1 st December 2014 - - PowerPoint PPT Presentation

1st December 2014

#rehabilitation

Welcome to the webinar:

Making rehabilitation work better for people

Chair of webinar: Presenters: Jane Nicklin

Senior Associate NHS Clinical Soft Intelligence Service

Penny Roberts

Service user member NHS England Improving Rehabilitation Services Delivery Board

Jon Barrick

Chief Executive The Stroke Association

Lindsey Hughes

Rehabilitation Programme Lead NHS England

Welcome

Jane Nicklin

Senior Associate NHS Clinical Soft Intelligence Service

Penny Roberts

Service User Member NHS England Improving Rehabilitation Services Delivery Board

Making Rehabilitation Work Better for People

Penny Roberts – Service user member

• f the NHS England Improving

Rehabilitation Services Delivery Board

Rehabilitation is everyone’s business

• It starts with the messages given to people at

the very beginning, after accident, illness or injury.

People see me and assume I have no function other than to be 'cared for'

• We need to change that expectation
• Education and change of attitude is the key

Rehabilitation should empower patients to 'get back to living life'

• We need to change that expectation rather

than imposing a standardised care system that people can't escape

Rehabilitation needs to be seen in a more flexible way

• …not just a period one goes through, in-

between being 'ill' and 'totally cured'

An integrated budget made the biggest difference to me

• Assistants, supporting me to get on with my

life, made the difference between being the real me and ‘an existence’

We need to measure and value the difference made by quality of life

• Previously, I was visited by up to 15 different

people in a day (carers, district nurses etc.)

• I had:

– many health problems – poor quality care – frequent hospital admissions – pressure sores – pain – and an expectation that this would never improve

Which is best value?

• I am now well... I don't take

any drugs, I don't have any

• f the complications

expected for a spinal injured patient of 20 years

• I haven't had a hospital

admission for 16 years, I rarely see my GP, I have no pain and I'm fit and active

• I also contribute to society

and I'm an employer and educator of others

Jon Barrick

Chief Executive The Stroke Association

Stroke Helpline 0303 3033 100 stroke.org.uk

Making rehabilitation work better for people

Jon Barrick CEO Stroke Association

Webinar Monday 1st December

Stroke Helpline 0303 3033 100 stroke.org.uk

Stroke: Key facts

• 2nd biggest killer in the world, Number one cause
• f severe disability in the world and in UK
• Due to medical advances more people now

surviving stroke so number of survivors in population rising, currently around 1.2 million in UK

• Can happen to anyone, anytime, any age, around

500 children a year have a stroke

Stroke Helpline 0303 3033 100 stroke.org.uk

Stroke Association Facts

• Help 66,000 stroke survivors and their families in direct

services each year funded by NHS and local authority

• Have a national helpline and have 6000+ trained volunteers
• Operate in all 4 countries of UK
• 395 services on ground, and additional 450 stroke clubs and

groups

• Main funder of Stroke Research for the last 22 years, in active

contact with 6000 stroke medical and care professionals

• 800 paid staff working out of 193 locations
• Shortlisted 4 times in last 9 years as Britain's Best Charity

Stroke Helpline 0303 3033 100 stroke.org.uk

Stroke Survivors views

• Most recipients of rehabilitation biggest

complaint is that the “dosage” is rationed

• That the NHS in being “evidence” driven

doesn’t use the evidence of users views, or recognise adequately that research itself does not exist to specify good practice so many questions are unanswered.

• That the “system” constrains patient centric

care

Stroke Helpline 0303 3033 100 stroke.org.uk

Done with, not done to

• Why rehabilitation, people need to understand , and

consequences

• Linking in to support mechanisms beyond the medical
• The NHS is not the health system, it is a very important

component, but there are other resources..

• Most limited resources are time and expertise, the therapist

has expertise, the client has time, how can the challenge of this be met

• NHS is dominated by risk aversion and problematic change

management, culture clash with those determined to give patient choice

Stroke Helpline 0303 3033 100 stroke.org.uk

Dosage rationing and closed system. Income and Costs Fixed

Income too low Costs too high Fix income, (bring in more) or close Fix the operations by achieving productivity improvement (costs held but work faster, longer, or smarter to pack in more) Reduce operation (dosage or numbers employed) to meet income Can’t reduce costs or fix operations then find someone else to do it, part of it or close

Room for re managing is very small

Stroke Helpline 0303 3033 100 stroke.org.uk

Dosage limited, consequences are

• NHS System works within budget
• Concept of a patient journey to a goal they determine along

a care pathway has to be a secondary consideration

• Concept of researching positive change further along 2, 5 ,

10 years not done very often. Result is concept of structured services around patients based on optimising individuals over years doesn’t occur

• NHS patients not receiving rehabilitation that could reduce

societal costs and possibility of reduced years of life with quality of life reductions

Stroke Helpline 0303 3033 100 stroke.org.uk

Expanding the view,

• ptions
• State gives more money to NHS rehabilitation
• Look for Productivity improvements particularly using new

technologies that the patient can use at home or with family

• Less individual, more group work
• New systems of working involving more resource being

brought in. Broadening concept of good practice

• Examples from the Stroke Association
• Communication Support and Communication +
• Stroke Association Child Stroke project with Evelina
• London Back to Work Service

Stroke Helpline 0303 3033 100 stroke.org.uk

Children and stroke

• Operating out of the Evelina Hospital and within

the Community

• Child stroke support co-ordinator
• Conduit to help parents/child understand the

therapies and work out what is appropriate

• Previous potentially long waits for therapy is

resolved

• Integration across geographies and system
• Better independence, outcomes and benefits for

child and family over a lifetime.

Stroke Helpline 0303 3033 100 stroke.org.uk

Return to work

• Almost a third (31%) of strokes occur in people under 65
• For many returning to work is important, not just for financial

reasons but to rebuild confidence and regain independence.

• Return to existing work can be possible but also new
• pportunities including volunteering
• Unfortunately only a small number are successful in returning to

work.

• Impairments caused by stroke can act as a barrier to some roles,

these may not become clear until survivor has returned to work – can result in crisis points

• Lack of stroke awareness from employers, failure to focus on

what survivors can do and a lack of practical support to help build survivors confidence and skills are also significant.

• Currently vocational rehabilitation services are patchy

Stroke Helpline 0303 3033 100 stroke.org.uk

Back to work Project

• 3 year Back to Work project in London provides support and

guidance for stroke survivors to return to existing work after stroke or to access new opportunities

• Caseload of around 25 people at various stages of
• Support for survivors through workshops on topics like

mindfulness, confidence building and assertiveness in the workplace

• Focus on working with survivors and employers to find low cost

practical solutions to some of the barriers they experience

• Works with employers through information, advice and training
• n stroke and it’s impacts
• Works best when alongside team of multidisciplinary

professionals

• Contact project manager kate.pieroudis@stroke.org.uk

Stroke Helpline 0303 3033 100 stroke.org.uk

Results

• Patients and families understand the therapies
• Person centric time allocation, outcomes and choices
• Receive what is relevant and appropriate
• Motivational and more “round the clock” support
• Individuals and families cope better
• More people drawn into supportive and change driven

activity

• Better independence and disability outcomes
• Benefits over a lifetime
• Therapists as part of a network, fight against arbitrary

bureaucratic boundaries

• Cost effective over long term

Stroke Helpline 0303 3033 100 stroke.org.uk

Reworking Our Service Model

Hospital to community – EIS-Stroke Recovery Navigator/Co-ordinator Rehabilitation/Reablement/Support-intensive

rehabilitation/exercise referral

Review Services Back to Work& Study Skills Service Communication support service- Aphasia, Dysphasia etc. Emotional needs support-Anxiety, depression, etc. Supported self management and confidence building-SASHA Secondary prevention Carer- Assessment and support Advocacy Specialist Childhood Stroke Service

Specialist

Advice & Information One to one support Online community Telephone Helpline Voluntary Groups and Clubs: Peer support, Sign-posting, Carer network and support, Befriending, Rehabilitation and Exercise programmes, emotional support Grants My Stroke Guide (SASHA)

Added Value

Sustaining Independence Building Social Capital

Contracted Services

Reablement, Support and Rehabilitation

Person Centred

Stroke Helpline 0303 3033 100 stroke.org.uk

Self management

For more information Helpline: 0303 3033 100 Website: stroke.org.uk

Lindsey Hughes

Rehabilitation Programme Lead NHS England

www.england.nhs.uk

Rehabilitation is everyone’s business

Lindsey Hughes Rehabilitation Programme Lead

1st December 2014

www.england.nhs.uk

• 2012 CAHPO asked by Sir Bruce Keogh to

establish if there was a case of need to improve adult rehabilitation services

• examples of good innovative practice and

service design but poor adoption and dissemination

• clinicians and service users - unsure of

services available and how to access them

• IARS COP
• 2013/14 Rehabilitation Engagement Project
• NHS IQ – Good practice examples

Improving Rehabilitation Programme

www.england.nhs.uk

Rehabilitation Team

Regional Rehabilitation Lead - North Sarah Sewell Regional Rehabilitation Lead - South Jackie Turnpenney Regional Rehabilitation Lead – Midlands and East Joanne Fillingham Regional Rehabilitation Lead - London Karen Robb Admin Assistant Peter King Admin Assistant Jessica Beach National Clinical Director John Etherington Deputy CAHPO Shelagh Morris Children and Young People Scoping Project Lead Anne Gordon Rehabilitation Programme Lead Lindsey Hughes

www.england.nhs.uk

• Create and communicate

the strategic vision for the NHS England rehabilitation programme

• Drive a whole system

approach to improving rehabilitation services

• Priorities

Return to work Long Term conditions

Rehabilitation Delivery Board

• System representation
• Service user
• NHS England
• PHE
• DWP
• ADASS
• CCGs
• AHPF
• BSRM
• RCGP

www.england.nhs.uk

• Regional Rehabilitation Leads
• Children and Young People’s rehabilitation scoping

project

• IRS Community of Practice
• Discussion forum
• Snapshots
• Soft intelligence questions
• Twitter conversations
• National Rehabilitation Conference 31st March 2015

Get involved

www.england.nhs.uk

• Remit of the regional leads
• Needed for the CYP scoping project
• Promotes dialogue
• Proves it can be done!
• Small change big impact – if introduced widely
• Five Year Forward View – “no one size fits all” but

can’t let “a thousand flowers bloom”

• Cross boundary working

Sharing good practice is critical

www.england.nhs.uk

Contacts:

Post Post holder Email address Rehabilitation Programme Lead Lindsey Hughes Lindseyhughes@nhs.net Children and Young People’s Rehabilitation Scoping Project Lead Anne Gordon Anne.gordon3@nhs.net Regional Rehabilitation Leads North of England Sarah Sewell Sarah.sewell1@nhs.net Midlands and East of England Joanne Fillingham Jo.fillingham@nhs.net South of England Jackie Turnpenney jackieturnpenney@nhs.net London Karen Robb Karen.robb3@nhs.net

www.england.nhs.uk

NHS IQ – good practice examples

http://www.nhsiq.nhs.uk/improvement-programmes/acute- care/recovery,-rehabilitation-and-reablement.aspx

Any Questions?

Joining in the conversation

Community of Practice Forum on NHS Networks Post your comments and information you want to share on: http://bit.ly/1nZVn8t

NHS Clinical Soft Intelligence Service Hosted by NHS Warrington CCG

Become a contact on the Community of Practice

email Katherine Andrews at katherine.andrews@nhs-commissioning.net

with your name, role, organisation, email, telephone contacts and region

1. A named contact for IRS - title your email ‘Named contact for IRS’

– You will receive direct emails -news and information – we will share your contact details with NHS England and other related work programmes so that they may contact you directly as someone with a local interest in IARS.

2. A general contact for IRS - title your email ‘General contact for IRS’

– You will receive direct emails -news and information – your contact details will not be shared with NHS England or other related work

• programmes. For data protection, contact details provided under the heading

‘General contact for IARS’ will be included in a database of contacts used only by the NHSCSI team.

NHS Clinical Soft Intelligence Service Hosted by NHS Warrington CCG

What are you doing? What is your experience?

• Tell the community of practice about your

rehabilitation developments: –‘Snapshots’ – complete the form http://bit.ly/1ul3Xht –‘Soft intelligence’ - respond to our invitations to tell us your views http://bit.ly/1nZVn8t

NHS Clinical Soft Intelligence Service Hosted by NHS Warrington CCG

Upcoming webinars

• 19th January
• 5th February
• 2nd March