John Etherington. Transforming Rehabilitation. National Clinical Director for Rehabilitation and Recovering in the Community

Transcription

1 John Etherington Transforming Rehabilitation National Clinical Director for Rehabilitation and Recovering in the Community

2 Vision: Rehabilitation will be key to every episode of care across all settings to maximise mental and physical health, well-being, independence and participation Aims high and includes vocational outcomes occupation, employment and education

3 Rehabilitation Plans For: Diabetes Cardiopulmonary Disease Mental Illness Cancer MSK Trauma Frail and Elderly

4 Stove Pipes? Acquired Brain Injury Limb Fitting Spinal Cord Injury

5 Paradigm shift Everyone s business Rehabilitation is integral to recovery from illness or injury - It is essential not a nice to have Embedded in the NHS to reduce readmissions to enhance the proper caring discharge of patients Rehabilitation for everyone - not just those with specialist needs We have to afford it. The NHS Outcomes Framework will only be delivered if rehabilitation improves

6 Imagine a condition with an effective treatment e.g. Acute MI Wrong sort of MI Can t see you this month - we are full Go to my less experienced colleague with no facilities Your CCG doesn t fund it You are only allowed one contact with the specialist team Roofer Fractured Pelvis Brachial Plexus Injury Fractured femur

7 Why Change? Rehabilitation Bio-psychosocial model - works Effective needs more evidence of cost-utility Patients value it - delivers the outcomes they want Conflicts have raised profile opportunity Reduces dependency on the State Delivers tax payers

8 Why Change? The New NHS Outcomes focussed Patient Centred It s the right thing to do

9 Rehabilitation Narrowing the Gap Episode of Ill-Health Enhanced Survival Reduced Morbidity Reduced Readmissions Reduced Medication Reduced Social dependence Patient Health /Functional status Deterioration in Health Rehabilitation Increased Vocational output Increased Tax Revenue Improved Quality of Life

10 Patient Health / Functional status Episode of Ill-Health

11 Rehabilitation Resisting the Decline

12 The Consequences of War Fighting

13 Complex Trauma Numbers individual inpatients of which 680 have been battle related, 632 from Herrick/Telic. 59% - 41% split BI:NBI. 200 active patients Amputee numbers falling New Total

14 Case Example Bilateral lower limb amputation Pelvic fracture Bowel damage with colostomy Multiple finger and upper limb tendon damage Multiple soft tissue loss and grafting

15 Defence Rehabilitation Lessons Learnt Early assessment and intervention Accurate diagnosis Multi-disciplinary team working Rapid access to onward referral for further opinion Close relationships between teams Active Case management Exercise-based rehabilitation Group therapy

16 WEEKLY TIMETALE Monday Tuesday Wednesday Thursday Friday Warm-up Warm-up Warm-up Warm-up Warm-up Intensity Hydrotherapy Hydrotherapy Hydrotherapy Hydrotherapy Hydrotherapy CT CT CT CT CT CT CT CT CT CT Break Break Break Break Break IP IP IP IP IP S&C S&C S&C S&C S&C Lunch Lunch Lunch Lunch Swim CT CT CT CT Lunch Swim IP IP IP RT RT RT RT Break Break Break Break CT CT CT CT Hydro Hydro Hydro Hydro

17 Force sensors in the pylon detect loading of the foot and ankle. Microprocessor Knee Systems Additional sensors read the angle of the knee joint. This data is read 50-times per second by the on-board microprocessor Increased stability, ease of swing, and greater efficiency Knee-disarticulation version available.

18 Prosthetics

19 Vocational Rehabilitation Work Prep Work Placement Support Follow-up

20 Return to Duty Headley Court Sufficient recovery Work Assessment Voc Rehab Support in Work RTU Down-graded

21 Prosthetic Outcomes Genium enhances function 6 min walk test 25 Duration from injury to RTW following final discharge from Complex Trauma Vocational outcome Number of patients <3mths 3-6mths 6-9mths 9-12mths 12-15mths 15-18mths 18mths - 2yrs 2-3yrs 3-5yrs >5yrs Duration from injury to RTW

22 Independent living at 4 mo (n=101) Frequency Frequency Distribution Majority of patients live independently (86%) Significant difference in median MPAI T score between who can v cannot live independently Cut off 52 0 no yes Independent living at 4mo No: 15 (14.9%) ; Yes: 86 (85.1%)

23 Employment status at 4 month (n=101) Frequency Distribution Majority are employed (59.4%) or are employable (17.8%) = 77.2% Frequency Only 22.8% will not work Significant difference in median MPAI T score between who can v cannot work 10 0 no employable Employment status at 4mo McGilloway, E and Dharm-Dhatta,S

24 Defence Rehabilitation Intensity Responsiveness to demand Good outcomes take time

25 Obstacles to Change Rehabilitation community is marginalised Lack of strategic leadership posts therefore lack of influence and easy target to cut Acute community often doesn t see value Social Care model as it can promote dependence and cause conflict over funding.

26 Obstacles to Change Capability Structure Restricted patient access Capacity Not enough units / trained people We can t afford it Attitudes

27 Initial Stakeholder Events Tasked with: Identifying key challenges and gaps Identifying what would help to address these Identifying key principles and objectives that should underpin high quality adult rehabilitation services

28 Scope of project Priorities Adult rehabilitation services Physical and mental health Transition Later Tertiary specialist to local specialist and general From C&YP services Tertiary specialist rehabilitation services C & YP rehabilitation services

29 Background Previous work reviewing adult rehabilitation services Chief Allied Health Professions Officer Evidence base review NHS Improving Quality (NHS IQ) Mapping of rehabilitation services NHSIQ Urgent and Emergency Care Review template Stakeholder engagement to draft, agree and disseminate principles and ambitions for adult rehabilitation services

30 A typical patient acute episode pathway In hospital phase, with current tariff payment for whole hospital spell Social Care / Community Cost Need for clinical input/support Pre admission/ community phase Acute phase Recovery phase Step down from hospital to community Home/social care/other A B C Time D

31 change the tariff at the point when the patients needs change and not when they change institution Assessment prescription for recovery primary care, community social care and patient the R point Need for clinical input/support Pre admission community phase Acute phase RRR HRG group Recovery, rehabilitation and re-ablement A B Hospital C D

32 Integrated Care Integrated Care and Support: Our Shared Commitment May 2013 National Collaboration for Integrated Care and Support

33 How do we Change? Ambition Identify best quality care Alter commissioning structures Networks Rehabilitation leadership New ways of working Earlier Intervention Generic forms of Rehabilitation Exercise-based medicine Outcomes

34 Elective Intervention

35 Episodes of Care Re-access

36 What Next? Consultation Principles and Expectations Rehabilitation Delivery Board Develop a framework for service development Service specifications Commissioning structure review Workforce Planning