What are rehabilitation, enablement and reablement?

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1 What are rehabilitation, enablement and reablement? Why are they important? Rehabilitation, enablement and reablement services help patients who have experienced changes to their health as a result of illness, injury, or a surgical procedure. These services work with patients to restore their independence, by addressing their physical limitations and using adaptations to reduce the overall impact on their life. There is an emerging view that a patient who is admitted into hospital following an emergency, like Joan, should be given a rehabilitation plan as soon as possible after they have been admitted. It is also thought that every patient going into hospital for a planned procedure should be given a rehabilitation plan before even being admitted to hospital. In both scenarios, the purpose is to enable rehabilitation to start as soon as a patient is ready on the ward, with the aim of getting the patient home quickly and enabling them to live as independently as possible. Rehabilitation, enablement and reablement review intro What is the Healthy Futures Programme? What is the review process? Meet the project board What matters to patients and carers? Graffiti wall For more info... Printer friendly version As with Joan s experience, it is thought that a large proportion of rehabilitation, enablement and reablement services should be provided in a community setting. A package of care should be provided, which is individualised to meet the patient s needs. Depending on the patient s need, it may be possible to prevent them needing to go into hospital at all, if a comprehensive package of care can be provided early in the home. There is a need for different rehabilitation, enablement and reablement services to be provided at different stages of the patient rehabilitation journey, relating to the patient s individual degree of dependency. The transition of care between services needs to be as seamless as possible so the services provided by the hospitals work well with the community services provided by the community health providers, social services and the voluntary sector.

2 Case Study Joan Butler is 74 years old and lives at home with her husband Gordon in North Bristol. Joan recently had a stroke and was admitted to Southmead Hospital after Gordon rang 999. Joan received a period of rehabilitation from a physiotherapist, speech therapist, occupational therapist and dietician during her stay on the Acute Stroke Ward at Southmead. After ten days on the ward, she was ready to be discharged, although she still had numerous rehabilitation needs. Staff decided that Joan could go back home once a comprehensive package of care had been put in place. Joan also has dementia, so she already had staff from the Community Mental Health Team visiting her at home. An occupational therapist from the local authority was also already involved with her care, helping with behavioural problems she had linked to her dementia. However, further input was now necessary from the occupational therapist to resolve some issues relating to the stroke. Following her discharge, Joan now needed input from a speech and language therapist, as the stroke had affected her communication. She also needed help from the community dietician to ensure her needs were met with regards to her swallowing problems. A physiotherapist was required to help her to regain her mobility. It was arranged that in the short term a care worker would come to the house once a day to support Gordon with Joan s general care needs. As Joan s main carer, it is important that Gordon gets the support he needs. He was encouraged to make contact with the Carers Trust to get help for himself, and they were both advised to contact the local area Stroke Foundation support group. Some minor adaptations to the house were also required to help Joan regain her independence, so the couple made contact with Care and Repair (a charity who provide services to home owners over 60 or disabled), and a workman came and completed the necessary work for them.

3 Rehabilitation: An active process by which those disabled by injury/disease achieve a full recovery, or if full recovery is not possible, realise their optimal physical, mental and social potential and are integrated into their most appropriate environment. 1 Rehabilitation is goal orientated and involves a mixture of clinical, therapeutic, social and environmental interventions. 1 Dr DM Beaumont, Dr J Morris, BGS Policy Unit Position Paper Rehabilitation in the NHS and Social Care. September 2005 attributed to WHO Enablement: Helping people become more independent and improve their quality of life both inside and outside their own home in order to help them get home and stay there. It gives adults the opportunity and confidence to relearn and regain some of the skills they may have lost because of poor health, disability or impairment or after a spell in hospital or problems at home Reablement: Relearning the skills necessary for daily living following illness, usually with guidance and support from health professionals, so that there is an improvement in function and increased independence Back to newsletter

4 Introduction to rehabilitation, enablement and reablement review In October 2012, the are at the centre of any new models of care. See Healthy Futures Meet the project board for more information. Programme Board established a project to agree models of care for rehabilitation, enablement and reablement. These models of care will describe how we think rehabilitation, enablement and reablement services should be provided in the future. Once the models have been agreed, contract negotiations will take place between Clinical Commissioning Groups (CCGs) and providers to ensure future contracts reflect the new models of care. The aim is to provide as much rehabilitation, enablement and reablement as possible in community settings, closer to where people live, through a variety of services which meet the needs of individuals. A project board has been established to steer and guide the review, with representatives from all organisations currently commissioning and providing rehabilitation, enablement and reablement services in Bristol, North Somerset and South Gloucestershire (BNSSG). There are also lay representatives from the Local Involvement Networks (LINKs) on the Board, to make sure that the needs of patients This review is needed for a number of reasons. A major driver is the need for clarity about what facilities are needed in the local community once the number of acute hospital beds is reduced following the opening of the new North Bristol Hospital. Another driver is the need to maximise resources to achieve a high quality, financially sustainable health system. Nationally, the NHS costs 100 billion a year. The economic downturn and an increase in demand mean that there is a growing gap between what will be available to spend and what healthcare will cost. Locally there is a 20 million pound funding gap between the budget the local NHS expects to receive and the demand on services. Dr Stephen Illingworth is the chair of the South Gloucestershire CCG and the senior responsible officer for the rehabilitation review. Stephen explains: The aim of the CCGs is to work in partnership to achieve improvements across the whole health and social care system. Rehabilitation, enablement and reablement are key to how we want to improve services. Getting these services right is critical to ensuring the whole health community can work in a productive and patient centred way. What is the Healthy Futures Programme? The Healthy Futures Programme is a transformational change programme operating across Bristol, North Somerset and South Gloucestershire (BNSSG). It is a partnership between commissioners, providers and local authorities, working together to improve the health outcomes of our population. The programme works to bring these separately accountable organisations together to discuss possible approaches to the challenges we face. Healthy Futures has the power to commission joint pieces of work and recommend appropriate adoption of new services, or changes to the way services are delivered. The Healthy Futures Programme Board approved the Rehabilitation Services Review on 11 July The Board agreed to support a programme of work to agree model(s) of rehabilitation, enablement and reablement services that will operate in BNSSG. Find out more on the Healthy Futures website:

5 What is the review process? How long will the review take? The review started in October 2012 and we hope to have an agreed business case for the new model of care by April This is a very tight timescale, but we want to inform and influence what is commissioned by the clinical commissioning groups (CCGs) as soon as possible. What is the scope of the review? For some services, it is better to provide them in partnership with neighbouring commissioners and providers, so the review is looking at what models of care are needed across Bristol, North Somerset and South Gloucestershire (BNSSG). The review will not include rehabilitation for people whose primary need relates to their mental health, or alcohol or substance misuse. However, the project will acknowledge that many patients receiving rehabilitation, enablement and reablement services may also have mental health or substance misuse issues. The review will include all adult services and will be mindful of the needs of teenagers transferring from children to adult services. It will include all rehabilitation, enablement and reablement services provided by health and social care, whether provided by the public, private or voluntary sectors. Work stream two describing what rehabilitation, enablement and reablement services are currently being provided in the community Work stream three organising events to start designing the model(s) of care we want in the future. A series of workshops for patients and carers, to find out what matters to them about rehabilitation are taking place throughout December 2012 and January The feedback we received from these events will inform a design and describe event for stakeholders on 11 January. Another key group of stakeholders are clinicians. We will be attending their team meetings to find out what matters to them, and this will also feed into the January event. In addition we are: researching what innovative practice is happening elsewhere collecting base line demand and capacity data for rehabilitation, enablement and reablement, so we understand what the need is and what we are currently providing to meet that need trying to agree a set of principles of care for rehabilitation, enablement and reablement that we can use to help design the new models of care. We have started to collate the information collected by work streams one and two into a directory of services. What work is happening currently? The review had its first project board meeting on 8 November The following work streams were agreed: Work stream one pulling together what rehabilitation is currently happening in the local acute hospitals If you would like more information about the review process, please contact the project manager, Elizabeth Williams on , elizabeth.williams@bristol.nhs.uk

6 Meet the project board The first meeting of the rehabilitation, enablement and reablement review project board took place on 8 November The meeting was well attended, with 22 board members representing the organisations involved in the review. The board was chaired by Richard Smale, the project director. Dr Stephen Illingworth, the chair of South Gloucestershire Clinical Commissioning Group (CCG), is the senior responsible officer for the project and Elizabeth Williams is the project manager. The minutes have been recorded and will be signed off at the next project board, which is due to take place on Monday 17 December They will then be made available on the Healthy Futures website. Who is representing each organisation on the board? North Bristol NHS Trust University Hospitals Bristol NHS Foundation Trust Weston Area Healthcare NHS Trust Cathy Timothy, head of therapy services Sue Tancock, senior clinical programme manager, Building our Future Dr Sue Wensley, consultant physician, older persons medical unit Dr John Holloway, consultant neuropsychiatrist Dr Angus Graham, consultant in rehabilitation medicine Henry Lumley, group manager rheumatology and rehabilitation Jayne Weare, head of therapy services Neina English, community matron at South Bristol Community Hospital Dr Gerry Tobin, consultant physician for older people Neil Evett, head of therapy services Bristol Community Health South Gloucestershire Community Health Services North Somerset Community Partnership Bristol City Council South Gloucestershire Council North Somerset Council Bristol CCG South Gloucestershire CCG North Somerset CCG BNSSG Avon and Wiltshire Mental Health Partnership NHS Trust Local Involvement Network (LINk) representatives Claire Madsen, consultant physiotherapist and allied health professional Lead Ceridwen Massey, general manager, Inner City and East Hazel Braund, lead for rehabilitation Rob Walker, business manager, specialist services Rachel Webber, clinical and operational lead, Clevedon Rehabilitation Team Jane Clifford, joint strategic service manager intermediate care and reablement Liz Sutton, strategic commissioning manager, Health and Social Care Jon Shaw, head of strategy and commissioning, Community Care and Housing Gerald Hunt, assistant director, finance, resources and strategic commissioning Richard Lyle, programme director, community and partnerships Kate Lavington, assistant director of primary and community care Kim Forey, associate director community commissioning/ commissioning support Nicola Caldecoat, stroke and neurological programme manager for BNSSG Leslie Grundy, service manager, rehabilitation services Gill Maw, Bristol LINk Gillian Seward, Bristol LINk Malcolm Watson, South Gloucestershire, LINk Jane Bollen, North Somerset, LINk

7 What matters to patients and carers? Making sure that patients and the public are actively involved is key to the success of this project, and representatives of North Somerset, South Gloucestershire and Bristol Local Involvement Networks (LINKs) sit on the project board. We are holding a series of engagement workshops to make sure that the views of patients and carers are considered at every stage of the process. Each workshop will be repeated across Bristol, North Somerset and South Gloucestershire so that as many people as possible are able to contribute. The first workshop was held on 10 December 2012 in Southmead. This was an opportunity for patients, carers and volunteers to tell the project team what works well in the current system and what needs to change, and to put forward suggestions for improvement. At the event a number of different stakeholders were represented and the real-life examples and stories which people brought with them will help to keep the review patient-focussed. Feedback is being collated into a lay-authored what matters to patients and carers document, which will be used when designing the new service. *There are two more workshops planned for North Somerset, 3rd January in Clevedon Community Centre and 7th January in the Academy in Weston-super-Mare. Patients and carers will have the opportunity to comment on the draft model of care at the next set of workshops*, which are planned for February If you would like to be involved in future workshops, or if you would like more information, please healthy.futures@bristol.nhs.uk or telephone Graffiti wall... Take the opportunity to have your say and send us your views about the rehabilitation, enablement and reenablement review. For more info... If you would like more information, or would like to get involved with the rehabilitation, enablement and reablement review, please contact the Healthy Futures rehabilitation review project support team by healthy.futures@bristol.nhs.uk or telephone We ll include your comments in future editions of the newsletter on our graffiti wall. healthy.futures@bristol.nhs.uk You can also visit our website: Please contact us if you would like paper copies of this newsletter or copies in a different format.