improving rehabilitation services regional stakeholder event

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Improving

Rehabilitation

Services

Regional

Stakeholder

Event

Leeds - 5th April 2016

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Dr Mike Prentice

Regional Medical Director (North)

NHS England

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• Housekeeping

• Event Programme

• Workshops

• Lunch and Breaks

Twitter #improverehab16

Wi Fi Username: res1 Password: res1

WELCOME

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Suzanne Rastrick

Chief Allied Health Professions Officer

NHS England

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Lindsey Hughes

Rehabilitation Programme Lead

NHS England

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Rehabilitation

Commissioning

Guidance

Lindsey Hughes

April 2016

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Regional Rehabilitation Leads, March 2015

“There is poor awareness of the scope of rehabilitation and the fact that rehabilitation happens along and across every pathway of care, from birth to end of life.”

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• National narrative

• Breadth and scope

• Solutions to local challenges

• Service design, redevelopment and change

• Commissioning for outcomes to drive improvement

• Demonstrating effectiveness and value

• Needs based services

• Collaboration between commissioners and providers

Regional reports and CYP scoping report

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Focus on outcomes

Centred on people’s need

Aims high and gives hope

Active and enabling process

Integration core and specialist

Responding to change in need

We know what good looks like

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In conversation with commissioners:

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Rehab is a priority as when it is not

done well, people often have more

admissions; business cases must

show the cost-savings associated

with good rehab e.g. admissions

avoidance”.

It would be great to be allowed the time to commission

rehabilitation correctly ……a Commissioning Framework is important to give support and confidence to commissioners”

“Relationships are hugely

important and

commissioners and

providers need to be

working collaboratively

This work is massively

important…. it is currently hit

and miss and there is so

much misunderstanding

about rehabilitation…”

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Physical

Sensory

Communication

Cognition and behavioural

Psychosocial and emotional

Medically unexplained symptoms

Mental health

Whole person & life course

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Birth to end of life

including 1° and 2°

prevention

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• Support to ensure children and young people have the best start in

life

• Control for patients and ability to self manage

• Reduction in demand for 1° and 2° care

• Prevention of admissions, readmissions and A&E visits

• Reduction in length of stay

• Increased QOL for people with long term conditions

• Support to enter and/or stay in employment

• Improved outcomes from surgical interventions

Why commission rehabilitation?

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• Realise the potential of children and young people

• Enable people to return to work, get into work & stay in work

• Reduce costs of nursing, residential and social care

• Reduce associated costs of mental health illness

• Reduce costs associated with diabetic care

• Reduce length of stay costs

Economic benefits of rehabilitation

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People centred services

Use existing guidance and standards

Integrated services

Commission for the whole pathway

Transitions

Along pathways

Across sectors

CYP to adult

Check list:

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Benchmarking, the principles & evidence

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Best Practice examples:

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WHO, World Bank and WCPT

“Rehabilitation is a good

investment because it builds

human capacity”

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Go to resource for Rehabilitation

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Acknowledgements and thanks:

Denise Ross, Rehabilitation Team

Vicky Whitfield, Rehabilitation Team

Laurie Palmer, Rehabilitation Team

Jayne Pye, Service User

Amy Frounks, Service User

Regional Rehabilitation Leads (2014-2015)

Commissioning Guidance Steering Group

Rehabilitation Programme Board

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Thankyou @Lindseyahughes

#improverehab16 #rehabimprovers

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Lynne Barr

Project Lead in Rehabilitation

North of England Commissioning Support

Partners in improving local health Slide 25

Rehabilitation:delivering

outcomes through

changing behaviours Masterclasses re: commissioning

Lynne Barr: Project Lead in Rehabilitation

Partners in improving local health

To engage those who influence commissioning in localities to understand what is possible through rehabilitation

To share the national direction, economic value and raise the challenges

To showcase some examples of recent developments across the region

To offer dialogue and an opportunity to discuss local challenges

Develop ‘top tips’ for north of England

Aims of Masterclasses x3


Where does rehab fit in your

sphere of influence?

Unplanned

care

Long term

conditions

Planned care Continuing

care

Integrated

care

Transitions

Survivorship

Trauma Vocational


• National evidence increasing – Economic return on investment

• Standard complexity score : RCS (various) from neuro to trauma .

• Continuing Health Care – personal budgets

• Cardiac and pulmonary (LTCs) primary care impact

• Self management : outcomes/person centred

• Digital support for assessments /reviews/value for money ( specialists)

• Local authorities and housing : joint working /under 55year olds

Context for commissioners


Emerging models based on

• Trajectories for rehabilitation – Long term conditions ( progressive)

– Sudden onset (recovery)

• Barriers to attending rehabilitation

• Person centred outcomes

• Specialist /generic working in the

community Slide 29


Examples :refer to

• Longterm conditions:

• Cardiac & pulmonary combined (stage 1)

• Pulmonary rehabilitation :person centred

• Community acquired brain injury

Slide 30


‘Get Well Stay Well’: Case for change

• Co-morbidities

• Acceptability

• Industrialise / ‘at scale’

• Pro-active

• Psychological needs

• Preventable deaths

NHS Unclassified - Slide 31


Menu based : domains of life

(GWSW and pulmonary rehab )


Pulmonary rehab:redesigned

Goals & actions

Slide 33


78% of participants felt more positive and less

depressed and anxious

Reflect on barriers to attending

rehabilitation: increase those able to

attend


Person centred outcomes

Slide 35

*Outcome Star:Triangle consulting ltd


Acquired Brain Injury :new

whole system pathway

onset/injury: clinical needs addressed.

Information /signposting /assessment

rehabilitation :specialist,

generic with ABI support, patient

peer support

connectivity with community/ services and

vocational goals

on going patient /family peer

support

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Scale & levels of need

A&E home 50 follow

up/contacts per week

interventions 4 per week

hospital admission up to 4 weeks short stay

851 – 1048 p.a.

16-21 per week

hospital admission/complex

(over 4 weeks) longer stay 148 p.a. 3 per week


Opportunities through audit

• New ways of working – address issues raised over the years by people effected by ABI.

• Build bridges and support people with appropriate service to need ( one size does not fit all)

• Raise the profile of rehabilitation in localities including vocational outcomes/connection to local communities.

• Shift the balance of specialists established in community : build capability in community


Outcome focus of masterclasses

• Top tips for commissioning (NECS)

• Network of interest established

• Knowledge hub (NECS)

• Sharing /distribution of information

• Commitment to action :KISS

– Individuals

– Commissioners

– Informing specifications/standard

• regional approach ?

Slide 39


More to do !

• [email protected]

• [email protected]

• www.advancingpotential.co.uk

Slide 40

mailto:[email protected]

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Break

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Dr Helen Banks

Dr Ganesh Bavikatte

Alison Price

The Walton Centre

The Cheshire and Mersey Rehabilitation Network

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The Cheshire and Mersey

Rehabilitation Network Dr Ganesh Bavikatte, Clinical Lead/Consultant in Rehabilitation Medicine, the Walton Centre

Mrs Alison Price, Manager, Cheshire and Mersey Rehabilitation Network

Dr Helen Banks, Consultant In Rehabilitation Medicine, The Walton Centre

CMRN Animation

https://www.youtube.com/watch?v=GSSnC

piDNCE

https://www.youtube.com/watch?v=GSSnCpiDNCE



• National:

– BSRM, UKROC, Specialist rehabilitation service

specification standards with an increasing focus on

provision, access and quality of services.

• Regional:

– implementation of the Cheshire and Merseyside Major

Trauma Collaborative

The development of the Network; National and Regional Drivers

Co-ordinated Rehabilitation Pathway

Address unmet demand and inequitable provision for patients with

complex traumatic injury or illness

Establish a co-ordinated pathway, across hospital and

community services, based on need and not diagnosis

Deliver holistic specialist rehabilitation- multi-disciplinary team

approach

Promote an innovative network to optimise patients’ clinical

outcomes, improve experience and maximise independence

Driving Vocational Rehabilitation

Partnership working between health and social care

The development of the Network Local Drivers - Our Vision and USPs


The Cheshire and Merseyside Rehabilitation Network (CMRN)

• 7 partner organisations across Cheshire and Merseyside and collaborative working region-wide for a wider scope of action than previously possible

• Funded by NHS England and Clinical Commissioning Groups

• Our region developing as the ‘go-to’ network for specialist rehabilitation

• Regional approach to improving health and delivering evidence-based specialist rehabilitation across inpatient and outpatient services

• Single structure to share and disseminate good practice and learning

Our Partner Organisations


http://www.partnershipsincare.co.uk/

Collaborative working region-wide

• Brain Injury Rehabilitation Centre

• Southport Spinal Injury Unit

• Cheshire and Mersey Major Trauma Collaborative

• Cheshire and Mersey Critical Care Network

• Aintree amputee and prosthetic services

• North West Assisstive Technology

• BIRT

• Headway, Neurosupport, SIA and other charitable organisations

• Isle of Man and North Wales specialist rehabilitation services

1. Establish A SERVICE PATHWAY

2. Deliver PATIENT FOCUSED services

3. Deliver COST EFFICIENT services

4. Attract and retain A HIGH CALIBRE WORKFORCE

5. Work in PARTNERSHIP to deliver High Quality Clinical

Audit, Research and Innovation and to drive

EXCELLENT PATIENT CARE

CMRN Objectives


Rehabilitation Level 1A Supportive Rehabilitation

Rehabilitation Level 1A Supportive Rehabilitation

Rehabilitation Level 2 Active Rehabilitation

Rehabilitation Level 3 Extended Rehabilitation

Rehabilitation Level 3 Community

Hyper-Acute Unit Lipton Ward

The Walton Centre

Complex Rehabilitation Unit Sid Watkins Building

Rehabilitation Spoke Units Seddon Suite,

The Phoenix Centre, Clatterbridge, Walton Spoke

Health and Social Care Partnerships,

Oakvale Gardens

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20

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2 Locality teams St.Helens & Knowsley,

Liverpool, South Sefton, Southport & Formby

CCG’s

A Framework for Partnership and Collaboration

CMRN Services offered • Comprehensive therapy team

– Physiotherapy – Occupational therapy – Speech and Language therapy – Clinical and Neuro Psychology – Dietetics

• Rehabilitation consultants • Rehabilitation coordination team • Rehabilitation nurses • Vocational rehabilitation specialist • Mental health team

– Consultant Neuropsychiatrist – Mental health nurse – Liaison Psychiatry

• Links with orthotics, orthoptics, medical and surgical specialties

What is Quality in Rehabilitation?

1. Clinical Outcomes

2. Patient Experience

3. Patient Safety

4. Integrated Service

5. Governance

6. Values

Quality in Rehabilitation: 1. Clinical Outcomes

Based on rehab need not diagnosis

Individual SMART patient goals

Functional outcome and discharge destination

Cognitive education programme

Communication

Response Time 14+ Days 1-2 Days

8% 35% 8-14 Days

10%

3-7 Days

47% Average

6 Days


Multi-Disciplinary Working and approach to deliver holistic rehabilitation

Patient Satisfaction

Family Involvement and Engagement

Communication

Quality in Rehabilitation: 2. Patient Experience

Quality in Rehabilitation: 2. Patient Experience – Multi-Disciplinary Working

Infection control measures

1:1 monitoring

Staff training

Monitoring of clinical interruptions

Communication

Quality in Rehabilitation: 3. Patient Safety

Whole pathway based on need not diagnosis Pathway delivered through partnership working across 7 organisations Joint working between health and social care Whole team approach in continuous review and on-going

development of services Annual work programme to support effective delivery of services and

implementation of strategies Staff experience – involvement, engagement and empowerment Communication

Quality in Rehabilitation: 4. Integrated Service

Whole pathway under one umbrella Rehabilitation Co-ordination Team Vocational Rehabilitation Model Dedicated clinical /neuro psychology and neuro psychiatry

provision Co-ordinated pathway from hospital to community Collaborative working with commissioners to support

development and delivery of specialist rehabilitation (e.g. Specifications/Standards, Research)

Quality in Rehabilitation: 4. Integrated Service – Our USP’s

Quality in Rehabilitation: 5. Governance

Continuous monitoring of quality, including: KPI’s Service Standards Agreed Criteria and Policies Standardised Medical, Nursing, Therapy Metrics UKROC National Data and Accreditation Research, Audit and Innovation Metrics Continuous Service Evaluation Training and Education Review Identification of gaps in K&S

development of accredited programme/modules in partnership with education establishment

Quality in Rehabilitation: 5. Governance

Working Together for Patients

- were always pulling together

Respect and Dignity

- we like to know what makes you tick

Empowerment

-were ready to pass the baton

Quality in Rehabilitation: 6. Values

Quality in Rehabilitation: 6. Values

Commitment to Quality and Care

- we believe in going the extra mile

Compassion and Empathy

- we put ourselves in your shoes

Honesty and Trust

- we promote transparency

Inequitable provision of spoke, extended and community specialist rehabilitation services for Cheshire patients

Changing commissioning landscape and financial sustainability/tariff

Delays in discharges and pathway transfers Management of realistic patient and family

expectations

Challenges to Quality in Rehabilitation

Commissioning: Collaborative review of our service specifications/standards

Clinical Tools: Development of outcome measures for community

Research and Innovation: Collaborative studies in hyper acute rehabilitation, vocational rehabilitation, community rehabilitation, virtual reality

Education: Collaborative Education Programme accessible for all disciplines/grades

Next Steps: Quality Initiatives in Rehabilitation

2016/17

Cost-efficiency of specialist hyper-acute inpatient rehabilitation services for medically unstable patients.

Objectives: To evaluate functional outcomes, care needs and cost-efficiency of hyper-acute rehabilitation for a cohort of inpatients with complex neurological disability and unstable medical/surgical conditions.

Design: A multicentre cohort analysis of prospectively-collected clinical data from the UK Rehabilitation Outcomes Collaborative(UKROC) national clinical database, 2012-2015.

Conclusions: Despite its relatively high initial cost, specialist hyper-acute rehabilitation can be highly cost-efficient, producing substantial savings in on-going care costs, and relieving pressure in the acute care services.

Patient experience

https://www.youtube.com/watch?v=jhEhrZ4R2Gc



Summary R - Regional co-ordinated pathway across a

whole systems model of care

E - Clinically effective and cost efficient

H - Holistic, person-centred approach

A - Achievement of regional and national

specialist rehabilitation standards

B - Based on rehabilitation needs, not diagnosis

Thank you

Any Questions?

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Lunch

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A. Children and young people's rehabilitation (Met 15)

B. Regional rehabilitation networks - supporting regional service

development (main room)

C. New Care models - regional vanguard(s) (Met 16)

D. Data sets and outcome measures - demonstrating effectiveness

(Met 17)

Workshops

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Reflection and Actions

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• Key learning points from today’s conference.

• How will today’s conference change my practice / approach?

• Key tasks as an outcome from today’s conference.

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Final comments

and

closing remarks

Shelagh Morris

Deputy Chief Allied Health Professions Officer

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Thank you

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improving rehabilitation services regional stakeholder event

Documents