Rehabilitation Service

Improving adult physical rehabilitation services – have your say

The Isle of Wight (IW) Clinical Commissioning Group (CCG) consulted on improving adult physical rehabilitation to improve patient outcomes and quality of life as well as making the service more efficient in terms of more integrated working for the benefit of the individual. The consultation closed on January 19, 2017.

The IW CCG and the IW Council are working together to identify how they can improve the existing adult physical rehabilitation services.

 

It was discussed what the current services offer with the people providing them and the people using them. We also looked at the changes that are happening within health and social care on the island (see www.mylifeafulllife.com) and thought about how best rehabilitation services could fit into the proposed new ways of working.

At the moment the rehabilitation services for adults with physical disabilities are managed via the Single Point of Access Referral, Review and Co-ordination Service (SPARRCS) at St. Mary’s Hospital where they liaise with rehabilitation teams working around the island and on the hospital site.

We found that sometimes a few people have to go to the mainland for rehabilitation when they need more specialist help. We realised this may always be the case for some people because we are living on a small island which cannot provide all the specialist services that are available on the mainland.

We also found that, although the people receiving the services were generally happy with them, there were problems for the staff delivering the services and that some people were not receiving enough rehabilitation to achieve their goals.

We realised that we will have to consider where best to provide rehabilitation beds, including considering providing rehabilitation beds and teams closer to people’s homes so that they can be accessed more easily.

Proposed Changes

Having looked at the different needs of the people currently receiving rehabilitation we realised that there are now two different types of service pathways required, each moving services to a 7-day a week delivery.

Our proposal is that one pathway will ensure that frail elderly people receive rehabilitation in the form of more integrated care as part of the new Integrated Locality Services.  This pathway also needs to be able to support those people with mild to moderate dementia who could benefit from rehabilitation.                                            

The other proposed pathway will ensure that people, who have neurological and/or working age rehabilitation needs, will be able to access sufficient rehabilitation services which are currently only available in a very limited way. People will also have the opportunity for vocational-type rehabilitation, which is unavailable at this time, involving close working with the local Job Centre. It is also important that this pathway supports the transitioning of young people with rehabilitation needs into adult services.

It is intended to move rehabilitation largely into the community and away from hospital-bedded provision although rehabilitation will continue to be undertaken as required for those people in acute in-patient beds at St. Mary’s Hospital as part of a care pathway.

We are proposing that rehabilitation provided at St. Mary’s Hospital in the General Rehabilitation Unit will be moved to the community. This will release the 22 beds in this Unit to be used by St. Mary’s Hospital for other purposes.

It is intended to provide as much rehabilitation as possible in people’s homes or in community facilities, as out-patients. Wraparound care could be provided by family members, community and/or the voluntary sector with social care and Integrated Locality Service support, as appropriate.

There will still be a relatively small number of people, currently managed in the hospital, who require 24-hour nursing care whilst they receive rehabilitation. These are mostly frail elderly people with ongoing medical conditions, or who are recovering from trauma, but who have passed their acute phase of illness. Stakeholder workshops have discussed where the provision of this element of rehabilitation should take place. The overwhelming consensus was that it should be in community beds in a nursing home environment. These beds must be located in, or very near, each of the Localities to enable ‘in-reach’ by the Integrated Locality Service, preferably with one nursing home allied to each Locality.

It is intended that the nursing home staff members are active partners who supplement the work of the Community Rehabilitation Teams by undertaking elements of rehabilitation. The aim is to enable people undergoing rehabilitation to become as independent as possible and to return to live in their communities supported by the Integrated Locality Service.

People receiving integrated care services in the community would remain under the care of their registered GP, but with input as appropriate from an Advanced Clinical Practitioner and/or in the future a Community Geriatrician - who can be part of the Integrated Locality Service. It is anticipated that these health care professionals will provide the medical support to the people in the community beds in the nursing homes.

It is anticipated that an extra 22 Nursing Home beds will be required above those currently commissioned, supported by the IW NHS Trust staff.