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A Delivery Framework For Adult Rehabilitation. Future Vision of Rehabilitation Services What do we need to do to meet the challenge? www.rehabilitationframework.scot.nhs.uk [email protected]. High Impact change – vocational rehabilitation. - PowerPoint PPT Presentation
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Future Vision of Rehabilitation
Services What do we need to do to
meet the challenge?www.rehabilitationframework.scot.nhs.uk
A Delivery Framework ForAdult Rehabilitation
High Impact change – vocational rehabilitation
Every health board area has accessible pro-active vocational rehabilitation services delivered in partnership with community planning partners.
LTC draft strategy calling for the same
Possibility of new HEAT target.
Enabling Life Potential through Vocational Rehabilitation
“a process that enables people with functional, psychological, developmental, cognitive and emotional impairments or health conditions to overcome barriers to accessing, maintaining or returning to employment or other useful occupation."
Enabling Life Potential through Vocational Rehabilitation
All services should be aimed at maximising functional capacity of the working age population – physical, mental, social, spiritual
It is not their diagnosis that is important – its what they can do!
AHP’s crucial in delivering vocational rehabilitation services in Scotland
Key service issues Services are fragmented, inaccessible and difficult
to navigate Communication within and across services is a
challenge Service activity is dominated by indirect activity Professional practice is primarily based on custom
and practice High incidence of transition episodes leading to
duplication Absence of whole system performance
management structure
Key issues for vocational rehabilitation
Culture change for AHP staff Incorporate non complex issues into
mainstream services Improve knowledge of AHP staff of
services providing return to work support
Improve access and develop robust systems so the client pathway is seamless
Rehabilitation Model requirements
Emphasis on early intervention / self management
Single access points into services Integrated teams delivering case/care
management models Critical overview of where rehabilitation
staff are situated to deliver this model – shifting balance of care!
Service Transformation Service transformation will require not only
the ability to influence processes, but to change mindsets, cultures, activities, and organisational power bases.
Quote – Albert Einstein
Insanity: doing the same thing over and over again and
expecting different results.
Improving access to services
This workshop is asked to consider how to align occupational health and vocational rehabilitation services to provide clear pathways to work and ensuring capacity in the system.
Healthy working lives – review
Health and employment-related services must improve their support for people to maintain or improve their health while they are seeking a return to the workplace.
Health services must recognise the need to include work outcomes as part of the patient’s plan for recovery.
Mapping Mapping of existing services both
nationally and at local level will allow a baseline for standards to be established and enable more effective collaboration between services.
Mapping to be undertaken in collaboration with rehabilitation co-ordinators
Enabling Life Potential through Vocational Rehabilitation - Healthy Working Lives Policy ReviewRedesigning the Client Pathways’.
Mapping current services and client pathways to work;Recommend improvements in provision of, and links between, services that move people towards work;Identify gaps in provision of relevant services and recommend how these can be addressed.
Improving access!
Key role for NHS 24 Providing information to support self
management Delivering effective and evidence based
triage More efficient and effective service delivery
to enhance the patient pathway and outcomes for patients
Innovative service delivery through tele- rehabilitation
Delivery of national targets (18 weeks)
Exemplar Musculosketal re-design• Existing systems for
self referral to physiotherapy need to be streamlined and utilised in a more cost effective manner.
• Nhs 24 could provide single point of access into physiotherapy services .
Exemplar Musculosketal re-design• Part of a whole
systems MSK pathway
• Onward referral management systems
• Self management advice
• Websites as support for self management
CommunityAHPMSK
Services
Integrated MSK
Team
PhysiotherapyPodiatry
OTDietician
ProstheticsRadiography
Specialist nurseGPwsi
Self Referral via NHS 24
Self management and advice
through NHS 24 web base for rehabilitation
GP Referral
Walk in Self Referral
Electronic Referral
Vocational Rehabilitation
Services & Chronic Pain
Services
Orthopaedic
waiting list
Rheumatology
services
Other acute services
Electronic Referral
GP Referral Electronic
Referral
NHS 24 – Enhancing the MSK pathway
Referral Management
electronic and appointment given to patient at time of call. In future a reminder text message will be sent to the person one day prior to appointment.
Appropriate interventions will be delivered or sign posted by AHP team including discharge and onward referral to;
vocational rehabilitation teams, self management programmes, leisure facilities the community based advanced practitioner multi-
professional triage team for a specific orthopaedic assessment. This team will screen to identify whether surgical opinion is necessary or any other secondary care service required.
Rationale for self referral
Self referral into physiotherapy services provides cost efficiencies of up to £2 million compared to GP referral. Figures based on 2004 figures prior to Consultant and GP contracts. (Holdsworth 2007)
In the UK 12.25 million work days are lost due to musculoskeletal disorders.
Low back pain is the most common musculoskeletal problem affecting an estimated 18 million people, with associated costs of £5bn p.a. to the economy due to working days lost.
In Scotland physiotherapists’ treat over 64,000 back pain patients and a total of 271,000 MSK patients per annum.
Benefits of this change in service delivery
Improve access to diagnosis and treatment Reduce waiting times Improve conversion rates to surgery in secondary
care Provide greater efficiency and productivity Support shifting the balance of care and other
Government policies (rehab framework, patient experience etc)
Develop and enable a self management culture for patients in Scotland
Promote health and well being Facilitate early return to work and avoid long term
absence and long term dependency on benefits
Future developments In the pipeline Dietetic services – planned demonstrator programme
with NHS Lothian and Highland. Rehabilitation web based advice – working backs etc Potential for innovation falls, mental health Tele-rehabilitation Link MSK work to national fit for work pilots for
vocational rehabilitation Next steps AHP Leadership within NHS 24
Developing a Vocational Rehabilitation
Service for Small and Medium
Enterprises in a Health Board area
- launched 12 February 2008
Working Health Services DundeeHotline
01382-825100
Working Health Services Dundee - Referral process
Individual
Hotline 01382-825100 - Telephone interview conducted
Information passed to local Case Manager
Case Manager assesses information and directs individual onto a pathway of care and eventual discharge
Ergonomists
Physiotherapist
Occ TherapistCounsellor
H&S Practitioners
Occ Health Nurse/Adv
Occ Health Physician
Occ Hygienist•Access to local services e.g Relate, Debt Counselling
GPs
Line Managerraise awareness
Enabling Life Potential through Vocational Rehabilitation
A proposed new Fit for Work service, based on a case-managed, multidisciplinary approach, would provide treatment, advice and guidance for people in the early stages of sickness absence.
Proposal for a Scottish Fit for Work National Service
Enabling Life Potential through Vocational Rehabilitation
build upon the national Condition Management Programme structure whilst complimenting the strategic approach undertaken by the Scottish Centre for Healthy Working Lives.
Add Vocational Rehabilitative Fit for Work Services to existing CMP teams
Incorporate the work of the 3 pilots.
Key Success Factors Whole systems approach Strong partnerships Skilled multi- professional staff Enabling ethos built around goals of value to the
service user Effective communication between all parts of
system Clear links needed between specialist teams,
primary care, social care services Focus on individual needs Return to meaningful activity / employment as
rehabilitation goal Measuring the impact
Vocational Rehabilitation in Lothian
Background & History Developing a Job Retention Service Current Position Future Aspirations
Background Established services Gaps in provision Partner services
Within NHS With others
Links with Occupational Health Service Developing a partnership with Healthy
Working Lives 332,000 people employed by SMEs Proposal for development Facilities
Current Position Established services continue
• Rehabilitation, OHS, Mental Health, Learning Disability, mainstream therapy
Upgraded Centre for Voc Rehab Working Health Lothian – one year
• Partnership with Dundee & Borders• Direct access, signposting, training,
evaluation Multidisciplinary involvement OHSXtra Increased skill set Validated assessments & tools for
interventions
Future Embed Voc Rehab into mainstream Employability awareness Direct access Common standards Evidence of outcome Multi professional across health,
social care, employment & voluntary sector
Help people with health problems to enter, remain in and return to work
