COMMISSIONING POLICY NEURO-REHABILITATION Neuro... · January 2007 Page 4 of 9 Commissioning Policy Neuro Rehabilitation HCW is responsible for the commissioning of acute rehabilitative

January 2007 Page 1 of 9 Commissioning Policy Neuro Rehabilitation

COMMISSIONING POLICY NEURO-REHABILITATION Release Version 0.7

Date: March 2007

Author: Ian Langfield, Specialised Commissioner, HCW

Owner:

Ian Langfield, Specialised Commissioner, HCW

Client:

Simon Dean, Chief Executive, HCW

Document History Revision History Date of next revision: Revision date

Previous revision date

Summary of Changes Changes marked

15th Jan 07 Added text

14th March 07 15th Jan 07 Admission criteria revised in line with comments of Neurorehabilitation Commissioning Advisory Group.

Approvals Name Date of Issue Version National Commissioning Advisory Board

Distribution This document has been distributed to: Name Date of Issue Version Cardiff and Vale NHS Trust

Swansea NHS Trust

NHS Trusts in Wales

LHBs in Wales

Comisiwn Iechyd Cymru (Gwasanaethau Arbenigol)

Health Commission Wales (Specialist Services)

Asiantaeth Weithredol Llywodraeth Cynulliad Cymru An Executive Agency of Welsh Assembly Government


Contents 1 Introduction ........................................................................................................... 3

1.1 Prioritisation ................................................................................................... 3 1.2 Review........................................................................................................... 3

2 Service Definition .................................................................................................. 3 3 Commissioning Responsibility............................................................................... 3 4 Service provision................................................................................................... 4

4.1 Epidemiology ................................................................................................. 4 4.2 Approach to providing services and expected outcomes................................ 5 4.6 Referral Pathway ........................................................................................... 5 4.7 Preferred Providers........................................................................................ 5

5 Access Criteria...................................................................................................... 6 5.2 Exceptional circumstances............................................................................. 6

Appendix I – Abbreviations........................................................................................... 7


1 Introduction The purpose of this Commissioning Policy (The Policy) is to clearly set out the circumstances under which patients will be able to access the services specified. The Policy clarifies the referral process, indicates which organisations are able to provide a neuro-rehabilitation service for Welsh patients and defines the criteria that patients must meet in order to be referred. In addition, the Policy provides background information to support the proposed level of access; this includes the epidemiology and anticipated outcomes. Relationship to other Commissioning policies This policy should be read in conjunction with the following policies: Spinal Injury (in development) 1.1 Prioritisation Health Commission Wales (HCW) is responsible for commissioning specialised inpatient neurorehabilitation services. HCW accepts the DH definition of Complex Specialised rehabilitation. It further defines specialised neurorehabilitation within this context as a service which is designed to meet the intensive rehabilitation demands of patients following traumatic or surgically induced brain injury or other complex acquired brain injury, with respect of the patient meeting their (inpatient) rehabilitation potential. Whilst neurorehabilitation services are not identified as a priority within the HCW Commissioning Plan, it is recognised that they provide a vital supportive role in specialised neurosciences services across NHS Wales. 1.2 Review The Health Commission Wales Commissioning Policy Group will review this policy annually. The next date for review will be January 2008

2 Service Definition The Department of Health Specialised Services Definitions Set (Dec 2002) defines a complex (specialised) rehabilitation service as “a service for patients with severe complex disabilities whose rehabilitation needs are beyond the scope of their local district rehabilitation services and is best commissioned collaboratively.”

3 Commissioning Responsibility As specified in WHC (2003) 63, Health Commission Wales (Specialist Services) has responsibility for funding of care of patients requiring specialist inpatient neurorehabilitation services.


HCW is responsible for the commissioning of acute rehabilitative care of a patient if admitted directly to either of the two Welsh designated neurorehabilitation centres located at Clydach Ward, Morriston, Swansea or Rookwood Hospital, Cardiff, and the post-acute care of the patient if transferred from a District General Hospital to either of these centres. Clydach Ward and Rookwood together provide a specialised neuro-rehabilitative service for patients resident in Wales, this also includes the repatriation of Welsh patients from other UK specialised neuro-rehabilitative centres. HCW will only fund the rehabilitative care of patients who are treated by this service. HCW is not responsible for the funding of the acute or post-acute phases of care if the patient’s care is provided at DGH but will support out-reach advice and assessment from the Welsh specialised neurorehabilitation service. HCW is not responsible for commissioning community brain injury teams. Local Health Boards are responsible for the rehabilitation including the rehabilitative care of patients following a cerebral vascular accident (CVA), however, patients presenting with CVA as a complication of traumatically, surgically or other acquired brain injury can be discussed with the teams at either specialised neurorehabilitation centre.

4 Service provision Specialised rehabilitation services should be led by a Consultant Specialist in rehabilitative Medicine, providing a service for patients with complex neurological disabilities requiring input from a specialist multi-disciplinary team. The majority of these patients are likely to have an acquired brain injury of whatever aetiology but the patient population will include other complex disabling conditions such as:

• Neuro-degenerative cerebral pathology • Peripheral nervous system pathology • Co-existing spinal and brain injury • Severe neurological disease

4.1 Epidemiology Because of the wide range of conditions that make up the population of ABI it is difficult to give exact figures for the prevalence of ABI in adults of working age � In those aged under 65, there are approximately 20 strokes per 100,000 population

per year. Subarachnoid haemorrhage affects 8500 people each year in the UK with a significant proportion occurring between the ages of 18 and 65 years.

� Head injuries requiring hospitalisation occur in the UK at a rate of about 275 per

100,000 population annually. There is considerable variation in different parts of the country, between urban and rural communities and between age groups. Moderate to severe brain injury is estimated to occur in 25 per 100,000 people per year of which: 2 to 4 (10 to 20%) of patients are likely to have severe disability or prolonged coma – 18 to 22 (65 to 85%) will have a good physical, but not necessarily cognitive or psychosocial, recovery. Recent improvements in the


emergency management of acquired brain injury have improved outcome overall but have probably led to an increase in survival of very severely injured and disabled patients.

4.2 Approach to providing services and expected outcomes The South Wales Neuro-Rehabilitation Working Group has developed the service specification and admission criteria for both Welsh Centres for specialised neuro-rehabilitation. 4.3 Quality This specialised neuro-rehabilitation service will be monitored through the Neurosciences services commissioned by HCW. 4.4 Performance Management HCW will be responsible for commissioning services in line with this policy. This will include agreeing appropriate data collection and procedures to monitor performance as well as how monies repatriated back to Wales have been utilised to improve the specialised neurorehabilitation service in Wales. 4.5 Waiting Times There is no specified maximum length of time for admission to specialised neurorehabilitation services, as this is dependant on the patient’s ability to participate in the rehabilitation programme. Patients waiting for this service should conform to Welsh Assembly Government Waiting Times Targets. 4.6 Referral Pathway All referrals should be assessed for suitability and need by neuro-rehabilitation multi-disciplinary teams based at Rookwood, Cardiff and Clydach Ward, Swansea. The referral pathways for each centre are located in Appendix 2. During the next six months the centres will work together to produce a single care pathway for patients resident in Mid, South and West Wales. 4.7 Preferred Providers Health Commission Wales hold Service Level Agreements (SLA) with Cardiff and Vale NHS Trust and Swansea NHS to provide specialised rehabilitative care. The SLA allows Health Commission Wales to monitor performance and activity as well as quality and expected clinical governance standards. 4.5 Designated providers • Rookwood Hospital, Cardiff • Clydach Ward, Morriston Hospital, Swansea


5 Access Criteria Prior to transfer for admission patients should be:

• Be medically stable • Not be mechanically ventilated • Be considered by the Unit’s MDT to have specific goals for assessment and

rehabilitation that can be met by MDT input. • Be able to tolerate or participate in an intensive rehabilitation programme

This service will only accept adult patients, but referral of patients between the ages of 16 and 18 can be discussed with the Centres Referrals received usually include patients with the following neurological conditions:

• Acquired Brain Injury from a variety of causes e.g. trauma, hypoxia, infection, tumour, ischaemia, haemorrhage, following neuro surgical intervention.

• Multiple Sclerosis and other demyelinating polyneuropathy such as Guillain Barre syndrome, CIDP, ADEM.’.

• Severely neurologically impaired patients requiring inpatient assessment and intervention by a specialist MDT.

Patients for whom suitable existing local services are available will not normally be considered for admission (i.e. Stroke Unit). At the discretion of the MDT other patients can be included. The Service is unable to accept referrals for patients with the following conditions:

• Spinal Cord Injury. (Referral to the Welsh Spinal Cord Injury Rehabilitation Unit at Rookwood is recommended)

• Significant premorbid dementia. • Those sectioned under the mental health act. (Referral to the Welsh Neuro

psychiatry Unit at Whitchurch Hospital is recommended) 5.2 Exceptional circumstances Referrals to the South Wales services are not subject to the Individual Patient Commissioning (IPC) Process, as this is included within the Service Level Agreements held with HCW. Referrals to Neurorehabilitation Centres in England will only be considered by the IPC panel, if supported by the lead clinician from either of the South Wales Neurorehabilitation Centres. In the rare or exceptional circumstances where a patient or clinician feel that the patient represents a special case then application can be made to HCW, where the case will be considered by the Individual Commissioning Panel. There are a number of reasons why patients may wish / require having access to other providers. If this is the case then the referring consultant should write to HCW providing full details of the case. The IPC Panel will review the case and consider if there are exceptional reasons for accessing an alternative provider. The HCW Policy for reviewing cases is available on the HCW web site.


Appendix I – Abbreviations HCW Health Commission Wales SLA Service Level Agreement IPC Individual Patient Commissioning MDT Multi Disciplinary Team ABI Acquired Brain Injury


Appendix 2 – Referral Pathway (Cardiff)


Referral Pathway – Swansea

Documents

COMMISSIONING POLICY NEURO-REHABILITATION Neuro... · January 2007 Page 4 of 9 Commissioning Policy Neuro Rehabilitation HCW is responsible for the commissioning of acute rehabilitative