Getting back to work

Stroke Care in Scotland

Scottish Stroke Care Audit meeting

29th August 2017

Thérèse Lebedis

Consultant Occupational Therapist in Stroke

NHS Grampian

What are the

issues?

• In 2016 of the 9331 people who had a final diagnosis of stroke in Scotland, 2321 (25%) were of working age i.e. aged 16-64.

• Decisions re return to work often made as soon as they have a stroke

• People attempt to return to work too quickly

• People are not always fully realistic about skills required for RTW

Return to work can ....

• Promote recovery and aid rehabilitation

• Improve physical & mental health and wellbeing

• Reduce social exclusion and poverty

• Waddell G & Burton AK: Is work good for your

health and wellbeing? 2009

Vocational rehabilitation

• Helping someone with a health condition to remain in or return to work

• Finding a match between a persons abilities and limitations following a stroke, the demands of the job and work environment

Scottish Stroke Improvement

programme

8.3. Living with stroke

• Vocational rehabilitation – Stroke services

should ensure that people of working age who

wish to return to paid or unpaid work or

voluntary work are signposted to vocational

rehabilitation services.

• People who wish to return to work are assessed

with regards to their capacity to do so; and

• Vocational rehabilitation services are available if

further advice and support is required.

Vocational

rehabilitation

services are

available to

people who

wish to

return to

paid, unpaid

or voluntary

work.

BLACK No vocational rehabilitation services available

for people who have had a stroke or plan to

establish them

RED Plan to develop referral process & pathway for

vocational rehabilitation services for people who

have had a stroke

AMBER

Vocational rehabilitation services exist for

people who have had a stroke, however

availability and referral is ad hoc across the

MCN area

GREEN

There is a documented referral process and

vocational rehabilitation pathway available, with

provision of specialist services in some MCN

areas

COMPLETE

All those across the MCN area with identified

vocational rehabilitation needs after a stroke

have access to specialised assessment and

intervention services as required.

S.I.P– priority 8.3 Living with stroke

Priority Action (3)

vocational rehabilitation

Ayrshire and GREEN

Borders AMBER

Dumfries & Galloway BLUE

Fife BLUE

Forth AMBER

Grampian AMBER

Greater Glasgow and

Clyde AMBER

Highland AMBER

Lanarkshire BLUE

Lothian GREEN

Orkney BLUE

Shetland GREEN

Tayside AMBER

Western Isles AMBER

healthWorks

• Presenting on behalf of the ‘healthWorks’ project

team. NHS Grampian

– Juliet McBean – Occupational Therapy Project worker

Steering group

– Susan Carr – AHP Associate director

– Thérèse Lebedis – Consultant OT - Stroke

– Dr Linda Leighton-Beck – Head of social inclusion

– Shona Strachan –AHP sector lead, Aberdeenshire

H&SC Partnership

healthWorks

• Public Health funded project since 2012

1. healthWorks training in understanding the link

between health and working/volunteering to all

health, social care and 3rd sector staff.

2. AHP Advisory Fitness for Work Report training

3. Three staff focus groups

4. Interview x3 people who have received a Fit

for Work report

Results

Stage 1 - healthWorks

• Number trained n=604

• Wide uptake from health, social care and 3rd sector

• Confidence increased

• Knowledge increased

• Awareness of services increased

• Good uptake of resources

Stage 2 – Fitness for Work

• Number trained 206

• OT (40%) PT (34%) Podiatry (26%)

• Pre-training n=191 : 97% had not completed a report

• 2 months post training – four people had completed a FfW report. (3x1&1x3)

• 6 months post training – six people had completed a FfW report

(1x11; 1x2; 1x3 & 3x1)

• 12 months post training - four people had completed a FfW report (1x29; 1x4 & 2x2)

Stage 3

Focus Groups

• Should we give advice?

Yes…importance of work to living

• Who should give advice?

everyone – at different stages when

the person needs it

• When?

As part of assessment process;

person dependent

• How?

In variable formats* - accuracy and

consistency needed

• To whom?

Adults/certain conditions

• What stops us?

17 reasons emerged but lack of time & ↓confidence

• What prevents us changing our practice

• Lack of clear processes; experience; complexity of cases

• What do we need in place…?)

better process/ access/ exposure to this type of work / VR specialist

Stage 4 – Service user interviews (n=3)

• All found the experience positive and helpful.

• All were proactive in seeking support and taking onboard advice

• Themes such as ownership and influence of the effect of the report emerged.

Recommendations

• On line training

• Training offered across organisations & professions

• Competency framework

• Improve communication.

• Specialist in employability and vocational rehabilitation

• Regular resource updates

• Develop pathways

What next......

• Active and Independent Living Programme

• Aims:-

– Development of vocational rehabilitation pathway in each health & social care partnership in Scotland

– National vocational education framework

– AHPs who are delivering vocational rehabilitation will be utilising the AHP Fitness for Work Report

Thank you

healthWorks - Full report available

www.hi-netgrampian/healthworks