Specialist Therapies -Adults

Cathy Ingram – Service Manager

Three Pathways

• Complex rehabilitationMultidisciplinary, incorporating the falls pathway

• Neurological rehabilitationMultidisciplinary, incorporating the stroke pathway

• Musculoskeletal physiotherapySingle discipline, incorporating new PBC & prison

services

Complex and Neuro

• Occupational therapy, speech and language and physiotherapy

• Approx 40 staff, flexing across pathways

• Illness, injury or disability affecting any of the following areas:

Personal care; Domestic tasks; Mobility; Leisure education

work; Communication; Swallowing

Complex and Neuro

• Aims – regaining independence, managing long term/ deteriorating conditions

• Assessment, advice, treatment, support, health promotion and education to clients and care givers

• Short term, outcome focused interventions

• Single or multidisciplinary

Scope of Services• 16 years up Lambeth resident/ GP

• Open referral system

• Home, intermediate care bed, care home, out patients, gym etc

• Individual 121, group and MDT clinics

• 2,500-3000 referrals per year

• Single point of access with prioritisation criteria

Key Partnerships• Intermediate care– community and bed based• Clinics- specialist older persons, falls, stroke,

Parkinson's etc• Specialist teams- elderly physicians, nursing etc• Community matrons• Social services• Integrated care pathways with hospitals,

Southwark PCT, LBL etc

Supporting

• Care closer to home• Long term conditions• Staying healthy• NSF long term neurological conditions• NSF older people• Stroke strategy• Demand management• NICE /RCP guidelines

Stroke Key Community Elements

•Rapid, responsive access to specialist rehabilitation

•Early Supported discharge with Economic & qualitative evaluation - ‘in reach’ to hospitals

•Psychology

•Specialist & integrated reviews post discharge/ acute stroke

•Links with long term support/ peer support

•User participation in service development

Overview ofOverview ofthe Falls the Falls JourneyJourney

ReferralFalls Clinic

Specialist assessment

Discharge

Tests e.g Tilt table, Dexa

scan, ECG etc

OT Home assessment

Physio / exerciseIntervention:

FUA for results

DischargeDecisionmaking

PT led fallsExercise & Education

Group

1:1 PTA Otago EP

1:1 Community PT or

Out-patient PT

Community ExerciseGroup

The Falls Team 2008Jenny Jeffery

Lead Falls Nurse

Consultant GeriatricianDr T Ernst

PT TeamCharlotte TinnKate BradfieldPaul Lagerman

OT TeamSamantha Dolor

Nurse Team:Jean Fairweather

Jane BrydgesLead Falls Nurse

Consultant GeriatricianDr Hopper

PT TeamJudith Hall

Kemi OyebodeSarah Holmes

Veronica BaileyBen Scott

OT TeamSimon O’Byrne

Nurse TeamOslyn Brathwaite

LCCC

Whittington

Future Potential C &N• Intermediate care community expansion

• Integration with LBL

• Integration with ALD therapies

• Pathways / ESD for other conditions

• Care out of hospital eg critical care in care homes, head and neck specialism

• Prison SLT service

• Technologies – assistive and therapeutic

Future Potential C & N 2

• Accessibility for hard to reach groups- communication / cognitively impaired- language / homeless /refugee

• Capacity building with voluntary and community groups & LBL

• Vocational rehabilitation- return to work

• Specialist resource within and outside PCT

Musculoskeletal Physio

Assess, treat and educate each individual (and as appropriate advise their carers / family) who present with a presumed musculoskeletal dysfunction

Return the individual back to his or her optimum functional potential

Clients are encouraged to be active participants in the management of their condition and SMART goals are agreed between therapist and patient

Single discipline- out patients only, 7 staff, 3000 patients

Examples of Conditions

• Osteoarthritis, back pain, knee pain

• Soft tissue injuries, sprains and strains

• Rehabilitation following orthopaedic surgery e.G. ACL reconstruction/fractures

• Sports injuries e.G. Groin pain

• Frozen shoulder

• Repetitive strain/ work related disorders

Recent Developments

• Orthopaedic triage service - PBC

• Preferred provider for many GP’s increasing demand by 30% in year

• Prison contract

• Part of Musculo-skeletal steering group -pathway scoping /planning

Future Potential- MS Physio

• Expand to 3 sites• Incorporate GP based physio’s within

service• Self referral • Extend telephone advice service • Occupational health physiotherapy• Develop locality alignment, +/-• Single point of triage/ access to Musculo

skeletal services

Questions??