A Strategy for the Therapy Services 2011/2016 Mid-Term Review, May 2014

Transcription

1 A Strategy for the Therapy Services 2011/2016 Mid-Term Review, May Introduction A Strategy for the Therapy Services 2011/2016 was published in May The purpose of the Strategy was to: Describe the Therapy Services within Aneurin Bevan Health Board Summarise the key achievements realised by the Therapy Services in recent years Set out the vision and direction of travel and the challenges to be addressed by the Therapy Services over the coming five years Identify further opportunities for development, including some blue sky vision around new services and extended roles that could be delivered by Therapy Services, describing their potential impact for the Health Board and the citizens of Gwent and South Powys. The Therapy Services included in the Strategy are: Occupational Therapy Arts Therapies (Art, Drama and Music Therapy) Dietetics Orthoptics Therapy Services Physiotherap y Podiatry and Orthotic Services Speech and Language Therapy A Strategy for the Therapy Service Board update May

2 The Strategy declared that the Therapy Services would continue to develop their services in line with the vision and strategic direction of the Health Board, leading, responding to and supporting major transformational programmes of change. It added that they would continue to drive down waste, harm and variation and would constantly strive to improve service provision in both cost effective and clinically effective ways. The Strategy described circa 100 individual priority areas for development across the Therapy Services, to be progressed between 2011 and Each of these was aligned to the Health Board s Five Areas of Priority Focus as outlined in its 2011/12 Annual Plan and was mapped against the Standards for Health Services in Wales. Chapter 4 of the Strategy also described a number of potential further areas for development, which could contribute to the delivery of cost effective sustainable health services. These potential developments included those that were more challenging in nature and were out-with the gift of the Therapy Services to deliver alone, requiring collaboration and agreement across a range of specialities within the Health Board. Many of these would require significant service re-design. This report provides an update on progress with the agreed priorities and the additional potential areas for development set out in the Therapy Strategy. 2. Progress Against Identified Priorities for 2011/2016 The Therapy Services have continued to work across directorate, divisional and organisational boundaries to provide care and support to citizens of all ages across Gwent and South Powys. They traditionally use a co-production approach with service users, carers and other service providers to promote, achieve and maintain independence as far as possible in order to improve the health and well-being of patients / clients and their families. The Therapy Services have made significant progress with the majority of the priorities set out in the Therapy Strategy. Many of these have been fully realised, whilst others have been partially progressed and are on track to deliver by A summary of each of the priorities and their updated status as at May 2014 is provided in Appendix A. Most of the developments have been achieved through redesigning processes and services within existing Therapy resources, while others have been supported by Health Board or external investment. A Strategy for the Therapy Service Board update May

3 A selection of key achievements from 2011/2014 is outlined below. Consolidation of Therapy Services into New Sites The Therapy Services have realised a number of successful moves into new sites over the past three years. Examples include: Consolidation of the clinical service models within the Therapies Unit at Ysbyty Aneurin Bevan (YAB) Establishment of the Therapies Unit within Ysbyty Ystrad Fawr (YYF) Establishment of the Therapies Unit within Serennu Childrens Centre Transfer of Learning Disabilities Arts Therapies clinical facilities from Llanfrechfa Grange Hospital to County Hospital Transfer of staff, including the Therapy Services Booking Centre from the Llanfrechfa Grange Hospital site to St Cadoc s All these moves were achieved with minimal disruption to clinical services. Benefits include improved ability for multidisciplinary working across Therapy teams, reduced travel time for staff, increased clinical activity and greater patient choice / awareness of available treatment options. Developments in the Use of Information Technology and E-Systems The Therapy Services have advanced in their use of information technology and e-systems to facilitate and support both clinical and administrative functions. This has helped to partly progress towards a paper-lite system of working. Examples include: Transfer of all community activity onto the previous Patient Administration System (PAS) in readiness for the transfer to Myrddin Successful implementation of Myrddin to support the patient focussed booking of Therapy community patient appointments Expansion of the use of Clinical Workstation and Med Secs software to facilitate electronic clinical letters Implementation of electronic tools including e-referral, e- expenses and self service of the electronic staff record (ESR) A Strategy for the Therapy Service Board update May

4 Orthotics Service Workshop Building on many years of developments and cost savings relating to orthoses, the Orthotic Service realised the opening of its new workshop at County Hospital in This has enabled: A much improved working environment that meets health and safety requirements Additional in-house manufacturing and further reduced reliance on contracting from the private sector for semi-complex orthoses Realisation of anticipated further annual savings of 52k Further opportunities include the possibility of income generation from neighbouring Health Boards for the manufacturing of semicomplex orthoses. Community Nutrition Support Team The prescribing support team was established in 2010 as a Spend to Save initiative to reduce inappropriate prescribing of oral nutritional supplements (ONS) in the community and to contain the growing costs relating to such prescribing. The project has proven to be successful, achieving savings of over 200k per annum. The team, which now comprises six dietitians, provide timely dietetic intervention to patients at risk of malnutrition within the community. It has developed into a core service within the Primary Care Division and receives referrals from GPs and community healthcare professionals. The team reviews patients in their own homes and registered care homes to provide appropriate dietary advice and support. Prior to this development this vulnerable group of individuals had limited access to dietetic intervention. The team also provides training to GPs, district nurses and care home staff on the assessment and appropriate treatment of malnutrition. In the longer term the service could potentially reduce the incidence of malnutrition in the community. The project has achieved total net savings of 903,902 for the ABUHB community prescribing budget since its inception in A Strategy for the Therapy Service Board update May

5 Promoting Emotional Health and Well-Being The Arts Therapies have instigated a number of initiatives to promote and improve the emotional health and well-being of clients and staff. This has been achieved via consolidation of a stepped care approach through Arts in Health and Well-Being. Examples include: Provision of advice and consultation to residential services, including identification of arts leads for each residency. Artwork produced by residents through leisure has been on public display in Nevill Hall Hospital Arts Therapies involvement in planning weight loss groups for clients with a learning disability, using the role of arts to help people express feelings associated with weight issues Successful bid to the Health Technology Fund to provide technology to help meet the emotional and mental health needs of people with learning disabilities Contacts maintained and partnership working explored with Gwent wide arts providers, e.g. GARTH, Arts Alive Wales, Head 4 Arts Early Identification and Intervention for Children with Speech, Language and Communication Difficulties Within the focus areas of public health, early identification and intervention regarding speech, language and communication, the Speech and Language Therapy Service has developed a whole systems pathway for children with speech, language and communication needs (SLCN) so that no child over the age of 7 remains undiagnosed. As part of this: A tiered service is well established in Flying Start and Families First, in child care settings and schools including special schools Joint training strategies for implementation of the tiered service are in place and expanding The value of the excellent partnerships is indicated by increasing service level agreements with Flying Start, Families First and Local Authorities Constant reviews and additions are made to the evidence for the pathways for identification of children with SLCN and the ways in which they are supported A Strategy for the Therapy Service Board update May

6 Improved Integration of Children s Services The Occupational Therapy Service has progressed a number of developments to support integration of services provided to children and their families. These include: Strengthened integration with Local Authority children s disability services The establishment of a single OT team for children s services comprising Local Authority, CAMHS and children s centre OTs Implementation of a single point of access for health referrals for children with disabilities and development difficulties This has resulted in a more joined up approach to the care of children, delivering a social model of care that focuses on independence and the development of life skills rather than on impairment or disability. Improved Access to Physiotherapy Services The Community Physiotherapy Service received in excess of 51, 000 referrals in 2013/14, equating to an increased demand of 6.5% compared to 2012/13. 90% of this demand relates to musculoskeletal (MSK) conditions. In order to keep pace with increasing demand, and improve access to the Service, a significant amount of work has been undertaken over recent years. This includes: Extensive review and standardisation of MSK clinic templates to maximise clinical capacity (shown to be at higher end of practice through UK benchmarking) Additional temporary resource secured in 2012/13 to remove backlog from MSK routine waiting list reducing maximum waits from 28 to 8 weeks Focus on improving orthopaedic post operative waiting times for physiotherapy Continued flex of clinical capacity to meet changing demands The Service delivered a total of 171,965 community patient contacts in 2013/14. There are currently circa 5000 patients on the waiting list and despite the increasing demand, the waiting time for routine MSK referrals is being maintained at 14 weeks in line with the Therapy waiting times standard. The service is now achieving over 90% of orthopaedic post-operative patients being treated within the internal 10 day target. A Strategy for the Therapy Service Board update May

7 Development of Student Training within Orthoptics The Orthoptic Service has progressed the development of the service as a teaching resource for Orthoptic students. A number of identified priorities have been achieved in relation to this: Further development of the Clinical Tutor role within Orthoptics Development and establishment of specialist teaching roles for band 6 staff Establishment of an in-house database for student resources for Orthoptic undergraduates, pre-registration optometrists and medical students In addition to the above, a number of further developments have occurred in response to emerging priorities and to support the transformational change programmes introduced since the publication of the Therapy Strategy. Some noteworthy examples are described below. Improved Monitoring of Quality and Patient Safety (QPS) Departmental, Directorate and Divisional structures and reporting mechanisms have been strengthened to improve the monitoring of Quality and Patient Safety across Therapy Services, aligned to the Health Board s QPS agenda. Developments include: Establishment of uni-professional and Therapy Directorate Quality and Patient Safety Fora Bi-monthly submission of exception reports to the QPS Operational Group in line with the Health Board s QPS requirements This structured approach facilitates sharing and learning from incidents and complaints and aids the monitoring of compliance with mandatory training requirements, Personal Appraisal Development Reviews (PADRs) and compliance with the Standards for Health Services in Wales. It also enables the sharing of achievements across the Therapy Services and wider. A Strategy for the Therapy Service Board update May

8 Improved Communication and Sharing of Good Practice A number of events and developments have been used to improve communication and share best practice within the Therapy Services, both internally and external to the organisation. These include: Two highly successful Health Board Therapy and Health Science Conferences held in 2012 and Both events were supported by Board members and included high profile speakers, including the Director General / Chief Executive of NHS Wales and the Minister for Health and Social Services. Each conference showcased a wide range of quality improvement programmes and best practice initiatives to circa 150 delegates. A number of internal uni-professional showcase and clinical governance events Use of uni-professional and organisational newsletters to share developments and celebrate staff achievements Development of the ABUHB Speech and Language Therapy Website to provide useful information and inform service users and carers what they can expect from the service Increased use of ABUHB social media networks e.g. Twitter and Facebook to communicate new initiatives and service developments A number of Therapy staff have been recognised through ABUHB Staff Recognition and NHS Wales Awards Improved Performance Monitoring and Benchmarking The Therapy Services have progressed a number of initiatives to improve the collection and monitoring of performance data. These include: Development of Therapy Service Dashboards to assist the monitoring of key performance indicators including clinical activity, workforce and financial data Development of an electronic Orthotic Prescription Access System (OPAS) to improve the monitoring of orthoses prescriptions and increase efficiency and turnaround times in providing equipment Participation in the NHS Benchmarking Network Acute Therapies Benchmarking Exercise in 2013 (Physiotherapy and Occupational Therapy) Planned desk-top benchmarking of Dietetics and Speech and Language Therapy against the NHS Benchmarking Network 2013 Report for these services A Strategy for the Therapy Service Board update May

9 Implementation of the ABUHB Integrated Adult Weight Management Service A fully integrated Adult Weight Management Service (AWMS) has been developed and implemented across the Health Board. This is the first of its kind in Wales, with ABUHB being the only Welsh Health Board that fulfils all of the level 1, 2 and 3 requirements of the Welsh Government s Adult Obesity Pathway. Key elements include: Development of a fully integrated patient pathway aligned to levels 1, 2 and 3 of the Welsh Governments Obesity Pathway Consolidation of existing Health Board resources that have historically supported adults with obesity, including Dietetics, the Joint Treatment Programme (JTP) and the Specialist Weight Management Clinic in Ebbw Vale Continued expansion of level 1 support for obese adults including roll-out of Foodwise across the localities served by the Health Board Development of a single point of access for referrals to level 2 and 3 services, with clear inclusion / exclusion criteria Implementation of an initial consultation clinic to assess, coproduce and agree with the individual the most appropriate level 2 or 3 package of care to meet their specific needs Further development of Slim 4 Life, the Dietetic-led Group Nutrition Education Programme Implementation of a 1:1 dietetic structured education programme The addition of Clinical Psychology support to the Service Continued ability to refer from the level 3 clinic to level 4 bariatric surgery services in Abertawe Bro Morgannwg University Health Board (ABMU) Continued links to the National Exercise on Referral Scheme (NERS) The new service was launched on 1 April The development built upon existing services and has acted to replace previous initiatives such as the Hearty Lives Project in Torfaen. It was supported with a grant of 50k from the British Heart Foundation and has received additional funding from ABUHB to expand the service and include Clinical Psychology support. Brief updates on progress with all other priority areas are given in Appendix A A Strategy for the Therapy Service Board update May

10 3. Progress Against Additional Potential Areas for Development Whilst there has been some progress made against the potential areas for development outlined in Chapter 4 of the Strategy, this has been more limited. This is due to the nature of the developments described, which require service re-design across a number of specialities and directorates. The following developments have been partially progressed; however, full implementation to achieve maximum anticipated benefits, would require significant service re-design and / or re-alignment of resources requiring support and endorsement by the Executive Team and Health Board. Front Door Occupational Therapy Services Additional funding has enabled the extension of OT presence in A&E / MAU / EAU in RGH and NHH to be available Monday to Friday on both sites, with RGH working 8am 7pm. In the Front Door OTs enabled 782 patients who would otherwise have been admitted, to be discharged home. The care planning for a further 331 patients who were admitted was commenced sooner than would previously have been possible. A PDSA will be undertaken during 2014 to determine whether extending the service to seven days a week has the potential to further increase admissions avoidance. Physiotherapy Emergency Department Review Clinic (PEDREC) This RGH A&E based Physiotherapy led initiative has continued to provide follow-up care for patients with soft tissue injuries. This clinic is provided twice per week and the potential to extend the service across the week and to NHH has been explored but will require additional resources to deliver. The Physiotherapy Service plan to continue to work with the A&E Team to identify a workable solution within available resources. Physiotherapy Led Orthopaedic Follow Up Physiotherapists have provided the orthopaedic follow-up for patients following a number of procedures including anterior cruciate ligament (ACL) repair for a number of years. Post operative Dupuytren s Contracture reviews are also now undertaken by physiotherapists in orthopaedic clinic. Further areas continue to be considered with the orthopaedic teams. OT Management of Mental and Physical Health OTs working in acute and rehabilitation hospitals have be trained in first level dementia care to enable a more holistic approach to patient care in physical health settings. The interface between older adult mental health OTs and those working in adult physical care has been enhanced to enable cross service consultation to the benefit of patients in both settings. The development of dual OT roles for older people is part of the 3 year plan for the service. Improved Management of Enterally Fed patients in the Hospital and Community Setting Progress has been made to standardise policies and procedures around enteral and parenteral A Strategy for the Therapy Service Board update May

11 nutrition. A multidisciplinary PEG clinic has been established at NHH. The Community Nutrition Support Team has been established and planning of work programmes has commenced with the NCNs. Further work includes the establishment of Nutrition Support Teams within the ELGHs, and in readiness for the SCCC. A draft business case has been developed and is being considered by the Divisional Nursing Team. Physiotherapy and OT in Occupational Health A business case has been developed and several funding streams explored but have to date been unsuccessful. The Therapies Directorate consider this initiative to be of significant potential value to staff and will continue to seek to identify a funding source. Improved Nutritional Status for MAU and Inpatients A poor appetite pathway has been implemented, training has been provided by the dietetic team, and its use is being monitored. Consideration now needs to be given to the development of dedicated nutrition roles for support workers at ward level. Dietetic Management of Insulin in Diabetes Progress has been made in RGH with specialist dietitians within the Diabetes MDT advising on insulin adjustment and carbohydrate counting. This has enabled cross cover working with the Diabetes Specialist Nurses. Discussions are ongoing with the diabetes team to progress this in NHH and YYF. An insulin adjustment protocol for dietitians working as part of the paediatric MDT has been developed and is awaiting endorsement from the Paediatric Directorate. Podiatry Led Medication in Community Foot Ulcer Clinics Podiatrists are currently able to prescribe medication under Supplementary Prescribing Legislation and it is expected that they will obtain fully independent prescribing rights in the near future. A training programme for all Band 7 staff has been established to progress this development, with 70% of staff trained to date. The next step will be to develop pre measured dose packs for use in clinical sites. Dietetic Led Management of Coeliac Disease This objective has been overtaken by development of a business case for an integrated dietetic led service for patients with irritable bowel syndrome (IBS). The business plan is supported by the Gastroenterology Directorate, but to date no funding stream has been identified. Plans are in situ to strengthen the business case with the help of ABCi and to consider progression through an internal invest to save bid. Seven Day Therapy Inpatient Services The Physiotherapy Service has developed a business case to replace the existing weekend out of hour s orthopaedic inpatient service with a full seven day service. This would lead to improvements in the quality of service provided at the weekend and potentially reduce length of stay. Staff agreement through a full consultation process has been achieved and discussions are currently ongoing to progress this development which an additional revenue cost of 50k per annum. A Strategy for the Therapy Service Board update May

12 SLT Led ENT Voice Clinics - Practitioners with the necessary skills have been identified. Discussions are progressing with the ENT Directorate to work towards completing this objective. SLT Led Video Fluoroscopy Clinics A service protocol has been jointly agreed between Radiology and SLT. Full implementation has been delayed due to a review of the IRMER training within radiology. It is hoped that this can be progressed once this training is re-instigated. The following developments have not been progressed to date but are still considered to offer potential cost effective sustainable solutions for the Health Board. In order for any of these proposals to be pursued, significant services re-design and / or re-alignment of resources would be required. Therapy Led Inpatient Services This development will be subject to detailed exploration and would require significant service re-design if taken forward. Physiotherapy Managed Spasticity Clinics Legislative change to enable Physiotherapists to train to become Independent Prescribers was passed in 2013 with amendments to the Welsh Regulations expected during Once this has occurred the Service plans to progress this development. GP Practice Based Therapists Provision of Therapy Services closer to patients homes as part of the Primary Care MDT could offer quality and access benefits but is resource heavy. The Therapy Services are therefore not currently able to progress this development within existing resources. A significant service development not specifically captured in the Therapy Strategy includes the re-design of stroke services as set out in the ABUHB Stroke Delivery Plan. This ambitions programme covers the whole stroke pathway from prevention to long term support for stroke survivors. Therapy Services have been instrumental in the design of the stroke pathway and will change the way they provide their services as the new model for delivery is implemented. To enhance the community support element of the pathway therapists will lead on the establishment of a Community Neuro Rehabilitation Service that will facilitate early supported discharge and community rehabilitation. This development has been funded in 2014/15 from a successful multi agency bid to the Welsh Government s Intermediate Care Fund. 4. Conclusion The Therapy Services have made significant progress in delivering the plans set out in the 2011/2016 Therapy Strategy, and have also responded to additional challenges and opportunities that have emerged in the last three years. The successful re-design of many services has enabled improvements in clinical care and enhanced patients experiences. The innovation and energy of therapists and their support A Strategy for the Therapy Service Board update May

13 staff have been evident throughout and will continue as they work to achieve the remaining developments contained in the Therapy Strategy, and to address any new ones that emerge in the future. Their activities have and will continue to be aligned to the strategic direction set by Welsh Government together with the Health Board s vision, values and planning cycles. In completing the remaining term of the Therapy Strategy the Therapy Services will embrace a number of key themes that will align to current service planning and modernisation principles. This will include the continued re-design of workforce and services to deliver the Clinical Futures model and the South Wales Programme; building on our university status; enhancing co-production at all levels and identifying opportunities to deliver prudent healthcare. A Strategy for the Therapy Service Board update May