Care Planning Partnership October 2009

Supported by: Care Planning Partnership October 2009 Benefits of a close working relationship We are continuing to develop our Chronic Obstructive Pulmonary Disease (COPD) services throughout Worcestershire. Recent examples have been the developments in primary care, the expansion of the COPD team (including weekend working) and the new contract with the Acute Trust which has reflected the findings of the national COPD audit. However the dangers of improvement are that they can reveal previously unmet demand. This is certainly the case in COPD where in primary care we are now identifying many more patients with COPD who would benefit from pulmonary rehabilitation. Despite an extraordinary effort by the COPD team we were in danger of developing a long waiting list. By carefully monitoring this we realised that there were no more efficiency savings to be made so we went to practice based commissioners requesting short term investment over the next year. We felt once we had done this the COPD team could cope with the new referrals without also having to treat all the patients who had never had this treatment previously. We successfully bid for funding and are now looking forward to continuing to work with a short waiting list of a treatment which has Grade A evidence of effectiveness. Dementia Care Planning Sub Group The dementia care planning group are delighted to report great progress since the last care planning newsletter was published The group, under new Chair Sandra Rote, Director of Clinical Development and Lead Nurse have expanded with the addition of the Joint Commissioning Unit which is already making significant progress in the development and expansion of services. The group are also lucky to have Professor Dawn Brooker from the Association of Dementia Studies, University of Worcester who is a national figure in dementia and a real asset to the group. We also are delighted to report that we bid for a Department of Health project to become one of the Dementia Demonstrator Sites and were successful, obtaining funding to support two posts for dementia advisor posts around the county, aligned to the developing Early Intervention Service and working across the Local Authority, Voluntary Sector (Alzheimer s Society), University and NHS Worcestershire boundaries. This has produced much media interest around the county and we are proud to be able to say we are taking the issue of dementia seriously. The group have developed a well received draft Worcestershire Dementia Pathway and comprehensive Dementia Strategy to support implementation of the National Dementia Strategy published by the Department in February this year. We would very much like to increase primary care representation on the group so if you think you would like to get involved, please contact kathrine.dale@worcestershire.nhs.uk

End of Life and palliative care GP practices are being invited to sign up to deliver a locally enhanced service for end of life and palliative care in primary care. The service specification supported by practice based commissioning and developed by Worcestershire GPs with an interest in palliative care aims to ensure best practice, as advocated in the nationally supported Gold Standards Framework, is adopted across Worcestershire for all patients regardless of diagnosis. The service will commence at the beginning of October and will include training for GPs, district nurses and community matrons to enable them to deliver the enhanced care. The work in primary care is just one part of a whole system approach to improving end of life and palliative care for patients that are being supported by Marie Curie s Delivering Choice Programme and the Worcestershire End of Life and Palliative care network. Examples of other work include improving access to carers 24/7 for patients dying at home, improving access to specialist palliative care, and improving care in acute and community hospital settings. If you are interested in hearing more or supporting any of the working groups please contact Debbie Westwood, Programme Lead for End of Life and Palliative Care, at debbie.westwood@nhs.net

Full Steam Ahead for SPA! The Single Point of Access Service (SPA) is celebrating its first birthday this September after a busy and successful year. The SPA service provides professionals with a one stop shop and a referral management service, when requiring access to Intermediate Care and Admission Prevention services. The service is an integrated approach between Worcestershire PCT and Worcestershire County Council and encourages collaborative and flexible working between health and social care professionals; maximising community opportunities for patients who require admission prevention strategies or rehabilitation. The Single Point of Access aims to: To provide a single telephone number for referring professionals to access Intermediate Care and Admission Prevention services To provide an equitable access to Intermediate Care and Admission Prevention services, in line with new Intermediate Care developments within the county To reduce unnecessary admissions to the local A&E and MAU units, by providing community alternatives To encourage patient centred health and social care, within the persons own home, or as close to their home as possible To provide a proactive, timely response to referrals with coordinated joint assessments performed as necessary; improving efficiency and reducing the potential for duplication of assessments To respond within 2 hours for urgent crisis situations To provide a secure referral management system with a simple and efficient process. When SPA launched on the 1st September 2008 the initial pilot phase covered patients registered with a GP in the Worcester City locality, between the hours of 8.30am and 17.00pm. Since then SPA has developed significantly and has moved from strength to strength. SPA has now extended its geographical coverage to the Pershore, Evesham, Broadway, Bredon and Inkberrow localities and more recently has extended operational hours until 8pm in the evening in conjunction with the expressed requirements of local GP s and paramedic crews. The SPA team are very fortunate to be working closely with the Social Care Emergency Duty Team (EDT) during the extended hours period, to ensure optimum health and social care outcomes are achieved for patients referred to them. A further exciting development has been the introduction of a Rapid Response Nursing Team (RRNT) attached to the SPA service. This is a team of qualified nurses, initially established on a temporary basis last Winter, to assist with preventing unnecessary hospital admissions in crisis situations. The SPA Customer Advisors can direct all urgent referrals, requiring contact within 2 hours, to this team if an immediate clinical need is evident, or rapid nursing assessments are required. The Rapid Response Nurses are also available from 8.30 to 8pm and will visit the patient within two hours of the referral and sooner wherever possible, with referrals from paramedics and GP s being prioritised. Due to the success of the RRNT and the positive outcomes achieved for patients, the service has now been extended for a further year. It is envisaged that SPA will become a countywide service in the near future and the team are currently working towards full coverage of the south of the county within the next few months. Once this is completed SPA will then be extending the service to the north of the county too. Alongside this, work is underway to provide the SPA service 7 days a week, 8am to 8pm initially, with the ultimate goal of becoming a 24 hour service very soon. So it s full steam ahead for the SPA team! If you have any questions about the SPA service or require any further information please do not hesitate to contact Jo Poyner at joanne.poyner@worcspct.nhs.uk

Innovative Practitioner Programme and IAPT The Improving Access to Psychological Therapy (IAPT) short term mental health service user initiative is being developed by the Programme Lead for IAPT as part of the Innovative Practitioner Accreditation Programme run by the National Institute of Innovation. The prototype project for submission will be undertaken during September, but the initiative will be ongoing and we would welcome contact from service users who wish to be involved. Project proposal The initial prototype stage will involve the recruitment of 4 or 5 short-term mental health service users who have been involved in Primary Mental Health Care services. The service users will be invited to complete a semi structured interview to record their experiences within the primary care service and they will also be encouraged to consider creative writing and other techniques to illustrate their experiences. The experiences will be used to inform the IAPT project using an experience based design model. The initiative will then pilot a short term service user group as a subgroup of the IAPT Consultative Group to continue the experienced based design approach. It is hoped this will become a sustainable approach to inform the IAPT project. For more information or to be involved in the initiative please contact Susan Pinfold-Brown at susan.pinfold-brown@ worcestershire.nhs.uk Improving the care of patients with COPD and Type II Respiratory Failure The management of Chronic Obstructive Pulmonary Disease (COPD) and Type II Respiratory Failure has improved throughout the West Midlands Region following partnership work with NHS Worcestershire and Worcestershire Acute Hospitals NHS Trust. A clinical audit was undertaken in October 2008 to examine the management of patients with COPD and also other conditions that increase the risk of retaining carbon dioxide by the West Midlands Ambulance Service (WMAS) and Worcestershire Acute Hospitals NHS Trust (WAHT). A meeting was arranged by Nisha Sankey, Programme Lead for Clinical Development, in November 2008 where WMAS and WHAT were invited to attend the meeting to present the findings of their audits. The findings of both audits indicated that patients were receiving higher than required levels of oxygen and that this practice may lead to complications in this patient group. Matthew Ward, Regional Head of Clinical Services for WMAS, developed and released guidance for staff based on the new British Thoracic Society Guidance for the emergency administration of oxygen. The guidance was released to all WMAS clinicians through the Trusts internal publication; the Clinical Times. The practice of oxygen administration was re-audited in March 2009 and the results have demonstrated a considerable improvement in the appropriate management of patients with chronic respiratory illness. Matthew Ward, Regional Head of Clinical Services said, the results indicate that the change in practice is not only in Worcestershire but across the rest of region. Patients are receiving more appropriate care, and this is due to the partnership work with NHS Worcestershire and Worcester Acute Hospital NHS Trust.

The Family Education Group A stroke is a life changing event not only for the person but for their families as well. Those who have had a stroke should receive rehabilitation but it is equally important that the families of those affected are provided with the opportunity to understand what has happened and what this will mean for the future. This is strongly advocated by the National Stroke Strategy (Department of Health 2007) and National Clinical Guidelines for Stroke, 3rd Edition (Royal College of Physicians 2008). The aim of this project, initiated as part of an MSc in Neurological Occupational Therapy, was to develop and implement a family education group to provide equal access to relevant information and practical support for those who care for someone after a stroke. The programme focuses on educating carers, identifying sources of social support, and developing personal coping strategies and practical skills for daily living. The programme is made up of 4 weekly evening teaching sessions: Session one - Information & Education Aims to help family members to understand exactly what a stroke is, what the consequences of stroke are and what is actually meant by the term rehabilitation Session two - Emotional Adjustment Designed to teach strategies to manage personal feelings during this challenging time, and enable family members to identify sources of social support to help them along the way Session three - Looking after Yourself Aims to help family members to identify and develop their own coping skills in order to manage stress and deal with change and new challenges Session four - Practical Coping Skills for Daily Living Family members learn where to find specialist advice for things like dealing with financial matters and claiming benefits. They are also taught strategies on how to prepare for and support their relative once home. Problem-based (PBL) and social learning theories (SLT) have been adopted to enable carers to take control of their learning, and these form the basis upon which the programme is structured. The programme was recently piloted on the Willows Stroke Rehabilitation Unit and the feedback received from the participants was extremely positive. The teaching activities used within the group, including brain puzzles, pop quizzes and board games were well received. It is now the intention for every family to be given the opportunity to attend the group during their relative s rehabilitation. Ongoing developments include the addition of a carers workbook to accompany the course and development of a suitable outcome measure to assess the useful of the programme for family members.

Elaine invited to present in Vienna Elaine Bevan-Smith has been invited to fly the flag for Worcestershire the next meeting of the European Respiratory Society in Vienna. Elaine will be attending the conference to present three topics: Validation of motivation measures for use in pulmonary rehabilitation programmes Factors relating to motivation within the context of pulmonary rehabilitation A focus group about end of life care in COPD. The conference attracts international professors of respiratory medicine, and is an excellent opportunity for sharing research and best practice methods. Elaine hopes to come back with plenty of new information about COPD research, in addition to putting Worcestershire on the map along the away! Find out how Elaine got on in Vienna in the next CPP newsletter. NICE Clinical Guideline No.88: Low back pain Physiotherapists have a wide range of treatment methods at their disposal in Worcestershire including exercise, advice, ice, electrotherapy, acupuncture, mobilisations and manipulations. NICE Clinical Guideline no.88 contains recommendations regarding the use of three specific interventions for the treatment of non-specific low back pain. These are: Structured exercise Manual therapy Acupuncture. NICE recommend that one of these treatment options should be offered to all patients, taking patient preference into account. If the chosen treatment does not result in satisfactory improvement, another of the treatment options should be considered. Physiotherapy services in Worcestershire are able to provide manual therapy, acupuncture and structured exercise programmes as methods of treatment. Acupuncture is more often used as part of a patient s treatment rather than in isolation, as a step up to reduce pain and enable patients to self manage, rather than a treatment in its own right. Manual therapy is commonly used in conjunction with a structured exercise programme. GPs should therefore continue to refer patients to physiotherapy for assessment and treatment of non specific low back pain rather than refer for the provision of acupuncture in isolation.

The EASY project The Early Access to Stroke Unit Your brain heals quicker (EASY) project is a countywide project running until 2010 which looks at one aspect of the acute pathway with the National Stroke Improvement team. National data recommends best practice is that 90% of patients spend 90% of their time in a stroke unit. This fits with national targets of quality markers seven, eight, and nine in the National Stroke Strategy and also with NICE and Royal College of Physicians guidance. The project is being undertaken in order to: Improve high quality patient care to provide the best clinical outcomes in a timely manner Optimise the utilisation of staff through training, ensuring competence and developing new ways of working to meet the needs of stroke patients. Maximise the use of health economy resources by using efficient processes to meet National and local stroke targets. Our objective is that all patients with a suspected stroke go directly to a stroke unit from their point of entry. We started the project with figures of about 20% and are now around 40%. Our aim is to reach 70% by the end of the year. Everyone has worked incredibly hard to facilitate getting the right patients in the stroke beds. We have a number of exciting developments that will help to achieve the target for the project: The appointment of a stroke nurse to co-ordinate the movement of patients at the Alexandra hospital Redditch Monies secured to appoint a stroke nurse which will help with the co-ordination at Worcester Two protected ring-fenced beds for stroke patients at Worcester bringing the total number of beds up to eleven A plan to ensure that all minor strokes are admitted to the acute stroke unit so that throughput can be maintained An escalation policy so that patients as far as possible can bypass MAU and go directly from A&E to the acute stroke unit. Those breaching this policy who end up on outlying wards are flagged up with senior managers Work is planned to look at the patient pathway and process map. This will hopefully identify any particular bottlenecks or problems within systems We have started coding our own notes so that we have data which reflects the current activity. For further information, please contact Elaine Stratford, Stroke Specialist Nurse, on 01905 760285. NHSW000020_Sept 2009