Specialist Therapies -Adults Cathy Ingram – Service Manager

Three Pathways Complex rehabilitation Neurological rehabilitation Multidisciplinary, incorporating the falls pathway Neurological rehabilitation Multidisciplinary, incorporating the stroke pathway Musculoskeletal physiotherapy Single 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 of the Falls Journey Discharge Tests e.g Tilt table, Dexa scan, ECG etc FUA for results Discharge Decision making OT Home assessment Referral Falls Clinic Specialist assessment Physio / exercise Intervention: PT led falls Exercise & Education Group 1:1 PTA Otago EP When to Refer: Hx of falls Hx of near misses Abnormalities of gait/balance // Nice guidelines 2004- older people (>65) who present for medical attention because of a fall, recurrent falls in the past year or demonstrate abnormalities of gait /balance should be offered a multifactorial falls risk AX Who Can Refer to the falls clinic Therapist – (Now need to complete falls telephone screen and generic falls Ax form) Doctors Nurses S/W Self referral – forms on SLIPS Web page Quick Reminder SPA Walking aid AX Referral Need to do Telephone falls screen – if falls / near misses/ fear of falling / abn in strength / balance highlighted Refer onto falls clinic What happens next: Telephone screen – if appropriate Decision re: Urgency Clinic appt booked – mostly within location Transport organised Phone call on day to ensure attending Falls Clinic day Falls Clinic: Involves 1) Geriatrician 2) Falls Nurse 3) OT team 4) PT team and: Investigates the course of falls Identifies whether a more detailed examination is required from the dr / PT / OT Identifies appropriate RX I.e Strength/bal exc, Med rev / OP RX / Adv Info / Home rev Specialist AX consists of Generic AX +/- OT AX PPA / PT AX Consultant AX Reasons for PT AX TUAG >15 seconds Need for W/A AX Unsteady gait/balance/ red strength probs Change in mobility status identified 1:1 Community PT or Out-patient PT Community Exercise Group

The Falls Team 2008 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??