1. Major Trauma Project Rehabilitation Workstream Jane BarnacleBeth Cordrey Rehab Workstream LeadSenior Clinical AdviserMajor Trauma Project

2. Overarching conclusions Broad spectrum of rehabilitation needs Rarely common or predictable pathways Inappropriate and inefficient use of existing services A more collaborative and flexible approach is required Consistent service standards and improved data management urgently required

3. Vision for the future a proactively managed system consistently high quality care and rehabilitation most appropriate setting, at the most appropriate time system works across boundaries care and rehabilitation provided as close to home as possible, as soon as is clinically appropriate.

4. Proposed strategy for trauma rehab services 1. Service Delivery Models and Structure Development of acute rehabilitation facilities Common standards and policies Governance opportunities Shared care models 2. Workforce Development of workforce model Workforce development plan Case management/coordination 3. Information Development of common data standards across the system Directory of services 4. Capacity When able to, carry out detailed capacity analysis of services contributing to major trauma rehabilitation

5. Project Phases Current Phase: May – mid August Future Phase: August onwards

6. Major Trauma Rehabilitation Model MTC TC IP Rehab Community Services Milestones Interventions Competencies System enablers Stabilisation Rehabilitation (including optimisation for rehab) Reintegration Principles, policies, procedures, structures Navigation Documentation (including prescription for rehabilitation) Data (using TARN) Governance Continuing Professional Development

7. Project Deliverable 1 Service Specification Original Designation Criteria was limited on rehabilitation Opportunity for development Initial focus on Major Trauma Centres and Trauma Centres Criteria Number Description Major Trauma Centre Trauma Centre 79. Physiotherapy Gym Gym on site equipped to provide acute phase assessment and acute phase rehabilitation to major trauma patients including management of the following injuries/patient groups: –Spinal injury –Traumatic brain injury –Complex musculoskeletal (e.g. pelvic fracture, soft tissue injury) Vascular and amputees (including general surgical patients ) X Gym on site equipped to provide acute phase assessment and rehabilitation to trauma patients X

8. Major Trauma Rehabilitation Model MTC TC IP Rehab Community Services Milestones Interventions Competencies System enablers Stabilisation Rehabilitation (including optimisation for rehab) Reintegration Principles, policies, procedures, structures Navigation Documentation (including prescription for rehabilitation) Data (using TARN) Governance Continuing Professional Development

9. Project Deliverable 2 Acute Rehabilitation Model Distinct from the ‘acute phase’ rehabilitation in MTC Takes principles of formal rehabilitation models Accessible by all major trauma patients Demand for London networks not yet known

10. Major Trauma Rehabilitation Model MTC TC IP Rehab Community Services Milestones Interventions Competencies System enablers Stabilisation Rehabilitation (including optimisation for rehab) Reintegration Principles, policies, procedures, structures Navigation Documentation (including prescription for rehabilitation) Data (using TARN) Governance Continuing Professional Development

11. Project Deliverable 3 Trauma Rehab Pathway Mapping the entire pathway from critical care through to community Encompass existing guidance/ standards i.e. National Service Framework for Long Term Conditions (2005), The NICE Guidance on Critical Care Rehabilitation (2009) and the British Society of Rehabilitation Medicine's Standards for Rehabilitation Services (2009) Using a model that focuses on key patient milestones, interventions, competencies and systems enablers

12. Major Trauma Rehabilitation Model MTC TC IP Rehab Community Services Milestones Interventions Competencies System enablers Stabilisation Rehabilitation (including optimisation for rehab) Reintegration Principles, policies, procedures, structures Navigation Documentation (including prescription for rehabilitation) Data (using TARN) Governance Continuing Professional Development

13. Project Deliverable 4 Data Performance metrics for rehabilitation Trauma Audit and Research Network (TARN) Identifying useful data to assess performance Links to the pathway being developed

14. Major Trauma Rehabilitation Model MTC TC IP Rehab Community Services Milestones Interventions Competencies System enablers Stabilisation Rehabilitation (including optimisation for rehab) Reintegration Principles, policies, procedures, structures Navigation Documentation (including prescription for rehabilitation) Data (using TARN) Governance Continuing Professional Development

15. Project Deliverable 5 Navigation Model Patient focussed advocate Facilitation of progression along the pathway: transitions Optimises patient experience and use of facilities and resources

16. Major Trauma Rehabilitation Model MTC TC IP Rehab Community Services Milestones Interventions Competencies System enablers Stabilisation Rehabilitation (including optimisation for rehab) Reintegration Principles, policies, procedures, structures Navigation Documentation (including prescription for rehabilitation) Data (using TARN) Governance Continuing Professional Development

17. Project Deliverable 6 Directory of Services Directory of Health and Social Care Services to support the London Trauma System Giving clinicians easy access to up to date and local information about services relevant to this client group May be outsourced & will need maintaining

18. Major Trauma Rehabilitation Model MTC TC IP Rehab Community Services Milestones Interventions Competencies System enablers Stabilisation Rehabilitation (including optimisation for rehab) Reintegration Principles, policies, procedures, structures Navigation Documentation (including prescription for rehabilitation) Data (using TARN) Governance Continuing Professional Development

19. Project Deliverable 7 Documentation For facilitating pathways and data collection in a more consistent manner Trauma booklet for London Trauma System Prescription for Rehabilitation

20. Major Trauma Rehabilitation Model MTC TC IP Rehab Community Services Milestones Interventions Competencies System enablers Stabilisation Rehabilitation (including optimisation for rehab) Reintegration Principles, policies, procedures, structures Navigation Documentation (including prescription for rehabilitation) Data (using TARN) Governance Continuing Professional Development

21. Project Deliverable 8 Rehabilitation Clinical Governance Framework Network level Tracking patients and reviewing outcomes and quality of rehabilitation provided at each stage of the pathway Reporting into an overarching performance framework at the London Trauma System

22. Major Trauma Rehabilitation Model MTC TC IP Rehab Community Services Milestones Interventions Competencies System enablers Stabilisation Rehabilitation (including optimisation for rehab) Reintegration Principles, policies, procedures, structures Navigation Documentation (including prescription for rehabilitation) Data (using TARN) Governance Continuing Professional Development

23. Project Deliverable 9 &10 Evaluation Impact and cost-benefit analysis to inform commissioning decisions Future Work Carrying on the work commenced … Analysis of demand & capacity (data dependent) Workforce review and development Ongoing development of standards Patient Outcomes - commissioning for outcomes