1. WHAT DO YOU NEED AND HOW DO YOU GET IT? DR DAVID THORNBERRY CONSULTANT IN REHABILITATION MEDICINE, PLYMOUTH PCT

2. WHAT TO YOU NEED AND HOW DO YOU GET IT “I WANT IT ALL AND I WANT IT NOW” (QUEEN)

3. “NEED” (AS OPPOSED TO WANT): THE ESSENTIAL REQUIREMENTS FOR A DISABLED PERSON TO PRESERVE INDEPENDENCE AND DIGNITY.

4. A NUMBER OF INDIVIDUALS HAVE VARYING NEEDS IN THE CONTEXT OF DISABILITY: “ YOU” MAY REFER TO THE DISABLED INDIVIDUAL. HIS OR HER FAMILY AND CARERS, BOTH PROFESSIONAL AND NON-PROFESSIONAL. MEDICAL AND PARA-MEDICAL PERSONS INVOLVED IN TREATMENT. FRIENDS, EMPLOYERS, HOUSING AGENCIES, RECREATIONAL AGENCIES ETC.

5. SUMMARY OF NEEDS MAY BE: INFORMATION ADVICE EQUIPMENT SERVICES TREATMENT CARE EDUCATION HOUSING WORK PLAY FINANCES ACCESS

6. LONG TERM NEUROLOGICAL CONDITIONS A BROAD SPECTRUM OF DISEASES AFFECTING INDIVIDUALS AT DIFFERENT STAGES IN THEIR LIFE HISTORIES. NEEDS THEREFORE WILL BE VERY VARIED THERE IS A DISTINCTION BETWEEN CHRONIC PROGRESSIVE CONDITIONS, WHERE NEEDS MAY BE CONSTANTLY CHANGING AND NON-PROGRESSIVE ONES, ALTHOUGH BOTH REQUIRE CONSTANT REVIEW.

7. THE MEDICAL MODEL THE SOCIAL MODEL AN HOLISTIC APPROACH

8. QUALITY REQUIREMENTS (QR’s): ELEVEN IDENTIFIED IN THE NSF RECOMMENDATIONS.

9. QR’s 1 TO 5: 1. A PERSON CENTRED SERVICE 2. EARLY RECOGNITION PROMPT DIAGNOSIS AND TREATMENT 3. EMERGENCY AND ACUTE MANAGEMENT 4. EARLY AND SPECIALIST REHABILITATION 5. COMMUNITY REHABILITATOIN AND SUPPORT

10. Investigations Diagnosis Treatment Quality Requirements 5 Community Team Quality Requirements 1 Surgery GP Quality Requirements 2 & 3 District General Hospital Consultant Neurologist Quality Requirements 4 Consultant in Rehabilitation and Team Patient Functional Assessment and Liaison with: Social Services Housing Education etc. Functional Assessment Treatment: Goals Review Care Package Discharge

11. “It is the teams function to ameliorate the mismatch that exists between patient and his(her) environment by whatever mediating factors they can command. Therapy, aids, equipment, information etc.” (Chamberlain)

12. A FULL MULTI-DISCIPLINARY TEAM ASSESSMENT WITH THE FOLLOWING EXPERTISE AVAILABLE:  CONSULTANT IN REHABILITATION  OCCUPATIONAL THERAPIST  PHYSIOTHERAPIST  SPEECH AND LANGUAGE THERAPIST  CLINCIAL PSYCHOLOGIST  SOCIAL WORKER

13. Functional assessment has both objective and subjective elements. Parameters of objective assessment include: Mobility Dexterity Continence Communication Swallowing Cognition Behaviour Vision Hearing Touch Balance Activities of daily living

14. Subjective assessment records information unique to an individual patient’s circumstances and will include such parameters as: Pre-morbid intellect Education Motivation (drive) Domestic responsibilities Work Income Interests Housing Driving

15. Neuro-Rehabilitation Services may be: HOSPITAL BASED IN-PATIENT NEURO- REHABILITATION UNITS COMMUNITY BASED EG. REABLEMENT TEAMS

16. QR 7 - PROVIDING EQUIPMENT AND ACCOMMODATION EG:PROVISION OF MOBILITY EQUIPMENT SUCH AS A WHEELCHAIR. PROBLEMS: IDENTIFICATION OF NEED AVAILABILITY OF IMPARTIAL ADVICE EG. APPROPRIATE SEATING PRESSURE RELIEVING CUSHIONS CONTROL SYSTEMS LEGISLATION INSURANCE ? SHOULD BE THE ROLE OF THE DISABLEMENT SERVICES CENTRES

17. POTENTIAL SOURCES OF WHEELCHAIR SUPPLY:  THE DISABLEMENT SERVICES CENTRES  THE PRIVATE SECTOR  ACCESS TO WORK  CHARITABLE SOURCES  MOTABILITY

18. QR 8 & 10: PROVIDING PERSONAL CARE AND SUPPORT SUPPORTING FAMILY AND CARERS

19. QR 8: HEALTH AND SOCIAL CARE SERVICES WORK TOGETHER TO PROVIDE CARE AND SUPPORT TO ENABLE PEOPLE WITH LONG TERM NEUROLOGICAL CONDITIONS TO ACHIEVE MAXIMUM CHOICE ABOUT LIVING INDEPENDENTLY AT HOME.

20. Q R 10: CARERS OF PEOPLE WITH LONG TERM NEUROLOGICAL CONDITIONS ARE TO HAVE ACCESS TO APPROPRIATE SUPPORT AND SERVICES THAT RECOGNISE THEIR NEEDS BOTH IN THEIR ROLES AS CARERS AND IN THEIR OWN RIGHT.

21. INTERFACES: INTERFACES BETWEEN OR WITHIN ORGANISATIONS ARE THE POTENTIAL WEAK LINKS IN CARE PATHWAYS, WHICH MAY LEAD TO DELAYS OR DISRUPTIONS. THE FOLLOWING ARE POTENTIALLY DAMAGING INTERFACES:

22. INTER-AGENCY INTERFACES: HEALTH / SOCIAL SERVICES HEALTH / EDUCATION HEALTH AND/OR SOCIAL SERVICES / HOUSING THE EEC REGULATIONS ON ACCESS / ENGLISH HERITAGE HEALTH / PLANNING AUTHORITIES

23. IMPEDIMENTA IN DISABLED LOOS: MOPS, BUCKETS AND CLEANING EQUIPMENT RANDOMLY DISTRIBUTED GRAB RAILS FOLD DOWN BABY CHANGING MATS HAND DRYERS PAPER TOWEL DISPENSERS ALSO ENCOUNTERED: BALES OF NEWSPAPERS RUBBISH BAGS BUCKETS OF FRESHLY PEELED POTATOES

24. INTRA-AGENCY INTERFACES: THE MANAGEMENT OF DISABLED PEOPLE ON GENERAL MEDICAL / SURGICAL WARDS (QR 11) HEALTH / HEALTH – RELATIONSHIP BETWEEN PRIMARY AND SECONDARY CARE SERVICES HEALTH / HEALTH – LIAISON BETWEEN PAEDIATRIC AND ADULT SERVICES FOR THE DISABLED HEALTH / HEALTH OR SOCIAL SERVICES / SOCIAL SERVICES ACROSS A GEOGRAPHIC BOUNDARY

25. SUMMARY: Quality Requirements as identified in the NSF provide a useful framework for the development of services. Hospital and Community based Rehabilitation Teams are effective in providing the health components of the quality requirements. The medical and social models are compatible and should be complimentary. We must focus on interfaces when developing pathways of care.