1. Future Vision of Rehabilitation Services What do we need to do to meet the challenge? www.rehabilitationframework.scot.nhs.uk Sarah.mitchell@scotland.gsi.gov.uk A Delivery Framework For Adult Rehabilitation

2. High Impact change – vocational rehabilitation Every health board area has accessible pro-active vocational rehabilitation services delivered in partnership with community planning partners. LTC draft strategy calling for the same Possibility of new HEAT target.

3. Enabling Life Potential through Vocational Rehabilitation “a process that enables people with functional, psychological, developmental, cognitive and emotional impairments or health conditions to overcome barriers to accessing, maintaining or returning to employment or other useful occupation."

4. Enabling Life Potential through Vocational Rehabilitation All services should be aimed at maximising functional capacity of the working age population – physical, mental, social, spiritual It is not their diagnosis that is important – its what they can do! AHP’s crucial in delivering vocational rehabilitation services in Scotland

5. Key service issues Services are fragmented, inaccessible and difficult to navigate Communication within and across services is a challenge Service activity is dominated by indirect activity Professional practice is primarily based on custom and practice High incidence of transition episodes leading to duplication Absence of whole system performance management structure

6. Key issues for vocational rehabilitation Culture change for AHP staff Incorporate non complex issues into mainstream services Improve knowledge of AHP staff of services providing return to work support Improve access and develop robust systems so the client pathway is seamless

7. Rehabilitation Model requirements Emphasis on early intervention / self management Single access points into services Integrated teams delivering case/care management models Critical overview of where rehabilitation staff are situated to deliver this model – shifting balance of care!

8. Service Transformation  Service transformation will require not only the ability to influence processes, but to change mindsets, cultures, activities, and organisational power bases. Quote – Albert Einstein Insanity: doing the same thing over and over again and expecting different results.

9. Improving access to services This workshop is asked to consider how to align occupational health and vocational rehabilitation services to provide clear pathways to work and ensuring capacity in the system.

10. Healthy working lives – review Health and employment-related services must improve their support for people to maintain or improve their health while they are seeking a return to the workplace. Health services must recognise the need to include work outcomes as part of the patient’s plan for recovery.

11. Mapping Mapping of existing services both nationally and at local level will allow a baseline for standards to be established and enable more effective collaboration between services. Mapping to be undertaken in collaboration with rehabilitation co- ordinators

12. Enabling Life Potential through Vocational Rehabilitation - Healthy Working Lives Policy Review Redesigning the Client Pathways’.  Mapping current services and client pathways to work;  Recommend improvements in provision of, and links between, services that move people towards work;  Identify gaps in provision of relevant services and recommend how these can be addressed.

13. Improving access!

14. Key role for NHS 24 Providing information to support self management Delivering effective and evidence based triage More efficient and effective service delivery to enhance the patient pathway and outcomes for patients Innovative service delivery through tele- rehabilitation Delivery of national targets (18 weeks)

15. Exemplar Musculosketal re-design Existing systems for self referral to physiotherapy need to be streamlined and utilised in a more cost effective manner. Nhs 24 could provide single point of access into physiotherapy services.

16. Exemplar Musculosketal re-design Part of a whole systems MSK pathway Onward referral management systems Self management advice Websites as support for self management

17. Community AHP MSK Services Integrated MSK Team Physiotherapy Podiatry OT Dietician Prosthetics Radiography Specialist nurse GPwsi Self Referral via NHS 24 Self management and advice through NHS 24 web base for rehabilitation GP Referral Walk in Self Referral Electronic Referral Vocational Rehabilitation Services & Chronic Pain Services Orthopaedic waiting list Rheumatology services Other acute services Electronic Referral GP Referral Electronic Referral NHS 24 – Enhancing the MSK pathway

18. Referral Management electronic and appointment given to patient at time of call. In future a reminder text message will be sent to the person one day prior to appointment. Appropriate interventions will be delivered or sign posted by AHP team including discharge and onward referral to; vocational rehabilitation teams, self management programmes, leisure facilities the community based advanced practitioner multi- professional triage team for a specific orthopaedic assessment. This team will screen to identify whether surgical opinion is necessary or any other secondary care service required.

19. Rationale for self referral Self referral into physiotherapy services provides cost efficiencies of up to £2 million compared to GP referral. Figures based on 2004 figures prior to Consultant and GP contracts. (Holdsworth 2007) In the UK 12.25 million work days are lost due to musculoskeletal disorders. Low back pain is the most common musculoskeletal problem affecting an estimated 18 million people, with associated costs of £5bn p.a. to the economy due to working days lost. In Scotland physiotherapists’ treat over 64,000 back pain patients and a total of 271,000 MSK patients per annum.

20. Benefits of this change in service delivery Improve access to diagnosis and treatment Reduce waiting times Improve conversion rates to surgery in secondary care Provide greater efficiency and productivity Support shifting the balance of care and other Government policies (rehab framework, patient experience etc) Develop and enable a self management culture for patients in Scotland Promote health and well being Facilitate early return to work and avoid long term absence and long term dependency on benefits

21. Future developments  In the pipeline  Dietetic services – planned demonstrator programme with NHS Lothian and Highland.  Rehabilitation web based advice – working backs etc  Potential for innovation  falls, mental health  Tele-rehabilitation  Link MSK work to national fit for work pilots for vocational rehabilitation  Next steps  AHP Leadership within NHS 24

22. Developing a Vocational Rehabilitation Service for Small and Medium Enterprises in a Health Board area - launched 12 February 2008 Working Health Services Dundee Hotline 01382-825100

23. Working Health Services Dundee - Referral process Individual Hotline 01382-825100 - Telephone interview conducted Information passed to local Case Manager Case Manager assesses information and directs individual onto a pathway of care and eventual discharge Ergonomists Physiotherapist Occ Therapist Counsellor H&S Practitioners Occ Health Nurse/Adv Occ Health Physician Occ Hygienist Access to local services e.g Relate, Debt Counselling GPs Line Manager raise awareness

24. Enabling Life Potential through Vocational Rehabilitation A proposed new Fit for Work service, based on a case-managed, multidisciplinary approach, would provide treatment, advice and guidance for people in the early stages of sickness absence. Proposal for a Scottish Fit for Work National Service

25. Enabling Life Potential through Vocational Rehabilitation build upon the national Condition Management Programme structure whilst complimenting the strategic approach undertaken by the Scottish Centre for Healthy Working Lives. Add Vocational Rehabilitative Fit for Work Services to existing CMP teams Incorporate the work of the 3 pilots.

26. Key Success Factors Whole systems approach Strong partnerships Skilled multi- professional staff Enabling ethos built around goals of value to the service user Effective communication between all parts of system Clear links needed between specialist teams, primary care, social care services Focus on individual needs Return to meaningful activity / employment as rehabilitation goal Measuring the impact

27. Vocational Rehabilitation in Lothian Background & History Developing a Job Retention Service Current Position Future Aspirations

28. Background Established services Gaps in provision Partner services Within NHS With others Links with Occupational Health Service Developing a partnership with Healthy Working Lives 332,000 people employed by SMEs Proposal for development Facilities

30. Current Position Established services continue Rehabilitation, OHS, Mental Health, Learning Disability, mainstream therapy Upgraded Centre for Voc Rehab Working Health Lothian – one year Partnership with Dundee & Borders Direct access, signposting, training, evaluation Multidisciplinary involvement OHSXtra Increased skill set Validated assessments & tools for interventions

33. Future Embed Voc Rehab into mainstream Employability awareness Direct access Common standards Evidence of outcome Multi professional across health, social care, employment & voluntary sector Help people with health problems to enter, remain in and return to work

34. Judy Gibson Rehabilitation coordinator Lothian Judy.gibson@nhslothian.scot.nhs.uk