Published on March 14, 2014
Rehabilitation is everyone‟s business Shelagh Morris, Acting Chief Allied Health Professions Officer Lindsey Hughes Rehabilitation Engagement Project Manager
Working Definition - Rehabilitation • Rehabilitation is the restoration, to the maximum degree possible, of an individual‟s function and/or role, both mentally and physically, within their family and social networks and within the workplace where appropriate.
Aims and outcomes for session • Explain background to the project • Define scope of the project • Set national context • Discuss current service provision and identify what could be improved and how • Explore and further develop the draft principles and ambitions
Background • Previous work reviewing adult rehabilitation services – Chief Allied Health Professions Officer • Urgent and Emergency Care Review template • Stakeholder engagement to draft, agree and disseminate principles and objectives for adult rehabilitation services
Scope of project • In Scope – Adult rehabilitation services – Physical and mental health – Transition – Tertiary specialist to local specialist and general – From children and young peoples‟ services • Out of scope – Tertiary specialist rehabilitation services – Children and young people‟s rehabilitation services
Specialised Rehabilitation Services • “„Tertiary specialist‟ rehabilitation services (Level 1) are high cost / low volume services, which provide for patients with highly complex rehabilitation needs following illness or injury, that are beyond the scope of their local general and specialist services.” Service Specification for Specialist Rehabilitation for patients with highly complex needs (all ages) http://www.england.nhs.uk/ourwork/commissioning/spec-services/npc- crg/group-d/d02/
Rehabilitation Rehabilitation is a focus throughout the Mandate, and is explicitly included in Domains 1- 3 “Every year, millions of people rely on the NHS to help them recover after an illness or rehabilitate after injury. It does so through effective treatment and through ongoing help in recovering quickly and regaining independence” NHS Mandate Refresh (2014-15)
Delivering improved outcomes Preventing people from dying prematurely Enhancing quality of life for people with long- term conditions Helping people to recover from episodes of ill health or following injury Ensuring people have a positive experience of care Treating and caring for people in a safe environment and protecting them from avoidable harm Domain 1 Domain 2 Domain 3 Domain 4 Domain 5 Effectiveness Experience Safety The NHS Outcomes Framework
Outcomes Framework Rehabilitation Indicators Domain 1- Reducing Premature Mortality •Reducing premature mortality from the major causes of death •Under 75 mortality rate from CVD Domain 2 Enhancing quality of life for people with long-term conditions •Improving functional ability in people with long-term conditions •Employment of people with long-term conditions •Enhancing quality of life for people with mental illness •Employment of people with mental illness •A measure of the effectiveness of post-diagnosis care in sustaining independence and improving quality of life Domain 3 Helping people to recover from episodes of ill health or following injury •Improving recovery from injuries and trauma •Proportion of people who recover from major trauma •Improving recovery from stroke •Proportion of stroke patients reporting an improvement in activity/lifestyle on the Modified Rankin Scale at 6 months •Improving recovery from fragility fractures •Proportion of patients recovering to their previous levels of mobility/walking ability at i30 and ii120 days •Helping older people to recover their independence after illness or injury •Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/ rehabilitation service •Proportion offered rehabilitation following discharge from acute or community hospital
Planning Guidance 2014/15 - 18/19 Level Summary Relevance to Rehabilitation Ambition for NHS • 5 categories of better outcomes • 7 measureable ambitions AND • 3 key measures QOL / LTC ambition - delivering transformational service models through better access, quality, innovation and value Improving the health related QOL for people with LTCs is a key measureable Steps CCGs are expected to undertake in order to deliver these ambitions • Local ambitions linked to the 7 measureable ambitions • Planning fundamentals • National conditions Rehabilitation is a planning fundamental - Improving QOL of people with LTCs - Reducing the amount of time spent avoidably in hospital - More integrated out-of-hospital services that provide proactive, coordinated support for people with LTCs - Increasing the no. of older people living independently at home following discharge from hospital. Assurance process – expectation that CCGs will cover rehabilitation as part of assurance process ‘Unleashing the power of local systems to deliver the ambitions of their population.’
Outcomes Indicators reflected in the CCG Outcomes Indicator Set Domain 1 Under 75 Mortality rate • Cardiac rehabilitation completion Domain 2 Improving functional ability for people with LTCs • People with COPD …referred to a pulmonary rehab programme Domain 3 • Improving recovery from injuries and trauma • Improving recovery from stroke • Improving recovery from fragility fractures • Helping older people recover their independence after illness or injury
Partnership Working Delivering the ambitions will not be a task for the NHS alone. CCGs, as the local leaders of the NHS supported by Commissioning Support Units, NHS England, and all NHS providers, will need to work closely with all the key partners (including the LAs and Health and Wellbeing Boards) who have an important part to play in delivering our vision of „high quality care for all, now and for future generations.” Planning Guidance, 2014/15
Draft principles and ambitions • Initial Stakeholder event December 2013 • Identifying key principles and objectives that should underpin high quality adult rehabilitation services • Drafted as principles and objectives written as “I” statements • Presented to the National Clinical Directors Forum January 2014 • Amended following feedback • Collated into themes for today and “I” statements now our ambition for patient experience in rehabilitation services
Where next: • Principles and ambitions platform for taking this programme of work forward – Stimulate change and improvement – Support commissioning of high quality adult rehabilitation services • Wider stakeholder event on 17th March – Present principles and ambitions – Stimulate debate and discussion to help prioritise how to develop rehabilitation programme
Principles and ambitions • Review the draft principles and ambitions – – Do they make sense? – Is the meaning clear? – Have we missed anything?
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