All Dorset MND special interest group membership joined up working

1. All Dorset MND special interest group membershipjoined up working • MNDA • Woodlands Community Team • PHFT • RBCH • DCH • Macmillan Unit • Forest Holme • Joseph Weld Hospice • Generalist Palliative Care Team • Commissioners

2. Motor Neurone Disease

3. Numbers • Number who get MND each year: 2 per 100,000 • Dorset = 18 new cases a year • 50-60 people pwMND Dorset • 5000 in the UK

5. Social Services Orthotics Joint Working Neurologist OT W/ch Service PT MNDA SALT Respiratory Team MND Patient and their family Dietician District Nurse GP Hospice Palliative Care Teams Palliative Care Consultant

6. Why are additional resources required? • Early assessment following diagnosis is essential. • Regular reviews as appropriate • Requires specialist therapists • Specialist clinics • To promote joint working between health, social care and the voluntary sector

7. Outcome of the investment • To improve quality of life • To maintain independent function for as long as possible • To enable access to the community • For health professionals to anticipate the needs of the client and carer including information, equipment, appropriate onward referrals and support • To avoid admissions to hospital This leads to effective use of NHS resources

8. ‘Aspirational’ Care Pathway for People Living With Motor Neurone Disease in Dorset Diagnosis of MND or probable MND Referral to Poole Community Therapy Team/Christchurch MND Team/Community Therapy Team in West Physiotherapy Occupational Therapy Speech and Language Therapy Referral MNDA Referral to MND 3 monthly clinic with Consultant Neurologist, Palliative Care Consultant, Specialist therapist/SPCN with an interest in MND Bi-monthly MDT meetings for People living with MND between Health and Social Care and voluntary sector Key worker Identified Close links - Attendance of monthly meetings Initial Home Assessment Within 2 weeks SAP completed Report to GP Referral for PEG/RIG as appropriate Referral for respiratory assessment as appropriate Special Interest Group Meetings Three monthly Led by MNDA GP Informed • Referral to appropriate services: • Wheelchair service • Care Manager • Social Services OT • Palliative Care Service • Orthotics • Hospice • District Nurse • Dietician • Help and Care • Disability Action Follow up Within 2 weeks Actions Required Equipment Advice Exercises Ongoing referrals Outcome measures initiated Advance Care Planning Review visits as appropriate From weekly to Six monthly

9. Requirements Bournemouth – Macmillan Unit: 0.5 WTE Specialist Palliative Care Nurse Macmillan Trust has pump primed for three years: 0.86 WTE Band 7 Physiotherapist 0.65 WTE Band 7 Occupational Therapist 1 WTE Band 4 Rehabilitation Assistant Practitioner Poole – Woodlands Community Team 0.6 WTE Band 7 Physiotherapist 0.5 WTE Band 7 Occupational Therapist 1 WTE Band 4 Rehabilitation Assistant Practitioner West Dorset 0.6WTE Band 7 Physiotherapist 0.5 WTE Band 7 Occupational Therapist 1WTE Band 4 Rehabilitation Assistant Practitioner 0.5 WTE Specialist Palliative Care Nurse