Community Stroke Services

1. Community Stroke Services The Prestbury Centre, Cheltenham Developing a different kind of service

2. Session Plan • Background • The team • Services provided • Individual Therapy • Life After Stroke Programme • Crossing the boundaries • Links to other services • Discussion & question time

3. Background National Standards: • Promote greater consistency in the availability and quality of services across health & social services • Ensure prompt access to integrated stroke care services: • Including a multidisciplinary programme of secondary prevention and rehabilitation NSF Older People 2001

4. Workshop - October 2003 Findings summary: • Non-specialist community therapy services (Chelt.) e.g. OT - Intermediate care (6 weeks) • Hospital based services e.g. SaLT - CGH or Delancey; Acute Stroke Co-ordinator • In-equitable service provision (Chelt v Tewkes) e.g. Tewkesbury ARU • Increased waiting times • No secondary prevention programme

5. Workshop - October 2003 Plans: • Build rehabilitation wing on existing day centre • Community based specialist therapy team: • SaLT, PT, OT, Rehab Assistants • Specialist Therapy Services (initially stroke) • Direct links with community based stroke coordinator • Life after Stroke Programme • Secondary Prevention • Falls & Balance Programme • Services to start October 2004

6. Who are we • Stroke co-ordinator • Therapists • Rehabilitation Assistants • Managed via the Day Centre- Chris Porter and Jan Worrad • Administrator- Sue Minchin

7. The Therapists • Specialist interest in Neuro-rehab • Jo - Occupational Therapist (Prestbury Ctr. & Falls Clinic) • Catherine - Speech and Language Therapist (Prestbury Centre & Intermediate Care) • Ant - Physiotherapist (Prestbury Ctr. & Falls Clinic) • Craig- Stroke Co-ordinator (Community)

8. Rehabilitation Assistants • 6- former day care officers • Transition to R.A.’s (Summer 2004) • Provide assistance with carrying out rehab programmes • Typically work 1 day a week with rehab service across SLT, PT and OT (rest of week in the day centre)

9. Rehabilitation Assistants • All working towards NVQ Level 3 in Health and Social Care. • All keep portfolios of experiences and training. • Core competencies checked by therapists.

10. Services we provide • Assessment and therapy predominantly for people with Stroke, (developing other neuro services) • Life After Stroke Programme • Falls Programme • Input and review for Day Centre users

11. Individual Therapy • Majority of work is therapy with people who have had a stroke: • After discharge from hospital • Community referrals (GPs; PNs; Social Services etc.) • Stroke Clinics • Interdisciplinary Work vs Multidisciplinary What is this?

12. Multidisciplinary Working Physical activity Physio Cognitive and activities of daily living OT Skills acquired- assumed that roles are resumed Speech, language, and swallowing Problem SLT Behaviour, emotional, cognitive Psychologist Personal care Nurse Social Worker Financial and social

13. Interdisciplinary working Psychologist/ Physio/ SLT Paid occupation Roles resumed Participation increased OT/ Nurse Leisure Participation Role in family SW/ Nurse/ SLT Role in social support network OT/ Nurse Role as home owner/ tenant OT/ SW

14. Interdisciplinary working • Goal Planning is the key to achieving service users aims using an interdisciplinary approach •  R.A.s at Prestbury are trans-disciplinary: work across OT/PT/SLT • Fits with interdisciplinary working • Allows continuity of care (one RA allocated)

15. Life after Stroke Programme Aims • Secondary prevention of stroke • Improving individuals awareness of their own risk factors • Goal based approach to making healthy lifestyle changes to reduce risks • Adjusting to change • e.g. memory, communication

16. Life after Stroke Programme • Lasts for seven weeks with follow-up at 4 months • Open to anyone following stroke, Partner or carer invited • Includes: • Risk factors; Medication; Healthy Eating; Communication; Exercise; Psychological approaches to making adjustments • Making Links with Carers Glos., EPP, local groups

17. Life after Stroke Programme So far: • Seven programmes completed • Total number of attendees: • People with stroke = 59, Partners/carers = 37 • Changes/improvements reported: • Confidence: return to work; going out, going to a gym • Increased uptake of exercise • Improved mood • Improved diet • Increased understanding: medication • Established links with Carers Glos., EPP & local stroke group

18. Crossing The Boundaries • Between social services and C&T PCT. • Social services fund the building and provision/maintenance of equipment. • Therapists employed by west glos pct or glos hospitals acute trust, funded by c&t pct • Rehab assistants and other support staff employed and funded by social services • Equipment – funded from social services. Therefore patients/clients have to meet social services eligibility.

19. Personnel Issues - Therapists • Salary/Travel/Training – All Funded From Health • Access To ECDL and other health training • Supported By Health HR dept. • Joint agreement on Job Descriptions/ recruitment between the two services. • Annual Leave/Toil – Agreed by centre manager, recorded with clinical supervisor.

20. Hurdles to overcome • Moving and handling procedures. • Notes storage, ownership and audit. • Development of team guidelines e.g. prioritisation, eligibility, discharges, working with R.A.’s. • Role of the keyworker - different systems between day care and rehab. • Follow Social Services policies e.g. lone working, sharing patient info, health and safety.

21. Therapists’ support mechanisms • Provided by senior therapists within NHS. • Day to day management provided by The Prestbury Centre. • Joint appraisals. Use Social Services and health paperwork • Attend professional training and meetings with each discipline.

22. Communication Infrastructure • Currently have access to ERIC (social services system) and social services intranet. • Working towards access to PAS (health) within the centre and other health internal electronic information systems. • No Direct Access To Medical Information/ Services. • No internal mail system between Prestbury and hospitals

23. Patient/Client Information • External OT and SLT notes are transferred but PT notes are kept with medical notes • Shared database within The Prestbury Centre. • Provide GP’s with information re goals and progress and attendance to programmes. • Data inputting duplicated for SLT.

24. Links to Professional Services • Intermediate Care • Tewkesbury ARU • Local hospitals and Social Services. • Voluntary agencies e.g. Carers Gloucestershire and other initiatives e.g. Expert Patient Programme.

25. Branching into the Community • Location allows bridge building between existing private and voluntary services in the community • Voluntary sector has increasing role to play © Jill Kersley 2005

26. Links to Community • Stroke and MS support groups • Local leisure centres and gyms • STAR centre courses and Evesham College • Speakability Group • The future… • Walking to Health Initiative • Links with GLOSCAT/University

27. Discussion and Questions