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Lothian Stroke MCN

Agenda. ApologiesMinutes of FebruaryActions from last meetingDevelopment of the OT roleStreamline of OT activity across RIE, WGH

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Lothian Stroke MCN

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    1. Lothian Stroke MCN Steering Group Friday 12th October 2007 2.00 – 4.00pm, Seminar Room 4, WGH

    2. Agenda Apologies Minutes of February Actions from last meeting Development of the OT role Streamline of OT activity across RIE, WGH & RVH. How can this activity be reflected in other AHP areas? Possible re-design of the therapy services?

    3. Occupational Therapy Service – Ward 101 RIE

    4. OT Pilot Service Redesign Based around more flexible working practices Donna’s return to work – 30 hrs pw 8am daily Mon - Fri Monday/Thursday 8pm Tuesday 6pm Friday 5pm 27% increased activity on Unit and for outreach

    5. OT Pilot Service Redesign Patient and staff satisfaction increased Contact time increased Evening home visits 4 day working for each staff member Further pilot with remaining 6 hours (Donna) for Saturday morning service before Xmas

    6. Services & developments for the inpatient

    7. National audit - executive summary of Lothian Stroke data from acute sites Inpatient analysis (RIE, WGH, SJH) Number of strokes per hospital per month Admission to stroke unit within 1 day Swallow screen test within 24 hours CT scan within 2 days Aspirin within 2 days Neurovascular Clinic (WGH & SJH) Number of patients seen in NV clinic per month Days from referral to clinic % seen in 7 days, % seen in 14 days

    9. Lothian strokes – per month by hospital

    17. Inpatient services…. cont. Direct admissions to Stroke Units AHP and nurse staffing in Stroke Units Outreach and research nurses Thrombolysis Telemedicine Liberton / AAH (south Edinburgh rehab sites)

    18. The Edinburgh Community Stroke Service A Pilot Mark Smith Consultant Physiotherapist October 2007 Apologies Minutes of 1 October 2004 Actions from last minutes Patient carer partnership leaflets – these have been distributed to WGH and RIE - still to be printed for GP surgeries. Apologies Minutes of 1 October 2004 Actions from last minutes Patient carer partnership leaflets – these have been distributed to WGH and RIE- still to be printed for GP surgeries.

    19. This presentation… The Rationale The Process The Bid The Pilot Service

    20. The Rationale

    21. Evidence for Therapy-based Community Stroke Rehabilitation Early Supported Discharge 2005 Cochrane – 11 trials, 1597 patients, 8 days Therapy-based Stroke Rehabilitation Services for patients at home 2003 Cochrane – 14 trials, 1617 patients, sig OT Services after Stroke 2006 Cochrane 64 trials, 1258 patients, sig

    22. The Strategies National Framework - Kerr Delivering for Health Changing Lives Better Health, Better Care CHD & Stroke Adult Rehabilitation Framework Pan Lothian Review of Older Peoples’ Services Joint Physical & Complex Disability in Lothian

    23. Adult Rehabilitation Framework - Target Groups Older people People with long term conditions People returning from work absence and/or aiming to stay in employment (vocational rehabilitation)

    24. Adult Rehabilitation Framework - Aims and Objectives Access to services Local Service Provision – community based Enablement and Self-Managed Care Comprehensive and Evidence-based Services Sustainable Multi-professional Teams Capacity

    25. Better Health, Better Care 2007 Improve long term condition management Locally involve service users and their carers in primary care and community settings Best use of clinical skills to maximise outcomes for patients Meet highest standards Improve transport infrastructure

    26. Better Health, Better Care 2007 Best value – eliminate unnecessary expenditure Develop new NMAHP Consultant roles Sharing service provision ie. Health & Social Care Engaging with the voluntary sector Shifting the balance from hospital to community-based services

    27. Better Health, Better Care 2007 Addressing quality of life and barriers to employment Care for people with disabilities Self-care/condition management strategy with the support of NMAHPs Cognitive/psychological therapies

    28. The Process

    29. Methodology Consultant AHP - Feb 2006 MCN Community Service Development Subgroup Semi-structured interviews – key stakeholders Service Directory – standard proforma Consultation Paper Nov 2006 - feedback

    30. Methodology CIHR Small Project Grant Researcher P/T 6 months Data sources: ISD, SSCAS, LSR, CHSS Follow-up interviews/clarification Final Report May 2007 Consultation Event 6 June 2007 Stroke MCN Steering Group 22 June 2007

    31. ISD Stroke D/Cs

    32. Scottish Stroke Care audit System (SSCAS)

    33. CHSS Stroke Liaison Nurse 05/06 vs Populations in Lothian

    34. CHSS Stroke Liaison Nurse 05/06

    35. The Bid

    36. Lothian Stroke MCN Ł84,818 from slippage funds – non recurring Operational Manager – Morag Barrow Physiotherapist Band 6 - 1.0 WTE 2 years - Ł70,239 Rehabilitation Equipment - Ł3,579 Lifestyle Management Courses Thistle Foundation - Ł5,000 Evaluation - Ł5,000 Training, Uniform, Travel - Ł1,000

    37. Edinburgh Local Authority Service redesign & developing ethos – no added cost Premises - Firrhill and Craighall Centres Management Medicine Occupational Therapy Speech & Language Therapy Clinical Neuropsychology Rehabilitation Officers Transport and Drivers

    38. The Pilot

    39. Edinburgh Community Stroke Service - 2 year pilot -- Something different! -- Joint funded by Edinburgh Council & Lothian Stroke MCN Firrhill & Craighall Centres “Stroke Days” - One per week at each Centre with ongoing rehabilitation input on other days Lifestyle Management Programme – Thistle Foundation courses Jan 2008, Jan 2009

    40. Under 65 – around 50 patients per annum in Edinburgh Referral sources: Hospital Discharges - MDTs Community Rehabilitation Service CHSS Stroke Liaison Nurses Up to one year Transport

    41. Assessment – baseline Battery of outcome measures: physical, functional, mood, cognition and satisfaction Evaluation Exit strategy Recommendations

    42. The Pilot Provisional Objectives: To develop an ongoing full MDT rehabilitation and management service for any younger stroke patients (referral criteria) in Edinburgh To allow ESD where appropriate To prevent hospital admission where appropriate To provide specialist, non time-limited multidisciplinary intervention

    43. Provisional Objectives…. cont. To hold regular MDT meetings To set client-centred goals within the team To measure baseline consumer satisfaction To collect and process service outcome data To work in partnership with other service providers, patients, carers and the voluntary sector

    44. The Way Forward… Improve data collection Consent to follow up Consumer satisfaction Evaluate pilots Address pan Lothian inequity – standardisation of rehabilitation services under the four CHPs Working in partnership with regional vocational rehabilitation services for young stroke patients Older people

    45. Stroke MCN Workplan

    46. Updates from Subgroups & Projects Patient & Carer Education & Training Service Developments Thrombolysis (will now shift focus to evaluation of telemedicine for thrombolysis) Research & Development Protocols & Guidelines

    47. Communications CHSS Awareness Week 1st – 7th October 2007 E-library (workspace), Website Stroke Core Competencies / STARS project Clare Adams

    48. Website questionnaire

    49.

    50.

    51.

    52. STROKE CORE COMPETENCIES Clare Adams Project Manager

    53. NES Funded Projects ‘An Evaluation of the Implementation of a Competency Framework for Stroke’ 2. ‘STARs’ (Stroke Training and Awareness Resources)

    54. ‘Evaluation of the Implementation of a Stroke Competency Framework’ Project Aims for Year 1: Investigate the dissemination and usage of the document Evaluate the CHSS Introductory Course in Stroke Care alongside the Core Competencies for Stroke Report any recommendations to enable integration of the Core Competencies into the CHSS Introductory Course

    55. Key Messages in Year 1 Report Dissemination & usage: 88% had received document 54% had further distributed document 17% actively using document Low profile AfC priority Lack of interest from staff Unclear on how to use document

    56. Key Messages in Year 1 Report CHSS Introductory Course Some content areas not currently covered Recommendations with CHSS Stroke Training Team Courses more than meets the level of required knowledge Courses are effective in increasing participants’ knowledge

    57. ‘Evaluation of the Implementation of a Stroke Competency Framework’ Project Aims for Year 2: Explore ways of implementing the Knowledge and Skills Framework (KSF) within CPD activities Raise the awareness of the Core Competencies and the KSF Explore opportunities for on-line learning

    58. STARs E-learning resource based on the Stroke Core Competencies Addressing accessibility to Stroke training Scotland wide In partnership with University of Edinburgh External review process early 2008 Launch mid 2008

    59. Contact Details: Clare Adams Project Manager Chest, Heart & Stroke Scotland 0131 225 6963 clare.adams@chss.org.uk

    60. Any other business Date of future meeting February 2008

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