Transforming Trauma Rehabilitation

1. Transforming Trauma Rehabilitation Recommendations for the North East Region Sharon Smith Paula Dimarco 1 NHS | Presentation to [XXXX Company] | [Type Date]

2. Overview of talk • Purpose of project • Background of project • Best practice pathway • Key findings • Recommendations

3. Purpose of project • On behalf of NE SHA • Provide information and recommendations • Develop a best practice pathway • Support commissioning for development of rehabilitation services following major or serious trauma

4. The Project • Regional steering group • Two work streams, JCUH and RVI • Review of MSK and neurological rehabilitation • Map of current pathway • Data collection and analysis • Stakeholder consultations • Identify models of best practice • Gap analysis

5. Best practice pathway

6. Key findings

7. No consultants in Rehabilitation Medicine in MSK and insufficient within neurotrauma National Standards Recommend: • 6 WTE per million population • No single handed consultants Current Regional Provision: • 3.8 WTE in level 1 Services • 3 WTE in level 2 services all working single handed There is a 2/3 Shortfall on the national standards.

8. Lack of communication, co-ordination and leadership across the pathway leading to disjointed care and inadequate management of patients • RVI has head injury nurse specialist • JCUH has acquired brain injury coordinator • No formal coordinated MDT rehab specifically for TBI at either MTC • No coordinator for MSK at either MTC • Rehabilitation needs to be well planned across the whole pathway, including TUs and community services

9. No specialist inpatient beds for MSK rehabilitation resulting in longer lengths of stay in acute beds or transfer to inappropriate settings • Case example: • 55 year old male – MSK polytrauma including ITU stay • MTC also patient’s local hospital • NWB for 6 months, remained on an acute ortho ward • Transferred to intermediate care at 7 months – little experience of younger patients and ortho rehab

10. No specialist community MDT for MSK rehabilitation leading to sub-optimal outcomes and longer lengths of rehabilitation • If there were community MSK trauma rehab teams, the outcome of the previous example may have been somewhat different

11. Insufficient level 1 and 2 inpatient rehabilitation facilities for neurotrauma patients • BSRM guidelines recommend 60 level 2 beds per million population • Currently 47 in the North East and Cumbria • Level 1 facility is Walkgate Park = 35 beds

12. Insufficient specialist community teams for neurotrauma patients • Only available in 3 areas: • Northumberland (3 therapies in one team) • Gateshead (no physiotherapy) • Cumbria • Different models at each locality • All teams work across health and social care

13. No robust system for data collection to indicate the number of patients requiring specialist and non-specialist Recovery, Rehabilitation and Reablement • TARN can provide a list of injuries and ISS, but these don’t tell us what the patient’s rehabilitation needs are and are retrospective • UKROC not used by all aspects of the pathway • Rehabilitation prescription yet to function as a data recording tool

14. Lack of vocational rehabilitation resulting in no focus on reablement, return to work and social integration • No vocational rehab for MSK trauma • Limited for neurotrauma • All have access to statutory services – not always appropriate • Momentum for neuro patients

15. No standardised or consistent approach to the use of outcome measures which makes it difficult to evaluate rehabilitation • Different emphasis at each stage of rehab, therefore a variety of outcome measures are used • No standardised approach • Work is being undertaken to determine best outcome measures to use

16. Recommendations

17. Recommendations • Provide additional Consultant level leadership in rehabilitation in order to promote inter-speciality working and improve patient management and outcomes e.g. Consultants in Rehabilitation Medicine/Consultant Allied Health Professionals.

18. Recommendations • Explore workforce options to improve coordination and communication across the whole pathway for example Rehabilitation Coordinators/Facilitators. • Devise robust, flexible, fit for purpose systems to collect data and inform future commissioning and service provision.

19. Recommendations • Develop specialist rehabilitation inpatient beds for major trauma MSK patients. This would also ensure the capacity to provide intensive therapy. Further work is recommended to identify the number of beds required. • Create specialist MDTs which would deliver specialist rehabilitation for MSK major and serious trauma patients (inpatient and outpatient/community).

21. Recommendations • Provision of more level 1 and 2 rehabilitation beds for Neurotrauma patients in line with national recommendations. • Increase the current number of specialist community teams for rehabilitation of Neurotrauma patients to cover all areas.

23. Recommendations • Undertake robust and committed service redesign to deliver a best practice pathway, with particular focus on strengthening Recovery, Rehabilitation and Reablement services. • Ensure regional implementation of the rehabilitation prescription process for all major trauma patients across all services, from injury to re-enablement. This should include the redesign of the current Rehabilitation Prescription.

24. Recommendations • Integrate vocational rehabilitation into the trauma pathway. • Undertake further work to develop recommendations for the use of outcome measures for the trauma rehabilitation pathway.

25. Recommendations • Develop a Directory of Rehabilitation Services with identified administrative support to maintain and update. Implementation of these recommendations requires a coordinated approach involving commissioners, expert clinicians and service users.