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/

RehabilitationRehabilitation 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 valueImproving 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 WorkingDelivering 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?