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  • Neuro Rehabilitation Project

    Interim Report October 2014

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    Executive Summary Our project aim is to work with our partners and patients across North West London to improve the lives and wellbeing of people who have sustained an Acquired Brain Injury in North West London. The purpose of this report is to provide a summary of Imperial College Health Partners (ICHP) neuro rehabilitation project and to provide some preliminary and interim recommendations, ahead of a final report in 2015, to help commission neuro-rehabilitation services for patients with Acquired Brain Injury in North West London. We have identified three work streams to help us achieve this:

    - Develop a demand modelling tool. This tool will help us understand how and when current services are used by patients so we can identify bottlenecks and constraints in the system that need to be addressed. This will mean we can ensure that in the future the right services are available, and there are enough of them to meet the demand of patients in North West London, thus reducing waiting times and improving outcomes.

    - Develop a web-based referral and waiting list system. This system will help clinicians refer patients to the most appropriate service, reduce the steps in the process, avoid duplication of referrals, and provide important feedback to clinicians on the time frame for patients being accepted on to a bed. Further, we will be able to monitor all patients that are waiting for neuro-rehabilitation services.

    - Review and make recommendations on the pathway of care for

    patients who have suffered an Acquired Brain Injury. Working with clinicians, patients and commissioners we will look at how patients who have received acute treatment for an Acquired Brain Injury then can access the optimal neuro-rehabilitation services. We will identify areas for improvement and make recommendations to clinical commissioners.

    The following recommendations are based on discussions undertaken among stakeholders, mainly clinicians. It was noted in undertaking these recommendations the burden of ill health among patients living with an Acquired Brain Injury. For example, estimates suggest that 1 in 4 people aged between 16 and 64 years with a chronic disability have a neurological condition

    Recommendations

    Priority resource improvement proposals in North West London for patients with Acquired Brain Injury to improve patient outcomes

    1. We recommend a further increase of Level 2 neuro-rehabilitation bed capacity for

    NWL residents by approximately 5 to 6 beds.

    a. This figure is an estimate, based on clinical experience of continued demand and waiting times for admission. It will be reviewed following the capacity modelling. The modelling will also need to consider where data allows the overall increase in Level 2 capacity through the additional provision of 16

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    beds at the Alderbourne Unit, Hillingdon Hospital. These beds are available for all patients resident in North West London.

    2. Undertake Multi-Disciplinary Team (MDT) reviews for patients with an Acquired Brain Injury who have cognitive deficits. Cognitive impairment is a risk factor for poor rehabilitation outcomes.

    a. It is estimated that in North West London there are 23,719 patients who have an Acquired Brain Injury (activity data). The proportion of those requiring review will vary according to the type of Acquired Brain Injury. For example, even mild Traumatic Brain Injury can cause long-term cognitive problems that affect a person's ability to perform daily activities and to return to work. Estimates for stroke patients suggest that between 30-50% will have a cognitive impairment. It is likely that MDT meetings will be needed weekly. There is a significant unmet need for cognitive rehabilitation and neuropsychological treatment.

    b. Increase access to neuro-psychology assessment and treatment, cognitive therapy and neuro-psychiatry provision for patients and carers to be available equitably across North West London and to ensure that sufficient provision exists in each area.

    3. Increase provision of specialist nursing and residential care rehabilitation services together with introduction of specialist domiciliary care services to work with community rehabilitation services.

    a. Approximately 50% of patients from the Royal Hospital for Neuro-disability (the largest Level 1 service complex physical disability unit in England) are discharged to a nursing home or residential placement.

    b. 1/3rd of disabled patients living in a residential setting have a neurological condition.

    c. Furthermore, there is a need to improve the clinical quality assurance among current providers

    4. Pilot a Neuro-Navigator role (Senior Allied Health Professional) as a pathway coordinator for patients (as per the Barnet /Royal Free model) across all boroughs and acute trusts.

    a. Proposal by ICHP to pilot and evaluate this model in North West London in one volunteer locality with the aim of quantifying the effect on delays in transfers of care.

    5. Commission vocational rehabilitation for patients to return to paid or unpaid employment and improve provision of social or day centres for working age patients with ongoing impairments who are unable to return to work. This may be in association with the third sector such as Headway.

    a. This will have wider impact on both health and social care budget, to enable patients where possible to return to work.

    6. Develop a system for early supported discharge from hospital to home by jointly commissioning social and community care services with specific neuro-rehabilitation expertise and assistive/supportive technology.

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    Priorities without resource implications

    1. Simplified referral process between services.

    o Current proposal of ICHPs work stream B is to develop and pilot a web based referral/waiting list tool. Although, this may have resource implications, simplifying the process does not.

    2. Develop standards for rehabilitation teams and refine metrics currently being collected across North West London.

    Conclusions

    A high percentage of the population who acquire a brain injury are of working age. The socio-economic benefits of improving rehabilitation among this group have long term implications for health and social care budgets. Imperial Partners Health Partners preliminary findings suggests that neuro- rehabilitation in North West London would benefit from integrating commissioning of health and social care for patients with Acquired Brain Injury due to their complex and varied needs. Our further work will include patient and carer engagement, developing links with North West London Whole Systems Integrated Care leads, to describe the current issues among people living with a long term neurological condition who need access to neuro rehabilitation services, and developing research questions and audit ideas.

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    1. Introduction Our project aim is to work with our partners and patients across North West London to improve the lives and wellbeing of people who have sustained an Acquired Brain Injury in North West London.

    The purpose of this report is to provide a summary of Imperial College Health Partners (ICHP) neuro rehabilitation project and to provide some preliminary and interim recommendations, ahead of a final report in 2015, to help the commissioning of neuro-rehabilitation services for patients with Acquired Brain Injury in North West London. We have identified three work streams to help us achieve this:

    - Develop a demand modelling tool. This tool will help us understand how and when current services are used by patients so we can identify bottlenecks and constraints in the system that need to be addressed. This will mean we can ensure that in the future the right services are available, and there are enough of them to meet the demand of patients in North West London, thus reducing waiting times and improving outcomes.

    - Develop a web-based referral and waiting list system. This system will help clinicians refer patients to the most appropriate service, reduce the steps in the process, avoid duplication of referrals, and provide important feedback to clinicians on the time frame for patients being accepted on to a bed. Further, we will be able to monitor all patients that are waiting for neuro-rehabilitation services.

    - Review and make recommendations on the pathway of care for

    patients who have suffered an Acquired Brain Injury. Working with clinicians, patients and commissioners we will look at how patients who have received acute treatment for an Acquired Brain Injury then can access the optimal neuro-rehabilitation services. We will identify areas for improvement and make recommendations to clinical commissioners.

    By undertaking the three work streams identified, we aim to achieve the following:

    Gain a better understanding of the current situation of how neuro-rehabilitation services are provided and accessed for residents of North West London to inform decisions and recommendations about how better to plan services.

    Develop and implement an innovative tool to reduce waiting times for neuro-rehabilitation services.

    Gain a better understanding of the current care pathways in place across North West London, identify areas for improvement and make recommendations to clinical commissioners.

    This report is divided into the following:

    background which details the reasons for undertaking this project; an outline of the project and associated work streams; and,

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    recommendations for priority areas for action in North West London.

    Further bac