john etherington transforming rehabilitation … john etherington transforming rehabilitation...
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www.england.nhs.uk
John Etherington
Transforming
Rehabilitation
National Clinical
Director for
Rehabilitation and
Recovering in the
Community
5 November 2014
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Rehabilitation will be key to every episode of care.
It will maximise mental and physical health, independence and occupation.
Rehabilitation is everyone’s business
Vision:
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A Recovery Pathway
Acute Episode
A&E ITU Acute Intervention
RRR
Acute Trust Rehab ‘Step Down’ General Rehab Services
Acute Rehab Team
OT
SW
Legal
CC Rehab Ward Rehab Team
Community Rehabilitation Services
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• Bilateral lower limb amputation
• Pelvic fracture
• Bowel injury with colostomy
• Multiple finger and upper limb tendon damage
• Multiple soft tissue loss and grafting
Case Example
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• 95% of CT patients are independent in ADL with or without an aid on
discharge
• Over 90% of the amputee patients are independent walkers (over any
terrain), without exercise limitation.
• An average CT patient reduces their analgesia on discharge from 6
separate medications to 1 (mainly Paracetamol)
• Over 75% of triple amputee patients do not need a wheelchair at discharge
• Outcomes for Amputees shows average walking gait, speed and energy
expenditure comparable to a normal healthy population.
Complex Trauma Outcomes
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• Independent Living:
87%
• None in institutional
care
3 year study on TBI Inpatients
n = 91 Follow up data on 79 pts at 4 mo
Living Independe-
ntly 87%
Living with support
13%
Institutional Care 0%
Independent Living Status
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• Stakeholder Engagement
• Documents
• Rehabilitation Delivery Board
• Working Parties
• NICE, HQIP, NHS IQ
Summary of Rehabilitation activities 2013-14
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• Dissatisfaction with current provision
• Resources
• Access
• Not focused on patient need
• Lack of focus on outcomes
• Vocational
• Commissioning structures an obstacle to care
Enthusiasm
Stakeholders
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Patient
Links
Specialist
Generalist
Social Care
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External Agencies
http://www.nhsiq.nhs.uk/improvement-programmes/acute-
care/recovery,-rehabilitation-and-reablement.aspx
NICE
HQIP
NHS IQ - Mapping
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Mapping
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Mapping
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Mapping
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• Rehabilitation for Economic Growth
• Commissioning Guidance, Incentives and Levers
• Vocational Rehabilitation
• Children and young people
• Workforce
• 2015 National Conference
Delivery Board working groups
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Issue Stakeholders
Return to work reduced reliance on
state benefits
DWP
Enable people to remain in work DWP
CYP – maximise educational
opportunities and decrease cost to
social care
DfE
Social care
DWP
Supporting elderly to maintain
independence
Social Care
Increase participation in
society/reduced behavioural issues
MOJ
Injury Cost Recovery
Insurers / NHS Trusts
National Economic Benefits of Rehabilitation
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Return to Work
Long Term Conditions
Transforming Rehabilitation
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Worker Primary Care Rehabilitation
PHC – OH OT
Work Hardening
Fitness Certification
Employer liaison
Exercise- based
rehabilitation
Physiotherapy
Exercise professionals
Social reintegration
Group therapy
Ill-health
Return to Work / Education
Economic Benefits Who?
Return to Work DWP
Reductions in Healthcare
contacts
NHS
maximise educational
opportunities
DfE
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• Community
Employment: 92%
• Supported
+
• Transitional
+
• Competitive
3 year study on TBI inpatients
n = 91 Follow up data on 79 pts at 4 mo
Unemployed 6% Sheltered
1% Supported 11%
Transitional 27%
Competitive 55%
Vocational Independence Scale
Dharm-Datta S, Gough M, McGilloway E, 2014
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• Five Years Forward
• NHS England Business Plan
NHS England - Rehabilitation
Programme – September 2014