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Providing Community Rehabilitation – Learning from Experience

Posted in Courses & Conferences on 12th Mar 2013

Report of the Community Therapists Network Annual Conference, 28th of November 2012

Reviewed by:  Professor Pam Enderby, UK

The Community Therapists Network 2012 annual conference was set up to help teams from across the UK to share different approaches of providing community rehabilitation and intermediate care. The Network had become aware of the many different models of service which have developed in the United Kingdom over the last decade. Pam Enderby reported on two projects examining the costs and outcomes of intermediate care providing information from 2003. The studies had included 32 teams, more than 300 members of staff and data from 9000 patients. The findings indicated that the different models were associated with different benefits and restrictions. Furthermore, the costs and impact on patients related to these services varied. This study emphasised the importance of a day such as this.

The Rapid Response service in Sussex was described by Lordson Simpson who underlined the importance of transdisciplinary working with a respect for cross disciplinary skills and an awareness of professional limitations. The importance of seven day week working and the challenge of this needed to be addressed. Caroline Eadson and Lynne Bakewell from Derbyshire stimulated much interest in their presentation of integrating health and social care in order to improve community rehabilitation. It had taken them time to integrate records and they pointed out the importance of needing to be flexible and to gain trust in cross boundary working in order to reduce the need for repeated assessments of the same issues by different services. It was heartening to hear how the many practical barriers had been overcome by steady and co-operative management facilitated by a common aim. Sheila Keeble and Laura Mason have also facilitated a combined health and social care approach to community intervention aiming to reduce hospital admission and facilitating early discharge in Staffordshire. They have recently been combined into one of the largest trusts in the UK and were aware of the many challenges associated with different cultures of the organisations. The case studies they presented demonstrated the real need for radical new thinking of both health and social care in order to exploit the benefits and possible savings as well as greater clarity for service users.

Exploiting opportunities by expanding the use of other public facilities such as education in the South Worcestershire College for the purposes of rehabilitation was discussed by Sally Ludlow and Alison O’Neill, both occupational therapists, who presented on the use of community education to develop and improve life skills of people with acquired brain injury. The opportunity for such patients to integrate in a non-health setting supported by the third sector had obvious benefits.

We had an award winning team present on service redesign. Cally Bennett and Sam Pessoll from the Derbyshire Community Health Care Home Support Team had won a ‘Transforming Community Services Innovation Award’ following the redesign and pilot which targeted local care homes. By considering equipment and training in manual handling they were able to demonstrate a 60% reduction in falls in a dementia unit. These presenters reported how encouraging and stimulating it had been to enter the competition and how motivating it had been to the team.

Reconfiguration of services was the theme addressed by most of the presenters. Anne-Marie Holliday detailed the new structure required by the intermediate care services in Leeds. The workforce had to be redesigned which required changes to roles and responsibilities with the aim of improving quality of patient care. Workforce redesign was key to their progress. This presentation was usefully followed by Lynne Peters and Sarah Ferguson who considered the very real difficulty of maintaining an effective team during times of change – communication and trust as well as leadership being key requirements.

Further change was detailed by Andrew Griffin and Nickki Adams from Bath who detailed the combining of the teams previously responsible for early stroke discharge with those providing community rehabilitation, with the aim of improving transition along the stroke care pathway. A slightly different approach had been taken by Jane Hicking and Ann Godfrey from Chesterfield. They reported developing and broadening the multidisciplinary community rehabilitation team in order to support colleagues in the acute trust to work collaboratively with them. The aim of these changes was the support and specialist care of stroke patients being discharged earlier, ensuring they received appropriate care and improved transition between hospital and home.

The day concluded with the presentation from Andrew Bateman from the Oliver Zangwill Centre in Cambridgeshire on neuropsychological aspects of rehabilitation. Andrew emphasised the importance of addressing the psychological support for patients requiring rehabilitation and the need for good record-keeping including the collection of robust outcome measures and patient reported outcomes measures in order to identify benefits or losses associated with changes to services.

In conclusion, there were several important messages coming from this day. Community rehabilitation and intermediate care across the country is still in a state of change. For these changes to result in improvements to services it is essential to have broad engagement across different agencies with an emphasis on blending services, requiring explicit and open trust between professionals. Stunningly good communication with all levels of staff and an emphasis on a shared goal facilitates engagement and energy as well as preventing inadvertent sabotage. Objective analysis allowing review of what has been gained and what has been lost can place anecdote into a context.

Anyone interested in learning more about the Community Therapists Network and getting involved in the next annual conference should go to www.communitytherapy.org.uk