Pathway updates
Discharge
During the pandemic, Social Workers were withdrawn from hospitals and a new process called discharge to assess introduced. These changes have sometimes led to poor patient experience (especially for more complex patients) and inefficient working between teams.
The network attended the Greater Manchester Directors of Adult Social Services meeting at the end of last year and was able to establish links with key localities where there are particular issues. Extremely positive collaborative meetings between social care management, inpatient teams and the regional complex discharge service have now taken place in Bury, Stockport and Wigan, with clear plans for action agreed in all. Work will focus on establishing effective MDTs, communication and processes. In many Trusts, social care staff are now returning to wards which will also be of benefit.
Vestibular rehabilitation
We are working with colleagues across neurorehabilitation, stroke, falls, audiology and vestibular physiotherapy to map current pathways for vestibular assessment and rehabilitation across the region. The hope is that we will be able to share a comprehensive picture of the current pathways in place to increase awareness and appropriateness of referrals. We are also in the process of developing a model for vestibular assessment and treatment within stroke and neurorehabilitation services, alongside standardised assessment and screening tools.
Slow stream rehabilitation
We are working with our Integrated Care Board and NHS England to develop a case management structure for patients needing to access slow stream rehabilitation in the independent sector.
Individual Funding Requests (IFR) and Permissible Activity
The Integrated Care Board have started a review of their Effective Use of Resource (EUR) policies, of which six apply to our services: Functional Electrical Stimulation (FES), Trophic Electrical Stimulation (TES) for Facial Palsy, Lycra, Communication Aids, Orthoses & 24hour Postural Management, and Cough Assist. These are currently managed under ‘Permissible Activity’ but there is question as to whether this is the appropriate commissioning arrangement. The FES and TES policies are currently under consideration and have had independent evidence reviews completed by public health commissioners. We have engaged with clinicians in our teams and submitted responses to these reviews and will be attending board meetings to discuss further with key clinical colleagues. The date for the FES review meeting is in mid July, with the date for the next TES meeting not yet set. The other policies will be reviewed during 2025 and 2026.
Neurological longer term support
Our steering group have developed a model which will be piloted in the Bolton locality to test its feasibility. The purpose of the model is to identify the support required for an individual to ‘live well’ with a neurological diagnosis, and the pilot will test how this can be delivered in practice. The results of will inform the direction of the project moving forward and tie in with similar life after stroke pilot work now completed.
Spasticity
A successful advanced spasticity workshop was delivered by Tim Walton and Lynn Fletcher over the course of 1.5 days at Bolton University. This was accessed by specialist physiotherapy and occupational therapists from across the region and focused on therapeutic handling of spasticity. This will form part of an ongoing training programme overseen by the steering group.
Vocational rehabilitation
We continue to facilitate a Community of Practice and recently asked members to complete a confidence rating scale. An average improvement of 13% was found when compared with the same exercise in January 2023, highlighting the benefits for clinicians of meeting and discussing complex interventions. A national forum is being established and our Facilitator, Cillian O'Briain is involved in a steering group to support its development.
Driving guidelines (Neuro)
Last year, we updated our stroke driving guidelines for professionals and this year we set up a task and finish group to develop similar guidelines for other neurological conditions. In May, we presented the guidelines at our Patient & Carer Group. Members offered invaluable feedback and shared personal experiences of returning to drive with a neurological condition. Some changes have been made to the guidelines and the final draft will go to our Clinical Effectiveness Group in the coming months for approval.
Motor Neurone Disease (MND)
The MND project is reaching its final stages with completion planned for July. The network will ensure the project’s progress and legacy continue, for example, the biannual MND Steering Group is now ‘business as usual’, a library of resources collated through the project is available in our MND Toolkit and plans are in place to ensure MND professionals have access to relevant training.
The project has highlighted the need for further focus on emotional support services and we are currently working with others on a grant for further MND Association funding. The collaborative nature of this project has proved to be an exemplar approach to (mostly cost neutral/saving) pathway development which we will employ to explore development opportunities in MS later in the year. |