Occupational Therapy News OTNews March 2020 | Seite 35

REHABILITATION FEATURE
‘I couldn’t hold a potato and peel it at the same time, for
example, but she helped me with a board with a spike to hold the
potato and peel it.’
But they also helped with the emotional side of things to adjust
back to family life. ‘Because of the brain injury, I get very emotional
quite quickly, and Nerys would be really good at talking to me,’
says Sara. The team also helped Sara to find a leisure centre that
she was comfortable with where she could further develop her
physical skills, and a community car scheme to help her get there.
The rehabilitation process for Sara has been a long one; Nerys
and Caroline’s visits started every week and gradually tapered
down before a recent finish. But it is the sort of long-term support
that has made it possible for Sara to be as independent as
possible.
‘I can’t praise them enough,’ says Sara. ‘I can walk unaided
around the house and with sticks outside. I don’t think I would be
as good as I am now without their support and encouragement.’
Nerys’s support has clearly meant the world to Sara, and she access to community rehab is extremely patchy at present, but
we need to make sure we focus on the quality of services, as well
as the quantity.
‘This isn’t just about a more holistic approach to supporting
physical and mental health, it’s also about health and social care
teams working more closely together.
‘Integration isn’t a new idea, there are already some great
examples of services working in an integrated way, and
occupational therapists are really well positioned to be part of that
because we are trained to work across multiple settings, and have
the ability to work at all levels, which is important in this as well.’
While the campaigning is looking to ensure there is equitable
funding for the future of community rehabilitation, many services
are starting to look at how they can meet growing needs in the
community more effectively. Several are starting to reorientate what
they offer more around what the can offer people’s needs, rather
than just what conditions people have.
Says Lauren: ‘As part of a personalised care agenda, there
and the team do the same for a whole variety of diverse needs in
the large, rural North Powys area.
‘We’re a really flexible service, mainly because we are so rural,’
she says. That means a broad remit for the community neuro
rehab team, which sees anyone with a neurological condition and
supports people from Powys who have had a stroke from district
general hospitals.
The tasks they cover is broad; an average day could see
Nerys tackling fatigue management and cognitive rehabilitation
in the morning, before looking at specialist seating and posture
management, manual handling and upper limb rehabilitation in
the afternoon. Mix in the psychological and emotional support
the team offer, and it is clear how well community rehabilitation
delivers on a vision on personalised health and care.
‘It’s about giving control back to the patient,’ says Nerys. ‘It
sounds cliché, but we truly work in a patient-centred way, working
towards the goals the person wants to achieve as otherwise
there’s no point in us being involved. I also think it’s really positive
that, as a therapist I get to follow the patient through their
community rehab process.’ is a need for specialised teams who deal with really complex
requirements, but there is also a really significant role for more
generalised services that will pick up people based on their need
rather than their condition.’
The new campaign
But the growing expectations from community rehabilitation will
only be met if it is properly funded, which is why RCOT has joined
with others to launch the Right to Rehab campaign (read more on
page 6).
The work is spearheaded by RCOT, the Chartered Society
of Physiotherapy and Sue Ryder, reflecting the fundamental
importance of multidisciplinary care in community rehabilitation.
‘There is a lot of expectation around community rehabilitation
within the NHS Long-Term Plan in England and corresponding
legislation elsewhere in the UK,’ says RCOT professional adviser
Lauren Walker.
‘There are commitments around expanding community health
teams and integrating existing services. This is very welcome, as
Tackling referral routes
That correlates with the way services have developed in North
Manchester. When Tracy Walker started five years ago as the lead
AHP and rehabilitation service manager for North Manchester,
part of the Manchester Local Care Organisation, she inherited a
spaghetti bowl of referral pathways that were largely based on fixed
criteria and conditions.
A falls patient aged under 60 went to the community
rehabilitation team for physiotherapy, but those aged over 65 would
go to the multidisciplinary falls team; nursing home residents who
fell would be referred to community physiotherapy teams, before
going on to the community falls team. Neuro patients would have
to access their speech and language therapy from one community
team, physiotherapy from another, and occupational therapy from a
separate city-wide team.
‘It was very complex for the first therapist to pick up a neuro
patient as you would spend half your time referring out,’ says Tracy.
‘And stroke routes were there, but they weren’t very productive
and efficient; we didn’t offer inreach services or early supported
discharge. They all needed modernising to break down barriers.’
A wholesale reorganisation has been put into action. Tracy
organised away days to work out new referral routes with her
team, and money was invested in locum therapists to clear a
backlog of cases, as the team focused on implementing some new
approaches.
The new system has been streamlined around a generic
community rehabilitation team – borne out of the old falls team,
occupational therapists and physiotherapists, with everyone
upskilled to provide more effective care – as well as specialist stroke
and neuro services.
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