Occupational Therapy News OTNews March 2020 | Page 36

FEATURE REHABILITATION
Rather than the confusing array of old routes into
the services, patients access care through a triage
system run by band four staff. They ring up new
patients and ask trigger questions to ensure that new
referrals are appropriate, before discussing them with
the wider team at daily huddles.
iPads and electronic records were also rolled out
to allow staff to do documentation in people’s homes,
and to massively cut down on paperwork. And while
the changes required a bit of a culture shift for the
team, they have become a fundamental part of how
they now work.
‘If you ask the team now, they wouldn’t do without
the triage process and daily huddles,’ says Tracy.
That is a huge benefit for stroke patients. Before
the launch of the North Manchester’s Integrated
Community Stroke Rehabilitation Service, stroke
patients often waited up to six weeks to be assessed to ensure that people get the right support as quickly
as possible. Take care home residents; in the past,
community teams could only be accessed by them
through a GP referral, which could take months.
‘I asked why they had to refer to the GP
and nobody knew,’ says Tracy. ‘People can be
concerned that we would get lots of referrals from
the care homes, but actually you won’t. We sent
an email out to all the care homes to say you don’t
have to refer to the GP now, here’s our referral form
on NHSNet, email it and we’ll triage it. It’s massively
reduced the amount of time these vulnerable patients
are waiting.’
Flexibility has been important, too. Guidelines
require teams to see early supported discharge
patients who have had mild to moderate strokes
within 24 hours; now, the team offers a visit within 24
hours, but will delay seeing them by a few days if the
and treated. Now, all stroke patients are seen within
three days of leaving hospital.
They include Anne McCullagh from Blackley in
Manchester, who had a stroke in January 2019,
and was discharged from hospital a month later.
‘My stroke was on my right side, and my right hand
was closed completely,’ she says. ‘I was told in the
hospital I wouldn’t get any movement back, but I was
determined I would.’
Anne was supported back home with a reablement
team and equipment put in place to help her get
back into her regular routines at home. She was then
supported by the stroke service to tackle exercises
and to help her back to her normal life at home
– including her love of baking, and how to make
scones.
With all the support, her index finger was the first
to have some movement come back, but gradually
her other fingers did too. ‘They were as pleased as
I was to get my fingers moving,’ says Anne. ‘Where
else do you get that kind of help?’
She was also helped by the team to regain
her confidence to walk down the road and meet
with someone from local disability organisation
Breakthrough UK, with whom she would then head
to an exercise class. She is also attending weekly
upper limb exercises to maintain and build function,
including more movement for her right hand.
‘When I was discharged from the hospital they
told me I would get aftercare, but I never expected
to get as much support as I have had,’ says Anne. ‘I
wouldn’t be where I am today if I didn’t have it.’ patient has a different time scale. ‘It’s about what they
need rather than a timescale,’ says Tracy.
The new team structure is a clear example of a
universal-targeted-specialist approach. While complex
cases are still supported by occupational therapists,
there is a general, universal offering that is trained to
support lots of people at once.
And those services have been realigned around
what patients want too. The old system saw falls,
strength and balance classes offered in a hard-
to-reach site which, unsurprisingly, had a poor
attendance rate. Classes are now offered in four
neighbourhoods in north Manchester in easier-to-
access community settings such as libraries.
‘It’s accessible for the patients and we found that
making it around the needs of the patients will really
improve your engagement,’ says Tracy. ‘It has to be
based around the patient and not miles away in a
massive acute hospital where people can’t park.’
The experiences in North Manchester are now
being replicated across the city to ensure there is
an equitable offer; Tracy is also willing to share the
modelling for community stroke and neuro patients,
as well as their experiences in changing generic
community rehabilitation, with other members.
But she is concerned about funding for future
initiatives to help ensure more people can avoid
unnecessary hospital admissions. ‘We have done
all the efficiencies we can and we just need more
funding,’ she says.
RCOT will be continuing to work with its partners
through the new campaign to make sure that such
equitable access is available in future.
Find out more about the campaign at:
www.righttorehab.org.
Changes for the future
Changes are continuing apace in North Manchester
36 OTnews March 2020