Occupational Therapy News OTnews May 2020 | Page 32

FEATURE REHABILITATION are not a seven-day service and neither is the hospital, but with staff volunteering we were able to provide a temporary weekend service. ‘Everyone has been very flexible in their thoughts – things are just being tested and trialled in real time, as there’s no specific right way to do these things.’ A silver lining to the current upheaval has been the way it has brought staff together in new ways of working.’We are already an integrated trust, but this has really shown everyone coming together; this has really helped as people have worked in a slightly different way,’ she says. The focus now is on supporting people in the safest way possible: offering telephone support to clients; sending rehabilitation programmes by email or post; and sharing online information and apps for topics like fatigue management where they are available. ‘People with neurological conditions often struggle outpatient appointments have stopped for now, much work is now done virtually, while work that cannot be taken online, such as measuring for equipment or upper limb work, is continuing in person. COVID-19 has meant that Rachel’s team has also seen some new work come into action. That includes working with neurologists and stroke physicians to support people who have had a stroke after diagnosis without them needing to be admitted to hospital in what she calls a ‘back door model’. ‘I’m really keen that some of these concepts continue moving forward,’ she says. ‘I think community has really shown itself to be a positive part of the patient’s journey.’ Rachel also praises the leadership from occupational therapists, such as those working as stroke leads, for sharing best practice across the country on how to best cope. ‘It’s been really positive,’ she says. with fatigue but their activity levels can be a lot lower at this time, so we wanted to make sure we could still optimise them where possible by creating activity and routine structures for them,’ says Amy. Finding what works Keeping rehabilitation services going And finding such ways to keep existing workloads going during the COVID-19 pandemic is vitally important. Says Lauren: ‘There are both physical and psychological concerns for those who are shielding; they are the most vulnerable. These are people who weren’t necessarily receiving rehabilitation previously and may have been pretty independent, but they may have deteriorated quickly. ‘A lack of physical exercise could have caused muscle-wasting that has increased their falls risk, as well as increasing risks around pre-existing conditions such as COPD and diabetes. But isolation could also affect them psychologically.’ Different approaches are being in different areas to manage existing workloads. Rachel Sibson, the clinical team leader for Wandsworth community neuro team, has vigorously pushed to ensure that the community staff were not automatically redeployed into acute services. ‘Our population isn’t going away – they’re self- isolating and very vulnerable – so we didn’t want to store up problems further down the line,’ she says. ‘The national guidance for us was very helpful, advising us to stop non-essential work and to focus on supporting patients out of hospital and prepare for potentially more referrals. That guidance was an indication we were already starting to do the right thing.’ A risk assessment plan helps to decide what work is essential and needs to continue. While group work and 32 OTnews May 2020 What is clear in the new landscape is that finding what works is going to be different in every area, based on the COVID-19 workload, existing practices and staffing arrangements. But what is common among rehabilitation services is the need for positive risk, juggling the need to provide vital rehabilitation with the risks of exposure to COVID-19, and finding innovative ways to support people in the community with whatever resources are available. Jamy adds: ‘What is important is finding ways to think differently. As we are not able to get out so easily, we have had families filming around their homes to help us facilitate with discharges. It’s thinking about positive risk, on where we can take risks, what is essential for that person at home.’ So how are your services changing, what changes do you want to keep permanently, and how do you want to see services come through the other side of this unprecedented period of upheaval? Says Lauren: ‘We know an increase in demand will happen – we don’t know how big it will be, but it will happen – and we know that many occupational therapists are working in different roles at the moment. ‘But what would be really good for people to do if they have the capacity is to start thinking about how their services are going to recover from this – how can they apply their learning from the different ways of working to find creative solutions that meet demands going forwards, and ensure people’s needs are met.’ Andrew Mickel, OTnews journalist, email: andrew. [email protected]. Read RCOT’s new materials on rehabilitation at: www.rcot.co.uk/rehabilitation