Occupational Therapy News OTnews October 2019 | Page 40

FEATURE EARLY INTERVENTION
occupational therapists work. For example, if they want
1.75 of a therapist we have to explain that it won’t work
in a shift pattern alongside the paramedics.
‘Getting the right language is tricky, but keep on going
back to them and translating it back on what they would
get for that money.’
Karin Orman, RCOT assistant director – professional
practice, said: ‘Talking to ambulance trusts, the challenge
with providing falls prevention services is finding sufficient
paramedic staff. Many are struggling with vacancies and
prevention is not seen as core business when workforce
capacity is strained.
‘Occupational therapy services need to highlight how
prevention not only improves the experience of patients
but also frees up capacity on existing crews, as well as
reducing the risk of unnecessary admissions.
‘Any service proposal needs to emphasis the potential
outcomes for the targeted patient population, outcomes
for the service providers and the impact on the wider
health and social care economy.’
Building the service piece by piece
None of the services featured here emerged in a fully-
developed form; all of them grew from temporary
structures or pilot programmes while evidence was
gathered that they could work.
In South Berkshire, the falls and frailty response service
was built on work done by a specialist paramedic in 2015,
who had been commissioned by Health Education England
as part of a quality improvement service to develop the
service. That one-year pilot ran on one day a week.
The service there is part time, working on Saturdays,
Sundays and Mondays when falls are more common, but
the team is now looking at extending it to a full-time service.
‘It has been so successful up until now,’ says Iva
Ricko, an advanced specialist occupational therapist and
the emergency department team lead at Royal Berkshire
NHS Foundation Trust. ‘It shows the service would have a
massive impact if it is extended to full time.’
Looking around at neighbouring areas to see if they have
any relevant experience to draw on has also proved helpful.
Says Iva: ‘Liaising with areas that have the service in place
would be beneficial as well, so you have some initial criteria
on what works elsewhere.’
Similarly, the service in Bath and North East Somerset
is now looking at how the service’s learnings can be
spread around the wider sustainability and transformation
partnership (STP).
In Norfolk, the service started as a three-month pilot
using bank occupational therapists while the business case
was proven.
‘We used that time to work out which calls to respond
to, how to do our documentation and learn to work
40 OTnews October 2019
alongside our emergency medical technician colleagues
to educate them about our community equipment,
services and pathways which would enable patients to
be safely left at home,’ says Helen.
‘We took our data to the A&E board in the local
hospital to show the number of admissions we have
reduced, and they straight away said, “We need this”.’
The service is continuing to develop from that
starting point of non-injury falls. Palliative patients are
also often now attended by the service. As occupational
therapists have access to live System One, they can
see where there has been anticipatory medication and
what contact the patient has already with community
services.
‘We can support the patient at home, make a fast
referral to palliative care services, and avoid conveyance
to hospital,’ says Helen.
The impact on others
The services profiled here do not just help people to stay
at home during their shifts – they are also supporting
paramedic colleagues to better understand community
services.
Iva in South Berkshire says: ‘A big thing that
has changed is in the training we conduct with the
ambulance service – not just with South Central
Ambulance Service but other local services too.
‘The paramedics have been more confident with
crew referrals, so we don’t have to wait for 999 or 111
calls; we get some referrals from the crew attending.
We of course prioritise 999, but can then also see other
patients who are referred and are safe to remain at home.
That’s a big change from the pilot scheme.
‘The paramedics also rotate – we don’t have a
paramedic who is full time on this service – meaning
they also take the knowledge from working with us and
implement it elsewhere, leaving them with a more holistic
approach on the patient environment, equipment, falls,
frailty, and know who to refer to.
‘They are more confident with mobilising them and
assisting them off the floor. That’s a massive change to
what it was before if they weren’t so confident in leaving
people at home.’
Similarly in Norfolk, across the wider STP, the team
is now developing weeklong placements for paramedic
students to learn about other community services to
ensure they understand what referral routes are available
to them.
Andrew Mickel, OTnews journalist, andrew.mickel@rcot.
co.uk. See more in the Improving Lives, Saving Money
report Reducing the pressure on hospitals – 12 months
on, at: www.rcot.co.uk/ilsm