www.england.nhs.uk

John Etherington

Transforming

Rehabilitation

National Clinical

Director for

Rehabilitation and

Recovering in the

Community

5 November 2014

www.england.nhs.uk

Rehabilitation will be key to every episode of care.

It will maximise mental and physical health, independence and occupation.

Rehabilitation is everyone’s business

Vision:

www.england.nhs.uk

A Recovery Pathway

Acute Episode

A&E ITU Acute Intervention

RRR

Acute Trust Rehab ‘Step Down’ General Rehab Services

Acute Rehab Team

OT

SW

Legal

CC Rehab Ward Rehab Team

Community Rehabilitation Services

www.england.nhs.uk

• Bilateral lower limb amputation

• Pelvic fracture

• Bowel injury with colostomy

• Multiple finger and upper limb tendon damage

• Multiple soft tissue loss and grafting

Case Example

www.england.nhs.uk

• 95% of CT patients are independent in ADL with or without an aid on

discharge

• Over 90% of the amputee patients are independent walkers (over any

terrain), without exercise limitation.

• An average CT patient reduces their analgesia on discharge from 6

separate medications to 1 (mainly Paracetamol)

• Over 75% of triple amputee patients do not need a wheelchair at discharge

• Outcomes for Amputees shows average walking gait, speed and energy

expenditure comparable to a normal healthy population.

Complex Trauma Outcomes

www.england.nhs.uk

• Independent Living:

87%

• None in institutional

care

3 year study on TBI Inpatients

n = 91 Follow up data on 79 pts at 4 mo

Living Independe-

ntly 87%

Living with support

13%

Institutional Care 0%

Independent Living Status

www.england.nhs.uk

• Stakeholder Engagement

• Documents

• Rehabilitation Delivery Board

• Working Parties

• NICE, HQIP, NHS IQ

Summary of Rehabilitation activities 2013-14

www.england.nhs.uk

• Dissatisfaction with current provision

• Resources

• Access

• Not focused on patient need

• Lack of focus on outcomes

• Vocational

• Commissioning structures an obstacle to care

Enthusiasm

Stakeholders

www.england.nhs.uk

Patient

Links

Specialist

Generalist

Social Care

www.england.nhs.uk

10

External Agencies

http://www.nhsiq.nhs.uk/improvement-programmes/acute-

care/recovery,-rehabilitation-and-reablement.aspx

NICE

HQIP

NHS IQ - Mapping

www.england.nhs.uk 11

Mapping

www.england.nhs.uk 12

Mapping

www.england.nhs.uk 13

Mapping

www.england.nhs.uk

www.england.nhs.uk

• Rehabilitation for Economic Growth

• Commissioning Guidance, Incentives and Levers

• Vocational Rehabilitation

• Children and young people

• Workforce

• 2015 National Conference

Delivery Board working groups

www.england.nhs.uk

Issue Stakeholders

Return to work reduced reliance on

state benefits

DWP

Enable people to remain in work DWP

CYP – maximise educational

opportunities and decrease cost to

social care

DfE

Social care

DWP

Supporting elderly to maintain

independence

Social Care

Increase participation in

society/reduced behavioural issues

MOJ

Injury Cost Recovery

Insurers / NHS Trusts

National Economic Benefits of Rehabilitation

www.england.nhs.uk

Return to Work

Long Term Conditions

Transforming Rehabilitation

www.england.nhs.uk

Worker Primary Care Rehabilitation

PHC – OH OT

Work Hardening

Fitness Certification

Employer liaison

Exercise- based

rehabilitation

Physiotherapy

Exercise professionals

Social reintegration

Group therapy

Ill-health

Return to Work / Education

Economic Benefits Who?

Return to Work DWP

Reductions in Healthcare

contacts

NHS

maximise educational

opportunities

DfE

www.england.nhs.uk

• Community

Employment: 92%

• Supported

+

• Transitional

+

• Competitive

3 year study on TBI inpatients

n = 91 Follow up data on 79 pts at 4 mo

Unemployed 6% Sheltered

1% Supported 11%

Transitional 27%

Competitive 55%

Vocational Independence Scale

Dharm-Datta S, Gough M, McGilloway E, 2014

www.england.nhs.uk

• Five Years Forward

• NHS England Business Plan

NHS England - Rehabilitation

Programme – September 2014