WHAT DO YOU NEED AND

HOW DO YOU GET IT?

DR DAVID THORNBERRY

CONSULTANT IN REHABILITATION MEDICINE, PLYMOUTH PCT

WHAT TO YOU NEED AND HOW DO YOU GET IT

“I WANT IT ALLAND I WANT IT NOW”(QUEEN)

“NEED” (AS OPPOSED TO WANT):

THE ESSENTIAL REQUIREMENTS FOR A DISABLED PERSON TO PRESERVE INDEPENDENCE AND DIGNITY.

A NUMBER OF INDIVIDUALS HAVE VARYING NEEDS IN THE CONTEXT OF

DISABILITY:

“YOU” MAY REFER TO THE DISABLED INDIVIDUAL.

HIS OR HER FAMILY AND CARERS, BOTH PROFESSIONAL AND NON-PROFESSIONAL.

MEDICAL AND PARA-MEDICAL PERSONS INVOLVED IN TREATMENT.

FRIENDS, EMPLOYERS, HOUSING AGENCIES, RECREATIONAL AGENCIES ETC.

SUMMARY OF NEEDS MAY BE:

INFORMATION ADVICE EQUIPMENT SERVICES TREATMENT CARE EDUCATION HOUSING WORK PLAY FINANCES ACCESS

LONG TERM NEUROLOGICAL CONDITIONS

A BROAD SPECTRUM OF DISEASES AFFECTING INDIVIDUALS AT DIFFERENT STAGES IN THEIR LIFE HISTORIES. NEEDS THEREFORE WILL BE VERY VARIED

THERE IS A DISTINCTION BETWEEN CHRONIC PROGRESSIVE CONDITIONS, WHERE NEEDS MAY BE CONSTANTLY CHANGING AND NON-PROGRESSIVE ONES, ALTHOUGH BOTH REQUIRE CONSTANT REVIEW.

THE MEDICAL MODEL THE SOCIAL MODEL AN HOLISTIC APPROACH

QUALITY REQUIREMENTS (QR’s):

ELEVEN IDENTIFIED IN THE NSF RECOMMENDATIONS.

QR’s 1 TO 5:

1. A PERSON CENTRED SERVICE2. EARLY RECOGNITION PROMPT

DIAGNOSIS AND TREATMENT3. EMERGENCY AND ACUTE MANAGEMENT4. EARLY AND SPECIALIST

REHABILITATION5. COMMUNITY REHABILITATOIN AND

SUPPORT

•Investigations•Diagnosis•Treatment

Quality Requirements 5Community Team

Quality Requirements 1

Surgery

GP

Quality Requirements 2 & 3

District General HospitalConsultant Neurologist

Quality Requirements 4

Consultant in Rehabilitation and Team

Patient

Functional Assessment and Liaison with:

•Social Services•Housing•Education etc.

Functional AssessmentTreatment:

•Goals•Review•Care Package•Discharge

“It is the teams function to ameliorate the mismatch that exists between patient and his(her) environment by whatever mediating factors they can command. Therapy, aids, equipment, information etc.”

(Chamberlain)

A FULL MULTI-DISCIPLINARY TEAM ASSESSMENT WITH THE FOLLOWING EXPERTISE AVAILABLE:

CONSULTANT IN REHABILITATION OCCUPATIONAL THERAPIST PHYSIOTHERAPIST SPEECH AND LANGUAGE THERAPIST CLINCIAL PSYCHOLOGIST SOCIAL WORKER

Functional assessment has both objective and subjective elements. Parameters of objective assessment include:

Mobility Dexterity Continence Communication Swallowing Cognition Behaviour Vision Hearing Touch Balance Activities of daily living

Subjective assessment records information unique to an individual patient’s circumstances and will include such parameters as:

Pre-morbid intellect Education Motivation (drive) Domestic responsibilities Work Income Interests Housing Driving

Neuro-Rehabilitation Services may be:

HOSPITAL BASED IN-PATIENT NEURO-REHABILITATION UNITS

COMMUNITY BASED EG. REABLEMENT TEAMS

QR 7 - PROVIDING EQUIPMENT AND ACCOMMODATION EG:PROVISION OF MOBILITY EQUIPMENT SUCH AS A WHEELCHAIR.

PROBLEMS: IDENTIFICATION OF NEED AVAILABILITY OF IMPARTIAL ADVICE EG.

APPROPRIATE SEATING PRESSURE RELIEVING CUSHIONS CONTROL SYSTEMS LEGISLATION INSURANCE

? SHOULD BE THE ROLE OF THE DISABLEMENT SERVICES CENTRES

POTENTIAL SOURCES OF WHEELCHAIR SUPPLY:

THE DISABLEMENT SERVICES CENTRES

THE PRIVATE SECTOR ACCESS TO WORK CHARITABLE SOURCES MOTABILITY

QR 8 & 10:

PROVIDING PERSONAL CARE AND SUPPORT

SUPPORTING FAMILY AND CARERS

QR 8:

HEALTH AND SOCIAL CARE SERVICES WORK TOGETHER TO PROVIDE CARE AND SUPPORT TO ENABLE PEOPLE WITH LONG TERM NEUROLOGICAL CONDITIONS TO ACHIEVE MAXIMUM CHOICE ABOUT LIVING INDEPENDENTLY AT HOME.

Q R 10:

CARERS OF PEOPLE WITH LONG TERM NEUROLOGICAL CONDITIONS ARE TO HAVE ACCESS TO APPROPRIATE SUPPORT AND SERVICES THAT RECOGNISE THEIR NEEDS BOTH IN THEIR ROLES AS CARERS AND IN THEIR OWN RIGHT.

INTERFACES:

INTERFACES BETWEEN OR WITHIN ORGANISATIONS ARE THE POTENTIAL WEAK LINKS IN CARE PATHWAYS, WHICH MAY LEAD TO DELAYS OR DISRUPTIONS.

THE FOLLOWING ARE POTENTIALLY DAMAGING INTERFACES:

INTER-AGENCY INTERFACES:

HEALTH / SOCIAL SERVICES HEALTH / EDUCATION HEALTH AND/OR SOCIAL SERVICES /

HOUSING THE EEC REGULATIONS ON ACCESS /

ENGLISH HERITAGE HEALTH / PLANNING AUTHORITIES

IMPEDIMENTA IN DISABLED LOOS:

MOPS, BUCKETS AND CLEANING EQUIPMENT

RANDOMLY DISTRIBUTED GRAB RAILS FOLD DOWN BABY CHANGING MATS HAND DRYERS PAPER TOWEL DISPENSERSALSO ENCOUNTERED:

BALES OF NEWSPAPERS RUBBISH BAGS BUCKETS OF FRESHLY PEELED POTATOES

INTRA-AGENCY INTERFACES:

THE MANAGEMENT OF DISABLED PEOPLE ON GENERAL MEDICAL / SURGICAL WARDS (QR 11)

HEALTH / HEALTH – RELATIONSHIP BETWEEN PRIMARY AND SECONDARY CARE SERVICES

HEALTH / HEALTH – LIAISON BETWEEN PAEDIATRIC AND ADULT SERVICES FOR THE DISABLED

HEALTH / HEALTH OR SOCIAL SERVICES / SOCIAL SERVICES ACROSS A GEOGRAPHIC BOUNDARY

SUMMARY:

Quality Requirements as identified in the NSF provide a useful framework for the development of services.

Hospital and Community based Rehabilitation Teams are effective in providing the health components of the quality requirements.

The medical and social models are compatible and should be complimentary.

We must focus on interfaces when developing pathways of care.