Nicola Davies
Senior Physiotherapist,
Chesterfield PCT
Tel: 01246 515921
Email: nicola.davies@chesterfieldpct.nhs.uk
Summary:
The Spinney Rehabilitation Unit is a five-bedded unit in The Spinney Home for Older People. It is a joint venture between Health and Social Services providing supported rehabilitation for people over 55 in the Chesterfield area. The Unit opened in July 2003 and its three aims are to prevent unnecessary hospital admission, facilitate early discharge from hospital and prevent transfer from residential to nursing beds. From the results of its first full operational year it was shown that 26% of admissions to the Unit prevented hospital admission, 69% facilitated early discharge and 5% prevented residential home admission.
Abstract:
The key objectives of the Unit were to fulfil the National Service Framework (NSF) for Older People, Standard 3, Intermediate Care. The aim of this is to provide integrated services in designated care settings to promote faster recovery from illness, prevent unnecessary acute hospital admissions, support timely discharge, maximise independent living and promote patient choice. This is for people over 55 who are medically stable, with a new physical impairment (or a flare up of a longstanding medical condition) that can accept and actively participate with an intensive rehabilitation programme for up to six weeks. A safe and homely environment conducive to rehabilitation is provided at the Unit, when the persons care needs cannot be met in their own home.
In 2001 the opportunity arose to bid for funding from the Strategic Health Authority for projects that would assist with Intermediate Care developments. The Area Manager from Social Services put a bid forward together with the Operational Manager from the PCT with assistance from Derbyshire County Council Architects’ Department. The bid was to fund the re-design of one wing in a Social Services Home for Older People, to make it more appropriate for rehabilitation.
When the Unit opened in 2003, GP cover was provided from the patient’s own practice but some difficulties were encountered. A local GP, with a special interest in Intermediate Care, was an addition to the team in 2004 to work with patients whose GP can not cover and to offer advice/liaison.
As part of the Service Development Strategy, local people, including carers and service users, were consulted and they indicated that more care local to their home was wanted. This shaped the development of the Unit.
Collaborative working within a multi-disciplinary team has increased job satisfaction of team members. This has been demonstrated through the completion of a Team Performance Inventory as part of the modernisation agenda. This was also echoed in joint staff liaison meetings that were held towards the end of 2004.
Patient views are encouraged through questionnaires and constructive comments are acted upon.
The whole team are proactive in promoting our service to all potential referrers resulting in an increased number of appropriate referrals. A major workforce development is the close working between health and social services staff in the care home and on the Unit. Prior to the Unit opening health staff only visited the Home when invited following a referral. The opening of the Unit saw health staff come en mass and relationships built on trust and mutual respect were established to aid its success. As staff are on site, being more visible and approachable, this has helped to build relationships and communication. New roles have also been developed as carers received enhanced training to work as enablers on the Unit to facilitate achievement of set goals.
The Unit has been a pilot site for the Single Assessment Process. Due to it being a joint venture between health and social services it has proved to be a model environment to put theory into practice.Intervention to improve functional abilities and levels of confidence has, in the majority of cases, reduced levels of dependency. Two therapy outcome tools are used on the Unit. These are DUKE OARS and FIM. Both are validated and designed to show improvement and measure independence. A clear benefit of the Unit is a reduction in ongoing Domiciliary or residential services and a lower admission to an acute or community hospital that can be measured in monetary value. From the figures collected following the Units first full working year 26% of admissions to the Unit prevented an admission to hospital, a possible saving of around £30,000 to the PCT. 69% of admissions facilitated an early discharge from hospital and therefore further costs were reduced. The average length of stay on the Unit was 34 days, which is within our six-week criteria.
The success of the Unit may best be summed up by the thank you letter of one patient who was admitted to us from a Residential Home following discharge from hospital.
“‘Rehab’ is a great service available here in Chesterfield.
‘Rehab’ has a cheerful and homely environment for a small group of patients with different needs. They all have one aim; to get better and return home.
The staff and carers are wonderful, taking care of physical and mental needs on a daily basis.
The feel good factor soon kicks in and a strong will to make progress.
Finally my great thanks to management and medical teams and the opportunity to have physiotherapy every day and to see the improvement.
I will remember my first steps (after 5 months).
I hope there will be more centres where mature people can get their lives back.
Thank you Chesterfield.
Now I am back in my own home.
My sincere thanks go to everyone who makes this possible”
The Unit reflects what the older population of Chesterfield wanted from rehabilitation, to be closer to their home and not be in a hospital environment. Mental health needs can be met by our specialist occupational therapist. Our staff group demonstrates its diversity as we are from wide ranging backgrounds in health and social services
We’re members of the Intermediate Care Operational Group that includes stakeholders from health and social services throughout North Derbyshire. Our work is shared through presentations to GP’s, Social Services and the Acute Trust. Close links have been formed with the Specialist OT in Elderly Care who works on A&E to prevent unnecessary admissions to the Acute Trust.
Our work and achievement was recognised this year at the PCT’s Clinical and Quality Awards where we were category winners.
The Unit creates an additional service to the Rehabilitation Portfolio that compliments other services in Chesterfield aiding a patient’s pathway.
We are a close and dedicated team with staff from both health and social services working excellently together in delivering a 7-day intermediate care service. We feel proud when our patients reach their goal. This is their achievement as well as ours.
