Freedom of Information Act Request Physiotherapy Services for Neurological Conditions

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1 Freedom of Information Act Request Physiotherapy Services for Neurological Conditions 1. In total how many physiotherapists does C&V UHB employ? s services 33 qualified paediatric physiotherapy staff in total (not WTE many staff are part time) services wte 2. How many physiotherapists does C&V UHB have with a specialist knowledge and expertise in neuroscience? s services Acute - 3 staff (WTE = 1.43) Community - 11 staff (WTE = 9.32) services WTE (NB this is the establishment employed to provide services. There will be other physiotherapists who have rotated across the UHB for example UHW have establishment of 7.7WTE but have headcount of 12 physiotherapists with expertise in neuro.) 3. What is your physiotherapy staffing establishment dedicated to working in the field of neurosciences? If possible provide a breakdown into the subdivisions: Condition services establishment (wte) s services establishment (wte) Stroke inc Outreach Neuromuscular Neurorehabilitation 6.51 (includes 0.7 in UHW) 0 (business case for MDT with WHSSC for consideration Neurosurgery Neurology Spinal Neuropsychiatry Other Neuro conditions e.g. Cerebral palsy 2.0 (neuro outpatients) 2.0 MS Risk sharing 1.0 Comm Brain Injury Team 9.32 Excludes support worker staff at grades 2, 3 and 4 Also excludes community resource teams (CRT) and day hospitals staff who deal with neuro patients but we are unable to disaggregate proportion of job plans. For example there is a case load of approx patients with enduring neurological conditions, who are managed on a needs basis, these will have targeted interventions as and when they require this includes

2 people with MS, MND and adults with cerebral palsy. Physiotherapists support the Parkinson s disease days (Movement Disorder Services) which are held in day hospitals and provide ongoing monitoring of this group of patients. 4. What is the process for referring to a neurophysiotherapist (a physiotherapist with specialist expertise in neurosciences) Please answer this from both inpatient and outpatient perspective. s Inpatient paediatric physiotherapy referrals at the s Hospital for Wales (CHFW) are seen following a written or verbal referral by a member of the multi disciplinary team (MDT - Drs, Nurses, AHP etc) Community paediatric physiotherapy referrals within C&V UHB are accepted from any member of the MDT in child health. Referrals can be made either by letter or by submission of the electronic referral form on PARIS Inpatients Patients are identified by their ward physiotherapist on a blanket referral basis. They will also be referred via ward handovers or directly from Drs. Neurosciences physiotherapists are based on the neurosciences wards but will assess patients with neurological problems on other wards as required. Outpatients Referred by Consultant or GP to physiotherapy. Directed to neuro physiotherapy by condition. Day hospital will be via MDT meetings Stroke Outreach Services via ward team. Community teams via inpatient ward staff. Neuropsychiatry referrals from MDT members for day and inpatients 5. How long would a patient typically have to wait from referral to see a neurophysiotherapist Please answer this from both inpatient and outpatient perspective. Inpatient referrals at the CHFW are seen within 1 session (½ a day) Community referrals for the UHB are seen according to RTT guidance but within 14 weeks Inpatient no waiting list. Urgent seen within 12 hours, non urgent 48hours on 5 day basis

3 Outpatients currently 4 weeks but would be seen as soon as practicable. Community Stroke Outreach - no waiting time Neuropsychiatry no waiting time Service will prioritise patients where there is evidence of; Vulnerable lone community dwelling patients Recurrent fallers Patients with deteriorating/ fluctuating conditions Carers struggling to cope 6. With many neurological conditions physiotherapy might prevent further deterioration of the condition rather than improve mobility. What mechanisms are in place to monitor the success of physiotherapy for someone living with a neurological condition and would a course of treatment be time limited? Response s North Star assessments SMART net assessments Monitoring of long term and short term individual goal / care plans / care aims Audit of any functional outcome measure such as GMFS, lung function, pain tools, postural management assessments, static and mobile seating assessments and mobility aid assessments which are held on the patients PARIS electronic record. We manage all children and young adults in C&V UHB from birth to transition into adult services at 18 25years. Patients receive 6/52 blocks of therapy based on clinical need and service availability. ; Treatment is provided on the basis of agreed goals with the patient. Where physiotherapy would have potential to prevent further deterioration, treatment goals and outcomes will be reviewed regularly to see if effect is measured. In case of no change, treatment will be amended and outcomes reviewed to establish a level of input needed to prevent deterioration. This level is then communicated through discharge processes with the local services and referral is made to local physiotherapy as appropriate.

4 Wherever possible maintenance programmes will be tested during the inpatient phase and recommendations made for care staff to undertake as part of a daily or weekly routine in a community setting. Maintenance programmes include those that patients can continue at home as well as referring on to other exercise groups such as the MS evening group based in UHW, exercise on referral etc. A range of clinical outcome measures is also used depending on the area of sub speciality within neuro. 7. Does C&V UHB follow the Map of Medicine Care Pathways for MD, MS, MND, CFS, Epilepsy, Fibromyalgia, Post Polio, ABI, Parkinsons Disease, Chronic Conditions Response - Map of Medicine (MoM) is no longer used in Wales as the contract was not extended at the start of Due to the multidisciplinary nature of the service provided to patients, pathways are written in a MDT format following the Map of Medicine pathways approach. Muscular Dystrophy Neuro-rehabiliation pathway - a business case for a MDT neuro rehab team based at the CHFW is currently with Welsh Health Specialised Services Committee (WHSSC) for consideration and until this is established we are unable to follow the care pathway for acquired brain injury. Specialist Chronic Fatigue Syndrome Services for C&V UHB paediatric patients are based in Bristol 8. Does C&V UHB use any other care pathways for neurological conditions (if so, which)? s Diagnosis and management of DMD part 1 and 2 Lancet 2009 Paediatric standards for the management of DMD Scottish muscle network 2008 APCP guidance for the management of DMD The Neuroscience review community models work has developed pathways for the care of ABI and SCI patients. In addition, pathways have been developed for Community Brain Injury Neuro psychiatry

5 In patient neuro rehabilitation Acute neuroscience. These have been further developed from the generic Acquired Brain Injury Maps and were developed in collaboration with the ABMU service. The National Spinal Cord Injury Strategy Board (NSCISB) in England has developed pathways for SCI. These have been used to develop the community models. The Welsh SCI rehabilitation service contributes to the NSCISB but is not a formal partner (due to the funding for the NSCISB coming from Department of Health (England only). The Map of Medicine pathways were designed to be open for local adjustment and development. An integrated care pathway has been developed for acute stroke and stroke rehabilitation but this is currently under review. The UHB is also using intelligent targets for stroke in acute and rehabilitation. Parkinson s disease - NICE guidelines 9. Does C&V UHB have any examples of innovation/good practice within physiotherapy services in the speciality areas of neurosciences that you would be happy to share with the Cross Party Group? C&V UHB children and young people physiotherapy hosts the years palliative care / transitional care physiotherapy service which operates in liaison with ABMU health board, providing services across South Wales. This consists of 1 wte paediatric physiotherapist split between C&V UHB and ABMU. The development and recent trials of making the Specialist Hydrotherapy Services at Rookwood accessible to community based people with complex neuro disability who cannot access other hydrotherapy of community swimming pools. Funding (charitable) has recently been secured for a FES Bike, which allows a person with a paresis or paralysis to exercise their muscles through electrical stimulation of up to 10 muscles in an arm or leg. This is thought to enhance people's recovery and is the only such equipment in neuro rehabilitation in Wales. Development of Stroke Outreach Service in Cardiff and Vale of Glamorgan

6 Training of physiotherapists in Regional Stroke Unit and MS Risk Sharing scheme to inject botulinum toxin Specialist Neuro rotation scheme for Band 6 physiotherapists which has assisted in developing the expertise and succession planning in adult neuro services. Physiotherapists rotate across the respective neurospecialities to gain expertise. Neuropsychiatry for patients with complex and challenging behaviour and physical disabilities. 10. Any further comments you may wish to make about physiotherapy services for people living with neurological conditions in C&V UHB, including any potential future initiatives that may be undertaken in the local area, would also be appreciated. Response C&V UHB children s physiotherapy services have a robust in service training programme for all band 5 and band 6 staff in order to facilitate succession planning and to develop the specialist neuro skills that staff require to treat patients effectively. All highly specialist band 7 children s physiotherapy staff working in neurosciences have current job plans that reflect clinical need and equitable service provision across the UHB. A business case for a full MDT to deliver specialist neuro-rehabiliation services to paediatric patients at the CHFW is currently with WHSSC for consideration, it is hoped that this will be funded in No questions have been asked regarding the provision of specialist physiotherapy equipment for patients. This remains an issue at all stages but is of particular importance during the transition from children s to adult services. C&V UHB Physiotherapists are actively engaged in the development of a training network for neuro physiotherapists in Wales ( Wales ACPIN). The current year (2012) is the first formal year of this group which was started last year and currently has over 80 members in Wales. This group aims to provide specialist training in all areas of neurology and neuroscience physiotherapy.

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