I write in response to your request for information in relation to physiotherapy services within NHS Lothian.

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1 Lothian NHS Board = Waverley Gate 2-4 Waterloo Place Edinburgh EH1 3EG = Telephone: Dear FREEDOM OF INFORMATION PHYSIOTHERAPY Date: 15/08/2016 Our Ref: 973 Enquiries to : Richard Mutch Extension: Direct Line: richard.mutch@nhslothian.scot.nhs.uk I write in response to your request for information in relation to s within NHS Lothian. 1. Please confirm/deny whether there is a community rehabilitation in your area for treating the following conditions: - Hip fracture - Stroke - COPD Hip fracture Yes Yes Yes Stroke Yes Yes Yes COPD Yes Yes Yes 2. Please provide the patient pathway for accessing any s confirmed in request one. Hip fracture patients requiring community rehabilitation will be referred to either Intermediate Care if there is a multidisciplinary need (PT/OT/Care) or domiciliary Physiotherapy Referral to D2A (Discharge to Assess), Domiciliary Physiotherapy(referral by GP or other Health and Social Care (H&SC) professional) or DRRT (Discharge Response & Rehab Team) and Community OT(referral by other GP and Health Professional or self referral Stroke inpatient/gp referral to Crabis ( Community Rehab Brain Injury Service ) or REACT ( Rapid Elderly Access and Care Team ) Hip - Inpatient /GP referral to Domiciliary physio or REACT COPD : Referral by any Chronic Obstructive Headquarters Waverley Gate, 2-4 Waterloo Place, Edinburgh EH1 3EG Chair Brian G Houston Chief Executive Tim Davison Lothian NHS Board is the common name of Lothian Health Board

2 health professional in primary or secondary care for Pulmonary Rehab (PR) Patients are allocated to the most convenient venue across Lothian, seen in a group information session and opt-in to assessment and PR programme. On completion of PR are followed-up for 12 months with option for top-up sessions by mutual agreement should a clinical need arise. Patients with severe COPD who are housebound and at risk of admission are managed by the led Community Respiratory Team. Once known to the patients can self refer. Stroke: Patients requiring community rehabilitation following stroke in Edinburgh will have their rehab with either Edinburgh Community Stroke Service or Intermediate care if also requiring care. Midlothian (MCPRT) - Have a physical disabilities rehab team consisting of OT/PT/SLT personnel which deliver rehab and work in collaboration with the Rapid response team to provide support on DC. Pathway - Direct referral by healthcare professionals (PT/OT) Pulmonary Disease (COPD) Consultant /GP referral to Pulmonary rehabilitation West Lothian - Can access a therapy team for working age patients with neurological conditions (OT/PT/SLT/Psychology) and a specific ICT for older people - Direct referral by healthcare professional (PT/OT)

3 3. Please provide the waiting times for accessing any s confirmed in request one. Urgent within same day or to 10 working days, routine up to 10 weeks. Hip Fracture: Varies depending on 48hrs if urgent 2.3 weeks for more routine Stroke: 4-6 weeks COPD: Pulmonary Rehab urgent referral max wait 2 weeks, routine average 6 weeks, (max wait 10 weeks) At risk of admission with 90 mins Rapid Elderly Assessment Care Team (REACT) - 48 hours for urgent referrals up to 1 week for non urgent referrals. Community Rehabilitation And Brain Injury Service (CRABIS) - approximately 5 weeks 4. Please confirm/deny whether patients can be a) re-referred into or b) self-refer back into any s confirmed in request one. Hip Fracture No self referral but can be rereferred a)yes b)yes a) all b) CRABIS patients only Stroke: Some self referral but not widespread. Can be rereferred. COPD: Pulmonary rehab offer top ups if required but no self referral. Can be rereferred Community Respiratory Team Self Referral via Lite Touch Telehealth

4 5. Please provide details of the staffing make-up of any s confirmed in request one. Hip Fracture - OT/PT; Therapy assistants and PT and OT Domiciliary Physio PT support workers REACT PT/OT Stroke: OT/PT; Therapy assistants and support workers COPD: Physiotherapy, assistant practitioners, OT. Wider input from Respiratory consultant, dietetics, pharmacy and psychology. CRABIS PT/support workers/mdt 6. Please confirm/deny that patients can access MSK through each of the following pathways: - By referring directly to the - and being given the details to book a appointment - who arranges the referral to the. - By seeing a Physiotherapist directly in a GP practice - Other (please provide details) By referring directly to the Members of the public over 16 years old can phone NHS 24 Musculoskeletal Advice & Triage Service. Following triage a) if is recommended they are referred that day b) If initial self management is recommended patients are signposted to self- management and advised to re-contact if their symptoms have not improved within ~2weeks. If the patient re-contacts for the same problem they will be asked safety questions and referred to Under 16 years of age are not appropriate for adult telephone triage, these patients can self-refer (usually via their parent/guardian)

5 and being given the details to book a appointment who arranges the referral to By seeing a Physiotherapist directly in a GP practice Other See above Yes Physiotherapy s are co-located in some GP practice buildings. The method of referral is equitable i.e. either through contacting NHS 24 or via referral from a Health or Social Care professional Any Health or Social Care professional can refer 7. Please confirm/deny that patients can access for their existing long-term condition through each of the following pathways: - By referring directly to the - and being given the details to book a appointment - who arranges the referral to the. - By seeing a Physiotherapist directly in a GP practice - Other (please provide details) By referring directly to the Stroke: Patients known to No CRABIS only our can re-access the. In addition a new community pathway for patients with long-term conditions who are under the care of a community rehabilitation consultant and may receive short stay planned admissions within our hospital is under development. COPD: No

6 and being given the details to book a appointment who arranges the referral to the By seeing a Physiotherapist directly in a GP practice Other No No No Yes Yes Yes No No No Any Health or Social Care professional can refer I hope the information provided answers your request. If you are unhappy with our response to your request, you do have the right to request us to review it. Your request should be made within 40 working days of receipt of this letter, and we will reply within 20 working days of receipt. If our decision is unchanged following a review and you remain dissatisfied with this, you then have the right to make a formal complaint to the Scottish Information Commissioner within 6 months of receipt of our Review response. You then have the option to proceed to the Court of Sessions if dissatisfied with the Commissioners decision. If you require a review of our decision to be carried out, please write to the FOI Reviewer at the address at the head of this letter. The review will be undertaken by a Reviewer who was not involved in the original decision-making process. Yours sincerely ALAN BOYTER Director of Human Resources and Organisational Development Cc: Chief Executive