The ULHT Rehabilitation Outreach Team

1. The ULHT Rehabilitation Outreach Team An evaluation involving patients, staff and stakeholders across Lincolnshire Jane Deville and David Nelson School of Health and Social Care LCHS Research Forum 20/04/16

2. Contents • The Evaluation • Service Expansion • Methods • Results • Limitations • Conclusion • How have the results been used? • References www.lincoln.ac.uk

3. The Evaluation • Approached by ULHT during Spring 2015 to conduct evaluation • Rehabilitation Medicine Service looking to achieve:- • Achieve British Society of Rehabilitation Medicine Standards • Ensure patients receive timely discharge home • Provide specialist support in the community • Ensure equity of service across Lincolnshire www.lincoln.ac.uk

4. Service Expansion - Location • Ashby Ward, Lincoln • Outreach Team Lincoln and Grantham • Expand to Lincoln, Grantham, Boston and Louth Louth Lincoln Boston Grantham www.lincoln.ac.uk

5. Service Expansion - Staff Not all full time posts www.lincoln.ac.uk

6. Methodology • Ethical approval • School Ethics Committee – Approved 6th August 2015 • Also shared with ULHT for comments and agreement

7. Methods • Mixed Methods (Curry and Nunez-Smith, 2014) combining a quantitative and qualitative approach. • Informed by existing research • Lukersmith et al, (2014) • Lit review on methods to evaluate community based rehabilitation (interviews, focus groups, questionnaires). • Ryan-Woolley, Wilson and Ann Caress (2004) • Evaluation of community rehab team (focus groups, semi structured interviews with patients, carers and staff) • Methods also informed by preliminary discussions with research team and ULHT.

8. Aims

9. Methods

10. Patient Experience Survey ULHT distributed by post and returned to research team. Input to SPSS. Participants in survey 2 given the option to register their interest in the focus groups by sending a contact slip with their details back to the research team.

11. Patient Focus Groups • Semi-structured topic guide – patients provided with beforehand to prepare responses. • To explore in more detail the areas covered by the questionnaire, including changes since service expansion. • 12th October 2015, Louth • 13th October 2015, Lincoln • 14th October 2015, Boston • 15th October 2015, Grantham • Conducted by a Site Lead OT, member of the evaluation team present. Asked to read and sign consent form. • Digitally recorded and transcribed verbatim. • Data analysed thematically.

12. Stakeholder interviews • Semi-structured topic guide. • To examine how the stakeholders worked with the team including any examples of good practice; and changes to working relationships since expansion. • N=13. • 22nd September – 13th October 2015. • Asked to read and sign consent form. • Interviews lasted 30-70 min. • Digitally recorded and (20-55 min) transcribed verbatim. • Analysed Thematically. • Unique ID codes used. • Digital and paper copies of transcripts stored securely.

13. Stakeholder Interviews

14. Staff Survey • 30 staff within the team sent a qualitative questionnaire from ULHT to ask their views of enhanced service. • Responses returned to evaluation team. • N=22 (RR, 73%) • Data analysed thematically. • Digital and electronic copies stored securely.

15. Results

16. Patient Consultation • General experience I never have the feeing that they rush through something. I really feel like we are the most important at that time. • Referral to the service • Over a quarter of patients felt they were being seen very quickly (27%) • Four out of ten patients felt it was very easy to contact the team and arrange to see them (40%) • Provision of more information about the service We should have been made aware of this service when the patient was discharged from hospital.

17. Patient Consultation • Communication with the team If you are ringing a department it’s very difficult. If you’ve got one vocal person and she will ring back, that’s very important. The great thing about them is somebody rings me. About once every six weeks and says “How are you doing and do you need anything”. That’s wonderful! They have included us in everything and as a carer, we very often get left out. I have been involved in every step. They ask my opinion on what would help. It makes a nice change.

18. Patient Consultation How well informed were you throughout your therapy with this team? To be honest we really have had good communication. They have helped us through decisions. Whatever has been said has been communicated with us. And we felt it’s helped us make better decisions.

19. Patient Consultation How much of a positive impact has the service had on your life? You guys stepping in was life changing and it’s allowed me to get back on track. The emotional support is very good as well. Your emotional wellbeing is so important when you are in pain and if you don’t feel you can cope with it.

20. Patient Consultation • Impact on quality of life I was talking to a gastroenterologist and telling him that my gut was not working properly and he said it was just irritable bowel and then I saw the Outreach Team and they said ‘Oh that’s really common and we’ll just give you this’. It was absolutely wonderful. The impact has been huge. I had to give up work due to the difficulties I was having…… When she started coming I wasn’t even able to get down a step. I’m now walking upright. …. Now I’m thinking of going back to work. It’s changed my family life because I’m more awake. I’ve come off medication. The pain is so reduced. It’s like getting my old self back.

21. Patient Consultation • More patients being seen in their own home

22. Patient Consultation • Value of being seen in the home The fact that you haven’t got to be up and dressed at a certain time. Somebody that will come to the home is just great. That’s where we spend all our time. For them to see us in our surroundings then the tips that they give is brilliant. It’s vitally important that they come out and see home circumstances. I think (patient’s name) has more confidence that way. He was able to talk more. Be able to explain and feel in a safe environment to do that. For me also travelling to the hospital. Finding parking. Getting the wheel chair out. Finding our way round. Getting there. It changes us. I’m not relaxed.

23. Stakeholder Interviews • Awareness of the outreach team • Confusion over team name • Team structure Improving the knowledge of other sectors of the NHS, you know, Social Services, District Nurses, GPs, the rest of the acute care, you know, nobody seems to know much about rehabilitation medicine and I think if we promoted ourselves better then we would be used better. • Joint working with stakeholders Very professional team, very knowledgeable, very good working relationship, a joined up service for people who have been diagnosed with, horrible diseases.

24. Stakeholder Interviews • The impact of the expansion • Team now dealing with more referrals I’m definitely more aware that there is more capacity on their side than there used to be. Yes, definitely • Size and rurality of Lincolnshire Because Lincolnshire is rural and semi-rural and it's a thinly spread population across a big patch so I think this hub model works well and I think the four hubs are the minimum required. • Improved quality of life for patients

25. Stakeholder Interviews • Maintaining patients in the community • Anecdotal evidence of fewer admissions to Ashby Ward I do think admissions, our community waiting list, has definitely reduced and the number of community admissions... we've gone from a couple of years ago there was something like 28 admissions from the community in one year and over the past couple of years it's been down to about 5 so there has been a significant reduction. • Involve the team in the discharge planning process • Impact of reducing the team Patients would probably be badgering the consultants more for information.

26. Staff Questionnaire • Improvements since the expansion I am able to see people more regularly than they were seen before and have had some positive feedback on the benefits of them having regular treatment particularly maintaining range of movement with regular stretches and exercises. Having to cover such a large area resulted in spending so much time travelling in the car. I can now give a better service to my own area patients. • Challenges since the expansion • Team structure

27. Staff Questionnaire • Future improvements and developments • Team structure • Single manager? • Regular countywide meetings • Administration • Database SystmOne • Marketing the service • Branding internally and to stakeholders

28. Limitations • Survey 1 • Full details of how survey 1 was coded not available. • Comparisons with survey 2 difficult. • Focus Group Attendance • Tight time scale, • some who wanted to attend were unfortunately unable to. • Patients and Stakeholders unable to comment on changes to the service • larger scale, longer term evaluation • Stakeholders – biased as already use service?

29. Conclusions • Delivery of the service • Response times had improved • More time spent with patients at home visits • Wider range therapies now available • Benefits of home visits • Communication with patients and stakeholders • Patients happy with level of communication, carers felt included. • Stakeholders good working relationships with team • More communication other health staff e.g. GPs, district nurses, to raise awareness • Promotion of the team • Confusion over what the team does and team name • Consider re-branding • Provide patients with leaflet • Internal staffing and systems • Lack of communication between sites since expansion, consider additional team meetings or additional post to oversee • Recruitment difficulties • Database system difficult and time consuming

30. How have results been used? • “The report helped greatly in demonstrating the value of the service to all stakeholders which has subsequently informed our business planning process.” • “I am very pleased to let you know that the business case submitted to the investment programme board for the continuation of the outreach service in its current form has now been approved. We have received confirmation that the demand and capacity plans submitted to the CCG have also been accepted, so we are now in a position to move forward with permanent recruitment to take effect from 1 April 2016.” Clinical Lead, Therapies and Rehabilitation Medicine

31. References • Curry, L. and Nunez-Smith, M. (2014) Mixed Methods in Health Sciences Research: A Practical Primer. Thousand Oaks, CA: SAGE. • Lukersmith et al. (2013) Community-based rehabilitation (CBR) monitoring and evaluation methods and tools: a literature review. Disability and Rehabilitation, 35(23): 1941-1953. • Ryan-Woolley, B., Wilson, K. and Caress, A. (2004) The implementation and evaluation of a community rehabilitation team: a case study. Disability and Rehabilitation, 26(13): 817-826.

32. Thank you for listening! Any questions or comments? Dr Jane Deville Email: jdeville@lincoln.ac.uk Tel: 01522 83 5562 David Nelson Email: dnelson@lincoln.ac.uk Tel: 01522 83 7343 www.lincoln.ac.uk