Oxford Centre for Enablement Information Booklet Continuing Disability

Oxford Centre for
Information Booklet
Continuing Disability
Management Service
C o n t a c t
D e t a i l s
Oxford Centre for Enablement
Nuffield Orthopaedic Centre
Windmill Road
Main Reception Phone:
Main Reception Fax:
01865 227600
01865 227294
March 2004 Version 1.0
© 2003 Nuffield Orthopaedic Centre NHS
About the Oxford Centre for Enablement
What does the service provide?
The team roles
How long will I stay?
What happens next?
How can I make the most of my contact with the
What are my rights and responsibilities?
Giving consent
Access to Information—Your Health Record
Information about you and how we use it
Your Health Record
If you have Comments or Complaints
Further Information
Contact Details
We believe that disabled people should be respected
and treated as full members of society. They should
expect equal opportunities and the services will
respect individual differences in culture, religion, race
age and ability.
Access to effective and efficient health and social care.
Information that is appropriate, accessible, accurate,
timely and relevant. To enable individuals to make
informed choices and to participate in decisions that affect
their lives.
Choice about every aspect of their lives and if necessary
assistance with the expression and implementation of their
Participation in society and
commensurate with their abilities.
Consultation and involvement in the planning of services
along with users families, voluntary organisations with
specialist expertise and other appropriate groups.
When writing or speaking to the hospital, please quote
your NHS number.
The aim of this booklet is to provide information about the
Continuing Disability Management Service at the Oxford
Centre for Enablement. It is written for patients, families,
friends and for professionals. It is designed to help answer
some of the questions that you may have. If your
questions are not addressed in this booklet , a member of
staff will be happy to help you.
The Oxford Centre for Enablement (OCE) is a purpose built
centre which provides specialist neurological rehabilitation
and disability services within Oxfordshire. The OCE is part
of the Nuffield Orthopaedic Centre NHS Trust in
The services included are the:
Neurological Rehabilitation Service.
Continuing Disability Management Service.
Oxfordshire Wheelchair Service.
Prosthetics Service.
Orthotics Service.
Specialist Disability Service.
The Continuing Disability Management Service provides a
service for adults with a wide range of disabling conditions
including progressive conditions such as Multiple Sclerosis
and Motor Neurone Disease.
The service provides
ongoing assessment review and support to the clients and
their families and carers. The service works with the
clients to increase their abilities, both physically and
emotionally , and to adapt to changes in their condition.
The service also provides outreach nursing or therapy to
give support and advice in patients’ homes, nursing homes
and acute hospitals.
The Continuing Disability Management Service is based on a
detailed assessment—looking at all the different aspects of
your care and needs, both at home and in the Centre.
Your individual plan is based upon goals that are set with you
and your family/carers. Ongoing assessment is at the centre
of the service to ensure that changes in your personal needs
and circumstances are identified and appropriate action
taken. A team approach will be taken at all times and your
goals are central to the process.
Staff and volunteers within the Centre are identified by their
name badges.
Doctors will be involved in the ongoing review and
management of any medical problems relating to your
disability. The majority of your everyday health needs and
medication will be managed by your GP and/or other hospital
doctors that you may be under the care of.
You will have a primary nurse who, with your nursing team,
will be responsible for your. The Primary nurse will also liaise
with your District Nurse and the community teams if required.
Occupational Therapy
The Occupational Therapists aim to enable you to maintain/
adjust to your changing levels of independence in the aspects
of daily living that are important to you. Assessment of daily
living activities may include domestic and personal care tasks
followed by provision of advice and liaison with relevant
services. They will also assess any equipment needs that
you might to maximise your safety and independence at home
and in the community. They work closely with the wheelchair
service to prevent difficulties arising from poor seating.
Advice can also be provided to help manage your fatigue.
The Physiotherapists aim to help you to maintain your
physical abilities and to minimise any complications. This is
achieved by regular reviews, which identify any problems that
require intervention. An individual plan to address these will
then be developed by you and your physiotherapist. It may
involve advice on posture, spasticity, provision of mobility
aids, development of a home exercise programme or an
individual gym programme. These may be shared with
community physiotherapists if required.
Clinical Psychology
Clinical/Counselling Psychologists and other Psychological
therapists apply psychology to a range of problems that can
occur associated with your disability. They see people who
may be depressed, anxious or worried about how they are
coping, as well as those who are having difficulties with
memory, concentration or problem solving.
They are also available to provide support and counselling to
assist you and your family members (adults and children). A
Relationship and Psychosexual Therapist is also available to
help you adjust to the impact your disability has had on your
Individual leaflets are available with more detailed
information about parts of the service described in this
Staff will be happy to answer any questions that you
may have or refer you to someone who will be able to
help you.
Contact Details:
The Continuing Disability Service
Oxford Centre for Enablement
Nuffield Orthopaedic Centre NHS Trust
Windmill Road
Nurses Office
Occupational Therapy Speech and Language therapy
[email protected]
(01865) 737205
(01865) 227294
(01865) 737260
(01865) 737249
(01865) 737220
(01865) 737230
(01865) 737335
Speech and Language Therapy
Sometimes this can take a little time to organise. If you
would like to see your own notes, please speak to your
consultant or one of the nurses on the ward.
If you would like to see your Health Record after you leave
hospital, or if you would like copies of your Health Record,
you will need to send a written
request, called a Subject Access Request, to the Health
Records Team Leader for the Trust.
Pease tell us clearly who you are, how you can be
contacted, what it is that you wish to see and why you wish
to see them. You may want to see your complete record,
or only things related to recent care.
There is a charge of £10 for Subject Access
Requests. Further charges (up to a total of £50) are made
for providing copies. When we receive your completed
form and the fee, we aim to respond to the request within
40 days or 21 days if your records have been updated
within the last 40 days. You have a right to ask for your
information to be changed or blocked if the information we
are holding about you is incorrect.
If You Have Any Comments or Complaints
Your comments are important to us and should be directed
to the Rehabilitation Services Manager, the Medical
Director or the Head of Nursing, in the first instance.
If you feel your concern has not been fully
addressed, please contact The Patient Advice and
Liaison Service on 01865 227459.
The Speech and Language therapist (SLT) and assistant
provide assessment, advice and if appropriate, individual
or group programmes for you if you have speech
(articulation), language, cognitive-communication, voice
or swallowing difficulties. If you require communication
aids, they will refer you to the Specialist Augmentative
and Alternative Communication SLT for assessment and
advice and support regarding funding suitable equipment.
They liaise with the Community Speech and Language
Therapy Service if they are also involved. They will
advise other staff on aspects of communication and safe
Social Services
There is not a resident Social Worker for the service as
most clients have a Care Manager in the community, but
the team will liaise with The social and Health Care
Pastoral Care
Chaplains are available to help you and your relatives in
your personal and spiritual response to your situation.
Chaplains and pastors of most faiths can be asked to visit
you while you are in the Centre. Please ask a member of
staff to arrange a visit for you if required.
Links with Voluntary Agencies
The centre has close links with voluntary agencies
involved with people with conditions such as MS, Motor
Neurone Disease and Stroke. Information is available on
notice boards around the centre or do ask a member of
staff for information on these organisations or others that
may be specific to your condition.
The Oxford Centre for Enablement is a centre for research
into, and development of, rehabilitation services. Some
patients may be asked to take part in a research project. If
you are asked to participate, the purpose and what it will
entail will be explained and your permission sought. All
such projects are registered with, and approved by, the
local Research Ethics committee. Whether or not you
choose to take part will not have any influence in your
personal care plan or treatment programme. If you do take
part, you may be helping to benefit future patients.
Your first contact with the service will normally be a home
visit from one or more of the team, when you may have
received this booklet. You may already have seen one of
the doctors at the Centre as an outpatient. The aim of the
home visit is to find out as much as possible about the
problems that you may have with mobility, activities of daily
living, communication etc. and to see how this affects you
and your family in your everyday lives. Seeing someone at
home provides the team with a much better picture of your
needs than in an outpatient clinic.
The next stage, if the team feels it is appropriate and you
wish so, is for a comprehensive assessment to be
completed by all team members. This is normally arranged
as an inpatient stay on the ward for four nights but can also
be carried out by attending a six week period as a day
Before you give consent for treatment, staff will clearly explain
your treatment and any risks or side effects which you may
Information about you, your medical treatment and family
background, may be recorded wither on paper or computer, or
both, as part of providing you with health care services. The
information forms part of your Health Record and will be kept
in case we need to see you again.
Staff at the Trust need to use information about you so that
you will receive the best possible care and treatment.
We may need to share information about you with other
People involved in your care, such as your GP, dentist, health
visitor, community nurse or social worker.
We may also need to share some of this information, by law,
or to prepare statistics for research and management.
You have the right to access your Health Record.
If you are staying in the hospital, you can usually look at your
Health Record folder. Your consultant will arrange for a
Member of staff to be present to explain medical terms and
answer your questions.
The Oxford Centre for Enablement is committed to
delivering the highest possible standard of rehabilitation and
Our staff will look after you with care and skill in
keeping with recognised standards, practices and
You have a right to considerate, respectful care at all
times and under all circumstances, with recognition of
your personal dignity and your right to privacy.
Your care and treatment will be sensitive to your cultural
and religious values and beliefs, sexual orientation and
disability issues.
All the staff at the OCE are legally and ethically obliged
to keep information on your health confidential. Only
health staff who are authorised can have access to
information about you. If any person outside the OCE
requires information, such as other doctors, or social
workers, we will ask your permission before releasing
the information.
You are entitled to receive information about all services
that may be beneficial to you and information about
strategies to help you in the management of your
You will be involved in the development of your care
You will have the opportunity to discuss your
continuing health care with staff before you are
patient HAPPENS
or occasionally
as an outpatient.
When all your assessments are completed, the team will
review all the findings and plan how your needs can best
be met. This may include:
Intermittent Admissions - to enable the team to monitor
your needs and provide active therapy/nursing care as
These admissions enable the service to
identify any new problems that may have arisen and can
be agreed in advance to enable your family or carers to
take a break away from home if they wish to. The
frequency of these is agreed on an individual basis and
will be reviewed each year.
Day Care / Hospital - The day service provides a weekly
visit to the Centre during which you can take part in the
activities in the day room, have the opportunity to meet
and socialise with other people who may have similar
problems to yours and/or receive therapy or any
treatment you require. It also gives you an opportunity to
raise any issues, in relation to your disability, which may
be concerning you. Some clients will come for day care
for a short period, others for much longer periods
depending on their individual needs and goals.
acute medical problems should always be discussed
with your GP.
Outpatient Therapy - a period of active treatment by one
or more of the professionals in the team to meet specific
Referral to Another Team - in your local area, who can
provide therapy in your own home, or as an outpatient,
day care or other support if this is more appropriate than
attending OCE.
It may be that you and the team agree that no active
intervention is required at this time. If this is the case, it
does not mean that they will not be willing to see you again
if your circumstances change. The service will accept a re
referral at any time either from you or your family or from
another person involved in your care.
The amount of input individuals receive from nursing and
therapy staff will be determined by your individual needs
and you many not see a specialist on every visit.
Please ensure that you do inform staff if you have any
concerns or needs so that they can be addressed.
Family members and friends frequently provide valuable
support and encouragement. We will consult with you to
ascertain how you would like us to communicate with and
involve your friends and family and keep them informed of
any issues.
Being aware of the following points will help you and the
team to make the best of the service offered.
Keeping appointments. If you are brought in by
transport please be ready on time.
If you wish to cancel an appointment for day care,
admission or outpatients, please telephone the Centre
and give as much notice as possible especially if trans
port is arranged for you.
If you repeatedly fail to attend your day care place
without giving good reasons, the team will consider
offering it to another client.
Practising some exercises in your own time and at
home if your therapist suggests that you should do so.
Raising any concerns or problems that you may have
with the relevant therapist or your primary nurse.
Taking as active a part as you feel able to or wish to, i n
the day to day activities in the centre.
Clients of the service are often in touch with the team over
a period of years and it is an important part of the role of
the service to provide support to you and the family/friends
involved in your care. There are lots of instances where
simple advice or information is all that is required but
sometimes there are more complex issues. The team here
are experienced in a wide range of problems and concerns
that can affect people with disabilities and the people who
are closely involved with them, and will be very willing to
listen. If there are steps that can be taken within the
service by referral to an appropriate member of the team
that will be arranged or it may be there is a source of help
outside of the OCE that we can help you to access.
Confidentiality is very important and the team would not
discuss personal issues concerning you with anyone in
your family without your permission. Similarly, they would
not pass on any information to another member of the team
against your wishes unless to not do so would compromise
that person professionally.