Cheshire and Merseyside
Rehabilitation Network.
2 year project – completed Jun 13
9
Hyper- acute Rehabilitation beds – for patients with the most
20
35
16
4
9
1
1
complex nursing and medical needs
Supportive Rehabilitation beds within the Complex
Rehabilitation Unit
Spoke Unit beds across Elyn lodge and Broadgreen
ABI Rehabilitation beds within extended rehab unit
(Merseyside)
Rehabilitation Consultants in post
Specialist Professional groups working across the pathway
Therapy Out-patient Team - St Helens Spoke
Specialist Complex Rehabilitation Community Team
– St Helens, Halton and Knowsley
To ensure that the network collects robust
data, which records treatment outcomes and
quality of life of service users during and
following care and treatment from the
network
Why?
 The ‘usual’ NHS definition of success of
treatment is a clinical definition and is
incomplete

Network Standards and KPI’s
49 Key Performance Indicators including:
1
3
17
23
UKROC outcome measure
11
Service Specs. e.g. Neuropsychiatry, Neuro and Clinical
Psychology, Bed Management Service, Support
Wellness and Advice Service & Podiatry
PROMS/PREMS
Quality and performance Indicators
Standards drawn from nationally recognised bodies
e.g. British Society for Rehabilitative Medicine to
demonstrate evidence of compliance
Scale of Pain Intensity Tool
(SPIN)
1
2
3
Does the service show signs of pain
How severe is the pain? – measured against SPIN scale
Does the service user understand the SPIN scale?
Three options (can mix and match)
Evaluate pain daily and reduce/ control
Refer to Speech and Language therapy for communication support
Refer to neuropsychology for assessment/ongoing care
Depression Intensity Circles
(DISC)
1
Does the service user complain of sadness or
depression
2
How severe is the depression? – measured against
DISC scale
3
Does the service user understand the DISC scale?
To Administrator, please ensure all 3 questions are completed, including NAME and DATE
The DISCs Screen.
1. Yale question:
Do you often feel
sad or depressed?
Patient Name………………………………….
Date……………………..

Comments: e.g. “I feel sad, but not depressed” – explain..
Yes
No
2. The DISCs
Instructions for administration:
Say to the patient:
Most severe depression
•
•
This is a scale to measure depression
Please point to each of the circles in turn to make sure that you
can see them all.
[Continue only if satisfactorily accomplished]
The grey circles show how depressed you feel.
•
[Indicate the clear circle at the bottom]
The bottom circle shows no depression.
•
[Indicate the fully shaded circle at the top]
The top circle shows depression as bad as it can be.
•
[Pointing at each circle in ascending order]
As you go from the bottom circle to the top, you can see that
depression is becoming more and more severe. Ask; How
depressed do you feel today?
•Yes
•No
•Not sure
No depression
If not sure, refer for Full screen
4. Summary of screen
•Depressed – refer to Integrated care pathway
•Not depressed – re screen in 4 weeks Date of re-screen ……………… 3. To the administrator:
In your opinion, does the patient understand
5. Re-screen
this scale?
•Depressed – refer to Integrated care pathway
Comments:
•Not depressed – pathway closed
Date pathway closed ………………
Network Performance Q1 2013
Case Studies
Patient A - 43yr old man - pedestrian vs car with
poly-trauma and multiple thoracic
fractures. History of substance misuse.
Admitted from Major Trauma Centre to
the Complex Rehabilitation Unit for 6
weeks. Discharged independently
mobile and self caring, complex
discharge planning due to housing
issues. Patient and family referred to
support groups and voluntary agencies
prior to discharge.
Case Studies
Patient B - 63 yr old man with poly-trauma and
orthopaedic injuries following attempted
suicide. Admitted from Major Trauma
Centre, transferred within 3 days of
acceptance to pathway to the Complex
Rehab Unit for 9 weeks Supportive
Rehabilitation. Discharged home mobile
and self caring with IV therapy
input whilst awaiting further orthopaedic
surgery.
Opportunities Realised
 Improved standards of clinical practice by working closely with service
users
 Established Neuro and Clinical Psychology and welfare services – in
and out of hospital
 Developed good working relationships- between key workers, MDT,
rehab consultants, trauma staff.
 Single Point of Access - effective in reducing times to access beds
 Improved outcomes - 55% of discharges have gone directly home.
 Development of a Centralised Database to record outcomes
Challenges
Recruitment - Vol. of staff/time to recruit
Delays - Commencement of
Broadgreen Spoke Unit
Spoke Unit Access - Gap in provision
for Cheshire Patients
Change in Commissioning - Delayed implementation
Landscape of outstanding elements
of pathway and ongoing
Rehab tariff - Introduction April 2014
Social care - Limited involvement
in pathway
Future Developments
 Implementation of vocational and educational rehabilitation
network
 Network Social Work Provision
 Implementation of Rehabilitation Competencies for all senior
Network professionals
 Specialist Complex Community Rehabilitation Service
- Liverpool and Sefton locality
 Therapy Out-patient Service
- Broadgreen
 Patient Experience Survey
 Rehab Network Service Evaluation
Research and Evaluation
• Evaluation - An 18 month research programme to support the
evaluation of the whole rehabilitation pathway has commenced this
includes:
Patient experience
Outcomes – clinical and lifestyle
Evaluation of Key worker role
Evaluation of pathway model
• Research – A consultant-led Clinical Research Programme is
currently under development
Thank You.