NORTH WALES NEUROSCIENCES REVIEW
Rehabilitation, Palliative Care &
Continuing Health Care
Wyn Thomas
Chief Executive Conwy LHB
Steers Review Recommendations
for North Wales (1)
Main Recommendation:
An inpatient neurorehabilitation centre should be
established in North Wales.
Rationale:
Evidence presented to the Review Group by patients,
professionals and by benchmarking data shows that the
North Wales population requires enhancement of
neurological, neurorehabilitation, neurophysiology, stroke
management and diagnostic facilities.
Steers Review Recommendations
for North Wales (2)
1. An inpatient Neurological Rehabilitation Centre should be developed in North
Wales for traumatic acquired brain injury, stroke and other neurological
conditions requiring rehabilitation.
2. Appoint 2 new whole time equivalent consultants in rehabilitation medicine.
3. The Centre will work with the acute rehabilitation that would be part of the
acute management of a patient at the tertiary centres for the more complex
rehabilitation patients.
4. All patients with acquired brain injury should have access to an acquired brain
injury team and neuropsychology and should not be returned to orthopaedic
or general surgical wards.
5. The working together of acquired brain injury teams/team members and stroke
community teams would maximise their effectiveness for patients.
6. The MCN must include the resources available through the voluntary sector
Project Scope
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The provision of post acute in-patient neurorehabilitation for North Wales
The provision of community brain injury
rehabilitation services for North Wales
The interfaces between neuro-rehabilitation
services and other key services within the
brain injured patient pathway, including acute
care, neuro-psychiatry services, continuing
care and palliative care
Services for patients with rapidly progressing
neurological conditions
Project Aim
• To identify and acquire the key service data and
information required to develop and evaluate a range of
options for the organization and delivery of neurorehabilitation services for North Wales.
• To conduct an option appraisal and to identify the most
appropriate model for the provision of neurorehabilitation services for North Wales.
• Develop a pathway for the care of patients across North
Wales with rapidly progressing neurological diseases
e.g. motor neurone disease
• To identify the key issues relating to the interfaces
between neuro-rehabilitation and other services,
including acute care for head injured patients, neuropsychiatry services, continuing care and palliative care
Defining the Need
• Acquired Brain Injury
– Trauma, Tumour, Infection, Younger stroke
Korsakoff’s, Neurological Conditions, Cerebrovascular events
– 242 people with significant brain injury ( Elliston & Rodgers, 1996)
– 1,000 brain injured people with disabilities (AWSG,1999)
– 35-45 patients per annum from N W DGHs (Rafal, 2002)
• Palliative Care
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MND (50-65)
MS (664)
Parkinson’s Disease (1063)
Process Mapping Exercise
Rapidly Deteriorating conditions
Current Provision
• Neurorehabilitation
– In Patient Care
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Walton Centre (38 bed days)
Clatterbridge Hospital (13 pts, 938 bed days)
N Wales DGHs? (64 pts, 4299 bed days)
Independent Sector CHC (50+ pts, 15,000+ bed days)
– Community Brain Injury Service
• Colwyn Bay Hospital (175 referrals per annum)
• Palliative Care
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DGHs
MDTs
Community Services
Hospices
Voluntary Organisations
Carers
Key Issues identified
• Identifying the patient numbers
– In the DGHs/ community
– Discharged to DGHs
• Agreeing definitions (e.g. sub/post acute,
conditions e.g. MND, MS)
• Understanding current pathway
• Developing pathways
• Palliative Care
– Delays in diagnosis, fragmentation, duplication,
equipment, communication, anticipatory care
Project Management
• Gathering Intelligence
– Visits, meetings, literature review
• Project Board
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Broad professional & geographic membership
2 Streams (Rehabilitation & Palliative Care)
Meeting March, April, July
Complete Current Knowledge
Develop options & plans
Agree final report & recommendations
• Project Manager
– Luke Archard, HCW